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Pharmaceuticals
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Use of Anesthetic Agents: Management and New Strategy
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Use of Anesthetic Agents: Management and New Strategy

A special issue of Pharmaceuticals (ISSN 1424-8247). This special issue belongs to the section "Pharmacology".

Deadline for manuscript submissions: closed (28 May 2025) | Viewed by 7032

Special Issue Editors

Dr. José Luis Guerrero-Orriach

E-Mail Website
Guest Editor
Department of Anesthesia, Hu Virgen De La Victoria, Campus Teatinos Sn, Malaga 29006, Spain
Interests: anesthesia; anesthetic drugs; inhalational anesthetics
Dr. María Dolores Carmona Luque

E-Mail Website
Guest Editor
1. Institute of Biomedical Research in Malaga, 29010 Malaga, Spain
2. Department of Anesthesiology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain
Interests: advanced therapies; organoprotection; anesthesia

Special Issue Information

Dear Colleagues,

The use of new anesthetic agents with the intention of promoting the recovery of patients in the postoperative process has been the subject of multiple studies. Procedures with multimodal anesthesia in which, at a pharmacological level, different approaches are addressed in the chain of nociception and in different situations of hyperalgesia, have been the subject of different research studies and meta-analyses with the intention of delving deep into the knowledge of their benefits.

On the other hand, the association of oncological recurrence with dissemination during the oncological process, thanks to the surgical procedure and possible hematogenous dissemination, and the possible regulatory role of anesthetic drugs in this type of procedure has been the subject of continuous work in which attention is drawn to the different activity of halogenated and intravenous drugs depending on the tumor type.

Finally, our knowledge of the organoprotective role of anesthetic drug administration to patients undergoing cardiac surgery or those with heart disease in the perioperative period has been advancing in recent years, drawing attention to the variation produced by these drugs in gene expression and their effect on cardiac conditioning pathways.

Therefore, we invite contributions to this Special Issue as an opportunity to evaluate anesthetic drugs as therapeutic tools.

Dr. José Luis Guerrero-Orriach
Dr. María Dolores Carmona Luque
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmaceuticals is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • anesthetic agents
  • anesthetic drugs
  • anesthetic
  • general anesthetic agents
  • therapeutic tools

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Published Papers (4 papers)

