RESUMEN
The Greater Auricular Nerve (GAN), a branch of the cervical plexus, is used to provide anesthesia or pain relief in the ear and neck region. This case report details the use of a GAN block in a 71-year-old male patient with basal cell carcinoma on his right auricular helix. Due to multiple comorbidities (myocardial infarction resulting in a cardiac stent, hypertension), regional anesthesia was preferred. We aim to share our experience with the GAN block for ear surgery.
Asunto(s)
Anestesia de Conducción , Bloqueo Nervioso , Masculino , Humanos , Anciano , Oído Externo/cirugía , Oído Externo/inervación , Ultrasonografía , Ultrasonografía Intervencional/métodosRESUMEN
Sphingosine-1-phosphate (S1P) is a phosphosphingolipid with pleiotropic biological functions. S1P acts as an intracellular second messenger, as well as extracellular ligand to five G-protein coupled receptors (S1PR1-5). In the brain, S1P regulates neuronal proliferation, apoptosis, synaptic activity and neuroglia activation. Moreover, S1P metabolism alterations have been reported in neurodegenerative disorders. We have previously reported that S1PRs are present in nerve terminals, exhibiting distinct sub-synaptic localization and neuromodulation actions. Since type 2 diabetes (T2D) causes synaptic dysfunction, we hypothesized that S1P signaling is modified in nerve terminals. In this study, we determined the density of S1PRs in cortical synaptosomes from insulin-resistant Goto-Kakizaki (GK) rats and Wistar controls, and from mice fed a high-fat diet (HFD) and low-fat-fed controls. Relative to their controls, GK rats showed similar cortical S1P concentration despite higher S1P levels in plasma, yet lower density of S1PR1, S1PR2 and S1PR4 in nerve-terminal-enriched membranes. HFD-fed mice exhibited increased plasma and cortical concentrations of S1P, and decreased density of S1PR1 and S1PR4. These findings point towards altered S1P signaling in synapses of insulin resistance and diet-induced obesity models, suggesting a role of S1P signaling in T2D-associated synaptic dysfunction.
Asunto(s)
Diabetes Mellitus Tipo 2 , Receptores de Lisoesfingolípidos , Ratas , Ratones , Animales , Receptores de Esfingosina-1-Fosfato , Receptores de Lisoesfingolípidos/metabolismo , Ratones Obesos , Insulina , Ratas Wistar , Esfingosina/metabolismo , Dieta Alta en Grasa/efectos adversos , Lisofosfolípidos/metabolismoRESUMEN
BACKGROUND: The Supreme™ and ProSeal™ laryngeal mask airways (LMAs) are widely used in paediatric anaesthesia; however, LMA use in infants is limited because many anaesthesiologists prefer to use tracheal intubation in infants. In this study, we compared the Supreme and ProSeal LMAs in infants by measuring their performance characteristics, including insertion features, ventilation parameters, induced changes in haemodynamics and rates of postoperative complications. METHODS: Infants of ASA physical status I scheduled for elective, minor, lower abdominal surgery were divided into two groups: the Supreme LMA group and the ProSeal LMA group. Times and ease of LMA insertion were noted. The percentages of tidal volume leakage as well as peak, mean and leakage pressures for all infants were measured. Heart rate (HR), oxygen saturation (SpO2) and end tidal carbon dioxide (EtCO2) values were recorded before and after LMA insertion and before and after extubation. After extubation, complications and adverse effects were noted. RESULTS: Demographic and surgical data were similar between the two groups. LMA insertion times were shorter for the ProSeal group than for the Supreme group (P < 0.002). The mean HR value for the ProSeal group was lower than for the Supreme group (P < 0.011). Both the peak pressure and the leakage percentage for the ProSeal group were statistically lower than for the Supreme group. The leakage pressure for the ProSeal group was statistically higher than for the Supreme group (P < 0.001). CONCLUSIONS: The ProSeal LMA is superior to the Supreme LMA for use in infants due to the ease of insertion, high oropharyngeal leakage pressure and fewer induced changes in haemodynamics. TRIAL REGISTRATION: ClinicalTrial.gov, NCT03251105 , retrospectively registered on 15 Aug 2017.