Anesthesia for GI endoscopy in the era of COVID-19

As a result of COVID-19, the last few weeks have necessitated a reevaluation of the sedation paradigm for gastrointestinal (GI) endoscopic procedures. Routine screening and some surveillance procedures have taken a backseat and likely to remain so until a vaccine or effective treatment becomes available. Anesthesia providers and endoscopists are required to adapt to this new reality rapidly. The general aim of sedation remains the same-patient comfort, reduced hypoxia, prevention of aspiration along with rapid recovery, and discharge. The present review focuses on necessary modification to reduce the risk of virus contagion for both patients (from health-care providers) and vice versa. A preprocedure evaluation and consenting should be modified and provided remotely. Unsedated GI endoscopy, sedation with minimal respiratory depression, and modification of general anesthesia are explored. Challenges with supplemental oxygen administration and monitoring are addressed. Guidelines for appropriate use of personal protective equipment are discussed. Measures for limiting aerosolization are deliberated

Oliceridine and its potential to revolutionize GI endoscopy sedation

Providing sedation to patients undergoing gastrointestinal (GI) endoscopy is a controversial and emotive issue. The mainstay of sedation is propofol, whose administration is within the sole jurisdiction of anesthesia providers, at least in the USA. Attempts have been made to seize the authority by the GI community. One of the first attempts was the use of the prodrug of propofol -fospropofol. However, as the drug has a similar adverse effect profile as propofol in terms of respiratory depression, the FDA did not approve its use by providers other than those trained in airway management. Sedasy

Recent developments in devices used for gastrointestinal endoscopy sedation

Hypoxemia is a frequent and potentially fatal complication occurring in patients during gastrointestinal endoscopy. The administration of propofol sedation increases the risk of most complications, especially hypoxemia. Nevertheless, propofol has been increasingly used in the United States, and the trend is likely to increase in the years to come. Patient satisfaction and endoscopist satisfaction along with rapid turnover are some of the touted reasons for this trend. However, propofol sedation generally implies deep sedation or general anesthesia. As a result, hypopnea and apnea frequently occur. Inadequate sedation and presence of irritable airway often cause coughing and laryngospasm, both leading to hypoxemia and potential cardiac arrest. Hence, prevention of hypoxemia is of paramount importance. Traditionally, standard nasal cannula is used to administer supplement oxygen. However, it cannot sufficiently provide continuous positive airway pressure (CPAP) or positive pressure ventilation. Device manufacturers have stepped in to fill this void and created many types of cannulas that provide apneic insufflation of oxygen and CPAP and eliminate dead space. Such measures decrease the incidence of hypoxemia. This review aimed to provide essential information of some of these devices

EVALUATION OF ANXIOLYTIC EFFECT OF MELILOTUS OFFICINALIS EXTRACTS IN MICE

Objective: Anxiety is one of the most common and serious mental illness affecting humankind and its extensiveness is on the rise at an alarming rate. Anxiolytic substances are highly acclaimed in the ranking of the most utilized drugs by human. The clinical applications of most widely used anxiolytic agents, that is, benzodiazepines are restricted by their undesirable side effects. Therefore, the development of new pharmacological agents for the treatment of this problem is well justified. Among medicinal plants, Melilotus officinalis (yellow sweet clover) has been recommended for relief of insomnia, convulsions, and as nervine tonic in traditional system of medicine. Nevertheless, no pharmacological studies have thus far evaluated its anxiolytic effect. Therefore, the aim of this study was to evaluate antianxiety effect of different extracts of M. officinalis in mice.Methods: The extracts of roots and aerial parts of the plant were prepared according to the polarity, that is, petroleum ether, chloroform, ethanol, and water. The anxiolytic effects of petroleum ether, chloroform, ethanol, and aqueous extract of aerial parts and roots of the plant (50, 100, and 200 mg/kg, p.o) were examined in albino mice using elevated plus maze (EPM) and mirror-chamber models of anxiety. High-performance thin layer chromatography (HPTLC) studies were carried out using toluene: Acetone: Formic acid as mobile phase.Results: Various extracts prepared from roots did not produce significant effect in both the models, whereas the ethanol extract prepared from aerial parts at 100 and 200 mg/kg showed a significant anxiolytic effect as compared to control and standard group. The petroleum ether, chloroform, and water extracts (50, 100, and 200 mg/kg) of the aerial parts of the plant did not produce meaningful effects in this study. HPTLC analysis of the ethanol extract revealed the presence of nine components.Conclusion: These results suggest that the ethanol extract of aerial parts of M. officinalis plant has statistically significant dose-dependent antianxiety activity which can be attributed to the presence of coumarin, and flavonoid compounds in it

Emergence of Ketamine as a Rapid Acting Antidepressant: Mechanistic Insights and Future Directions

Ketamine is a phencyclidine derivative and N-methyl-D-aspartate receptor antagonist, widely popular as a dissociative anesthetic. Its use as an anesthetic in humans was progressively fallen out due to its associated adverse effects and the emergence of newer and safer anesthetics. In recent few decades, various reports related to its efficacy in the treatment of resistant depression with anti-suicidal potential draw significant attention from researchers around the globe. The rapid clinical effect of ketamine within hours as compared to traditional antidepressants that take several weeks makes it a hot topic in antidepressant research. Studies conducted in the recent past suggest its mechanism of action through glutamate modulation via receptors like NMDA, AMPA as well as downregulation of BDNF etc. This chapter will shed light on the various mechanisms of ketamine related to antidepressant activity. Along with that its pharmacokinetics, toxicology and ongoing clinical trials will also be discussed

