Melatonin is a pineal gland neuro-hormone influencing the biological regulations of the circadian rhythm. Numerous investigations have revealed variable effects of melatonin in vivo, including ...anti-inflammatory, antioxidant, sedative, and anxiolytic effects. The effects of using exogenous melatonin as an adjuvant to propofol on the degree of sedation in patients were investigated.
We aimed to test the feasibility of melatonin as a sedative agent in traumatic brain injury patients.
This research was a double-blinded clinical trial conducted on 38 participants suffering from traumatic brain injuries necessitating sedation and mechanical ventilation. Participants were assigned randomly into two groups. Both groups were sedated by propofol infusion and monitored by bispectral index (BIS). Nineteen patients received 10 mg of melatonin, and 19 patients received a placebo (control). Propofol infusion rate and BIS values were recorded each 30 minutes for 12 hours.
Exogenous melatonin administration led to a significant decrease in the amount of infused propofol necessary to attain the desired level of sedation. The propofol infusion rates were 4.87 ± 2.91 ml/h in the melatonin group and 6.37 ± 2.87 ml/h in the control group (P- values = 0.001).
Exogenous melatonin acts as an adjuvant to propofol in sedation, reducing the amount of propofol infusion needed.
Patients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome ...its undesired effects on the haemodynamics and post-operative pain. Scalp nerves block are considered one of these strategies. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations.
64 patients undergoing elective craniotomy operations were enrolled in this prospective randomized, double-blind comparative study. Patients were randomly assigned to two groups. Group LA, patients subjected to scalp nerves block with 15 ml bupivacaine 0.5%, 15 ml lidocaine 2%, in 1:400000 epinephrine. Group H as Group LA with15 IU /ml Hyaluronidase.
Patients in the H group showed lower VAS values for 8 h postoperative, compared to the LA group. The haemodynamic response showed lower values in the H group, compared to the LA group. Those effects were shown in the intraoperative period and for 6 h post-operative. No difference was detected regarding the incidence of complications nor the safety profile.
Our data supports the idea that addition of hyaluronidase to the local anesthetic mixture improves the success rates of the scalp nerves block and its efficacy especially during stressful intraoperative periods and in the early postoperative period. No evident undesirable effects in relation to the addition of hyaluronidase.
Clinical Trial registry on ClinicalTrials.gov , NCT 03411330 , 25-1-2018.
Background
Aneurysmal subarachnoid hemorrhage (aSAH) can have serious consequences related to vasospasm and delayed cerebral ischemia (DCI). Serum biomarkers have emerged as a promising assessment ...tool to facilitate earlier diagnosis of cerebral vasospasm (CV) and to identify pre-clinical vessel narrowing.
Objectives
Our aim was to detect the predictive value of serum biomarkers such as von Willebrand factor (vWF), vascular endothelial growth factor (VEGF) and matrix metalloproteinase9 (MMP-9) in CV after aSAH.
Subjects and methods
Thirty five patients with recent aSAH were included. Patients were divided into two groups; 19 patients (CV group) and 16 patients (non-CV group). The CV group was further subdivided into 9 symptomatic (DCI) and 10 asymptomatic patients. All patients underwent transcranial Doppler (TCD) evaluations three times a week for 2 weeks measuring the mean flow velocities. Serum level of vWF, MMP-9, and VEGF were assessed twice (at onset and within 2 weeks).
Results
A statistically significant increase in serum biomarker levels was found in the CV group. Cutoff value for vWF, MMP-9, and VEGF were > 4985 ng/ml, > 495 ng/ml, and > 184 pg/ml, respectively. Statistically significant positive correlations were found between serum levels of biomarkers and degree of vasospasm. No difference was found in the biomarkers between symptomatic CV and asymptomatic CV.
Conclusion
Serum biomarkers are a reliable tool to predict CV following aSAH, their levels reflect the severity of vascular vasospasm, yet, they cannot predict DCI. TCD has a strong role in early detection, monitoring of post subarachnoid vasospasm and successfully capturing asymptomatic DCI.
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