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Research

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16 pages, 280 KiB  
Article
The Effect of Adding Remifentanil to Thiopental for Anaesthesia Induction on the Success of Classic Laryngeal Mask Airway Insertion: A Randomised Double-Blind Clinical Trial
by Mensure Çakırgöz, İsmail Demirel, Mert Akan, Ömürhan Saraç, Ergin Alaygut, Aysun Afife Kar, Oğuzhan Demirel and Emre Karagöz
Pharmaceuticals 2025, 18(5), 654; https://doi.org/10.3390/ph18050654 - 29 Apr 2025
Viewed by 248
Abstract
Background: Remifentanil, an ultra-short-acting µ-receptor agonist, is used with propofol for optimal laryngeal mask airway (LMA) insertion. However, no studies have assessed its effects when combined with thiopental on LMA conditions. The combined use of thiopental and remifentanil may offer advantages, such [...] Read more.
Background: Remifentanil, an ultra-short-acting µ-receptor agonist, is used with propofol for optimal laryngeal mask airway (LMA) insertion. However, no studies have assessed its effects when combined with thiopental on LMA conditions. The combined use of thiopental and remifentanil may offer advantages, such as enhanced cardiovascular and respiratory stability. This study aims to compare the administration of thiopental with different doses of remifentanil to assess their combined effects on LMA insertion conditions and success in a prospective, randomised double-blind study. Method: A total of 100 ASA I–II patients (18–65 years), including both male and female participants, were randomly assigned to four remifentanil dose groups (0.5–3 µg.kg−1). Induction involved thiopental (5 mg.kg−1) after remifentanil. LMA insertion conditions were evaluated using a six-variable scale. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and bispectral index monitor (BIS) values, as well as apnoea duration, eyelash reflex loss time, and insertion attempts, were recorded at baseline, before insertion, and at 5 min post-insertion. Results: Time to eyelash reflex loss and LMA insertion were shorter in Groups III and IV than in Groups I and II (p < 0.001). Apnoea duration was longest in Group IV, followed by Group III (p < 0.001). Groups III and IV had significantly better LMA placement, mouth opening, and ease of insertion (p < 0.05). Coughing and gagging were highest in Group I (p < 0.001). SAP, MAP, HR, and DAP were significantly lower in Group IV at various time points (p < 0.05). HR was significantly higher in Group I compared to Groups II and III at multiple time points (p < 0.05). Conclusions: The administration of 5 mg.kg−1 thiopental with 2 μg.kg−1 remifentanil has been found to provide a stable haemodynamic response and 96% excellent or satisfactory laryngeal mask insertion conditions without increasing the duration of apnoea. Full article
(This article belongs to the Special Issue Use of Anesthetic Agents: Management and New Strategy)
14 pages, 3306 KiB  
Article
MicroRNA-197-3p Transfection: Variations in Cardiomyocyte Gene Expression with Anaesthetics Drugs in a Model of Hypoxia/Reperfusion
by Jose Luis Guerrero-Orriach, Maria Dolores Carmona-Luque, Maria Jose Rodriguez-Capitan and Guillermo Quesada-Muñoz
Pharmaceuticals 2025, 18(2), 146; https://doi.org/10.3390/ph18020146 - 23 Jan 2025
Viewed by 944
Abstract
Background: Our research team analyzed the microRNA (miRNA)-197-3p involved in cardioprotection, and we demonstrated that the overexpression of miRNA-197-3p could be linked to a higher risk of cardiac damage. Recent research indicated that miRNA-197-3p inhibits the effector proteins of the anaesthetic preconditioning mechanism [...] Read more.
Background: Our research team analyzed the microRNA (miRNA)-197-3p involved in cardioprotection, and we demonstrated that the overexpression of miRNA-197-3p could be linked to a higher risk of cardiac damage. Recent research indicated that miRNA-197-3p inhibits the effector proteins of the anaesthetic preconditioning mechanism of halogenated drugs. In this scenario, we proposed to determine the role of miRNA-197-3p in cardiac injury and its effects on myocardial conditioning under halogenated exposure. Hypothesis: Patients having myocardial revascularization surgery have increased heart damage due to postoperative miRNA-197-3p upregulation. Methods: Human cardiac myocytes (HCMs) were used in an in vitro hypoxia/reperfusion (H/R) model. The miRNA-197-3p-MIMIC was transfected into the HCMs. Three H/R-induced HCM groups were performed: negative MIMIC-control transfected, MIMIC transfected, and non-transfected. Each H/R cell group was exposed to Propofol (P), Sevoflurane (S), or non-exposed. Healthy cell cultures were the control group. ELISA assays were used to assess the Akt1 and p53 cell secretion capacity, and the Next Generation Sequencing assay was used to measure the differential expression of miRNA targets. Results: The secretion capacity of H/R-induced HCMs transfected with the MIMIC was higher under sevoflurane exposure regarding Akt-1 cytokine (I/R + S: 0.80 ± 0.06 ng/mL; I/R + P: 0.45 ± 0.28 ng/mL; p > 0.05), and lower regarding p53 cytokine (I/R + S: 38.62 ± 6.93 ng/mL; I/R + P: 43.34 ± 15.20 ng/mL; p > 0.05) compared to propofol. In addition, a significant gene overexpression of five miRNAs, in the sevoflurane group, was linked to cardioprotection: miRNA-29-3p, 24-3p, 21-3p, 532, and miRNA-335-5p. Conclusions: miRNA-197-3p inhibits the cardioprotection induced by halogenated exposure and can be considered a biomarker of cardiac damage. Additional research is required to validate our findings in other clinical settings. Full article
(This article belongs to the Special Issue Use of Anesthetic Agents: Management and New Strategy)
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Review