Spectral Analysis of Drug Loaded Nanoparticles for Drug-Polymer Interactions

PLGA [Poly (lactic-co-glycolic acid)] is a one of the widely used biodegradable polymer. The extensive use of PLGA is due to its biocompatible properties and is also approved by FDA and European Medicine Agency in parenteral drug delivery system. Chitosan (CS) is also an extensively used natural polymer in the field of medicine. It has been well documented as a potential drug carrier due to its biocompatibility. Various reports has also suggested the role of chitosan in formulation of nanoparticles to increase the drug bioavailability and efficacy. The characterization of these systems pose interesting analytical challenges. Fourier Transform Infrared (FTIR) technique helps to analyze the adsorption of functional groups on nanoparticles and also to investigate the drug polymer interactions. X-ray powder diffraction (XRD) analysis helps in detection of crystallinity of drugs and polymers on basis of diffraction patterns. This study investigates the characterizations of methotrexate (MTX) and Fluorouracil (5-FU) loaded nanoparticles of PLGA and chitosan with help of FTIR and XRD techniques. Keywords: PLGA, XRD, MTX, Chitosan, FTIR, 5-F

Biomedical Nanomaterials: A Short Insight of Applications

Nanotechnology is rapidly expanding area in the field of science that helps us to manipulate matter at the atomic and molecular level thus having varied and new properties with huge potential. It is the study of extremely small particles ranging from 1-1000 nm. This small size imparts the nanoscale devices their applications in medicine and physiology while permitting them to interact with cells and tissues at subcellular level, with bioreceptors on both the surface and inside of cell membrane thus providing a high degree of functional specificity to the systems. Nanodevices in medicine involves applications of nanoparticles, polymeric micelles, dendrimers, nanotubes, inorganic nanoparticles, nanocrystals and quantam dots which are currently under development as well as constitute the major part of  longer range research. Improvement in drug solubility, high drug loading capacity, ease of surface modification, increase in blood circulation time, controlled release and highly site-specific targeted delivery are the advantages responsible for such wide applications of these nanomaterials. The applications include drug and gene delivery to specific site, delivery and detection of specific proteins, biological imaging and biosensors, DNA probing, tissue engineering, pathogens and tumor detection. This article has made an attempt to cover the few insights of nanotechnology as an interesting approach and illustrates various nanosystems along with their advantages, applications and well approved commercially available products. Keywords: Polymeric micelles, Dendrimers, Nanotubes, Inorganic nanoparticles, Nanocrystals and Quantam dot

Technology Overview and Current Biomedical Application of Polymeric Nanoparticles

Polymeric nanoparticle are of great importance in the treatment of various diseases, due to the flexibility in the  modification of their structures. Recent advances in the field of nanotechnology facilitate the engineering of multifunctional polymeric nanoparticles. All the scientific efforts of the pharmaceuticals companies are mainly focusing on two basic aspects, one is to discover new molecules of potential therapeutic interest and second is to develop of a new drug delivery system. In the last few decades,  research and development (R&D) scientists has directed their efforts toward formulating novel drug delivery systems that includes sustained and controlled release, modified release and targeted drug release dosage forms. Application of nanoscience and nanotechnology has opened several new possibilities in development of formulation This review compiles the different preparation methods of polymeric nanoparticles and then briefly explained their current potential applications. Keywords: Polymeric nanoparticles, PLGA, Biomedical applications, Biodegradable, Dialysis metho

Synthesis of 2-substituted-l-[(2'-carbo-xybiphenyl-4-yl) methyl]benzimidazoles

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A randomized feasibility pilot-study of intravenous and subcutaneous administration of ketamine to prevent postpartum depression after planned cesarean delivery under neuraxial anesthesia

BACKGROUND: Evidence suggests ketamine may prevent postpartum depression (PPD) after cesarean delivery (CD) although intolerability and inconvenience of administration are problematic. We assessed the feasibility of studying ketamine (0.5 mg/kg, via subcutaneous injection or 40-min intravenous infusion) to prevent PPD after CD. METHODS: Twenty-three women scheduled for cesarean delivery under neuraxial anesthesia were randomized to one of three groups: subcutaneous ketamine (SC Group, n = 8), intravenous ketamine (IV Group, n = 8) or placebo (n = 7). We measured depression (Edinburgh Postpartum Depression Scale [EPDS]) scores pre-operatively and at 1, 2, 21 and 42 days postoperatively. Anxiety, adverse effects, surgical site pain and analgesic consumption were also assessed. Feasibility was assessed based on acceptability, burden of disease, ability to collect study data and, tolerability of interventions. RESULTS: Baseline characteristics of groups were similar, however, more women in the placebo group had pre-existing anxiety disorder (p = 0.03). 20.7% (25/121) of those approached consented to participate and 34.8% (8/23), of those assessed, screened positive for depression in the postpartum (EPDS \u3e 12). PPD screening data was complete in 78.3% (18/23). No differences were observed for any adverse effect outcomes except for fewer incidences of intraoperative shivering with ketamine (SC: 25%, IV: 0% and Placebo: 85.7%, p = 0.01). No statistically significant difference in positive screening for PPD was observed (SC: 14.3%, IV: 50% and Placebo: 42.9%, p = 0.58). CONCLUSION: An RCT was judged to be feasible and there was no evidence of intolerability of either route of ketamine administration. Dispensing with the need for intravenous access makes the subcutaneous route a particularly attractive option for use in the postpartum population. Further examination of these interventions to prevent, and possibly treat, postpartum depression is warranted. TRIAL REGISTRATION: NCT04227704, January 1