Synchrony between basic neuroscience investigations and clinical research has been deficient for quite some time. Translational research includes several dimensions such as laboratory research, clinical demands, government policies, and availability of funds. Through translational research, techniques of neuroanesthesia have become precise and secure over time. Perioperative translational science and contemporary translational research are the two major dimensions of translational research in perioperative neurosciences. The knowledge gap in perioperative neuroscience can be filled with scientific and technological advances with a multidisciplinary approach. In this review, we will discuss various domains of translational research in perioperative neurosciences and have a glance into the translated clinical applications.
Background: The quality of postanesthesia recovery is among the important issues of general anesthesia that affect the patient's ability to perform daily activities. This study hence aimed to investigate the effects of general anesthesia with isoflurane and propofol on the quality of recovery (QoR) in patients undergoing an abdominal hysterectomy.
Methods: This clinical trial was conducted on 80 women aged 30-65 years who visited Ayatollah Rouhani Hospital of Babol for an elective abdominal hysterectomy in 2020. Based on a randomized block design (4 blocks of 20), the participants were equally assigned to two groups of propofol (P) and isoflurane (I). The QoR-15 scale was employed to measure the QoR in terms of physical and mental dimensions, as primary outcomes, and duration of anesthesia, duration of surgery, response time, quality of extubation, changes in blood pressure and heart rate, length of stay in the recovery unit, Aldrete score, pain score, and prevalence of postoperative nausea and vomiting (PONV), as secondary outcomes.
Results: The results showed that there was no significant difference between the two groups in terms of postoperative physical and mental changes (P = 0.142), except for the second night after surgery (P = 0.001). The QoR, both physically and mentally, significantly changed in both groups over time (P ＜ 0.05). The results also indicated that response time (P ＜ 0.001), quality of extubation (P = 0.01), prevalence of PONV (P = 0.001), and increase in blood pressure (P = 0.02) were significantly lower in the propofol group (P) than in the isoflurane group (I). There was no significant difference between the two groups in the length of stay in the recovery unit (P = 0.44), pre-discharge Aldrete score (P = 0.31), pain score (P = 0.18), duration of anesthesia (P = 0.30), duration of surgery (P = 0.64), and heart rate (P = 0.30).
Conclusions: Propofol outperformed isoflurane in terms of response time, quality of extubation, prevalence of PONV, and increase in blood pressure. In addition, the physical and mental QoR on the second night after surgery was higher in patients anesthetized with propofol compared to those anesthetized with isoflurane.
Background: Infraumbilical surgery today is done preferentially under subarachnoid block. The relatively short duration of analgesia is a limiting factor which is overcome by adding an adjuvant to intrathecal bupivacaine. We aimed to determine optimum dose of intrathecal dexmedetomidine as adjuvant to 0.5% hyperbaric bupivacaine in infraumbilical surgery.
Methods: A parallel group, double blind, randomized controlled trial was done with 105 adult patients posted for infraumbilical surgery under subarachnoid block. All subjects received 3.0 mL (15.0 mg) of 0.5% hyperbaric bupivacaine. Groups D5.0, D7.5, and D10.0 (n = 35 each) received additionally 5.0, 7.5, and 10.0 mcg intrathecal dexmedetomidine as adjuvant. The onset time of sensory block, its peak level and time to this level, maximum motor block and time to it, total duration of analgesia (time to first rescue), and vital parameters were recorded at intervals. Postoperative analgesia was assessed by visual analog scale score at 15 and 30 minutes, then every 30 minutes until 2 hours and then every hour until 6 hours. Treatment emergent adverse events (bradycardia, hypotension, and sedation) were documented.
Results: Maximum sensory level achieved was higher in Group D10.0 than in the other two groups. There was significant and dose-dependent shortening of the mean time to peak sensory block (3.9, 3.3, and 2.9 min; P ＜ 0.001) and peak motor block (5.6, 5.3, and 4.8 min; P ＜ 0.001), and prolongation of postoperative analgesia duration (206.9, 220.8, and 244.0 min; P ＜ 0.001) with escalating doses (5.0, 7.5, and 10.0 mcg, respectively) of dexmedetomidine. Hemodynamic effects and adverse events were comparable in the three groups.
Conclusions: Intrathecal dexmedetomidine (10.0 mcg), as adjuvant to 0.5% hyperbaric bupivacaine (15.0 mg), facilitates rapid onset sensory and motor block and prolongs duration of postoperative analgesia in spinal anesthesia without significant adverse effects. Although absolute differences are modest, the results are better compared to 5.0 and 7.5 mcg doses.
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