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18 pages, 304 KiB  
Review
Glucose-Lowering Agents Developed in the Last Two Decades and Their Perioperative Implications
by Basavana Goudra, Geno J. Merli and Michael Green
Pharmaceuticals 2025, 18(1), 4; https://doi.org/10.3390/ph18010004 - 24 Dec 2024
Viewed by 1433
Abstract
The last two decades have provided far more options f both patients and their physicians in the treatment of diabetes mellitus. While dipeptidyl peptidase-4 inhibitors (DPP-4is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) have been approved for nearly two decades, sodium–glucose cotransporter 2 [...] Read more.
The last two decades have provided far more options f both patients and their physicians in the treatment of diabetes mellitus. While dipeptidyl peptidase-4 inhibitors (DPP-4is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) have been approved for nearly two decades, sodium–glucose cotransporter 2 inhibitors (SGLT-2is) are relatively new. Of interest to perioperative physicians, these drugs present specific perioperative concerns, prompting many societies to issue guidelines. Retained gastric contents due to slow gastric emptying is a significant drawback of GLP-1RAs, increasing the risk of aspiration. Recommendations include withholding GLP-1RAs for a predefined period of time, performing gastric ultrasound to evaluate gastric contents, modifying anesthesia management, particularly with regard to the airway, or canceling the scheduled (elective) surgery or procedure. SGLT-2is are known to increase the risk of euglycemic ketoacidosis. The benefits of both GLP-1RAs and SGLT-2is extend beyond the treatment of diabetes. As a result, perioperative physicians may encounter their use outside of their traditional indications. SGLT-2is are being used extensively to treat heart failure and obesity, for example. There have been other developments as well. For instance, Imeglimin, a variant of metformin available in Japan and India, Icodec, a once-weekly basal insulin formulation, and IcoSema, a once-weekly combination of Icodec plus semaglutide, are all being explored, although in their early stages or facing approval challenges. Full article
(This article belongs to the Special Issue Use of Anesthetic Agents: Management and New Strategy)
14 pages, 2280 KiB  
Review
Does Topical Capsaicin Affect the Central Nervous System in Neuropathic Pain? A Narrative Review
by Kareem Alalami, Jenna Goff, Hannah Grimson, Oliver Martin, Eloise McDonald, Thonima Mirza, Dhruvi Mistry, Adanma Ofodile, Sara Raja, Tooba Shaker, Danah Sleibi and Patrice Forget
Pharmaceuticals 2024, 17(7), 842; https://doi.org/10.3390/ph17070842 - 27 Jun 2024
Cited by 1 | Viewed by 3887
Abstract
Research has been conducted investigating the neuronal pathways responsible for the generation of chronic neuropathic pain, including the components of it in conditions such as chronic post-surgical pain, phantom limb pain, and cluster headaches. Forming part of the management of such conditions, capsaicin [...] Read more.
Research has been conducted investigating the neuronal pathways responsible for the generation of chronic neuropathic pain, including the components of it in conditions such as chronic post-surgical pain, phantom limb pain, and cluster headaches. Forming part of the management of such conditions, capsaicin as a molecule has proven effective. This review has investigated the central nervous system modifications exhibited in such conditions and the pharmacological mechanisms of capsaicin relevant to this. The current paradigm for explaining topical capsaicin-induced analgesia is that TRPV1-mediated calcium ion influx induces calpain, in turn causing axonal ablation and functional defunctionalisation in the PNS (Peripheral Nervous System). Demonstrated through the analysis of existing data, this review demonstrates the changes seen in the CNS (Central Nervous System) in chronic neuropathic pain, as well as some of the evidence for capsaicin modulation on the CNS. Further supporting this, the specific molecular mechanisms of capsaicin-induced analgesia will also be explored, including the action of TRPV1, as well as discussing the further need for clinical research into this area of uncertainty due to the limited specific data with suitable parameters. Further research this review identified as potentially useful in this field included fMRI (functional Magnetic Resonance Imaging) studies, though more specific observational studies of patients who have already been administered capsaicin as a current treatment may prove helpful in studying the modification of the CNS in the long term. Full article
(This article belongs to the Special Issue Use of Anesthetic Agents: Management and New Strategy)
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