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Department of Anesthesiology, Pain and Perioperative Medicine, India
Submission: October 23, 2018;Published: October 29, 2018
*Corresponding author: Mithilesh Kumar, Department of Anesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India.
How to cite this article: Mithilesh K, Misha G, Ashish G, Summit K, Jayashree S. Nanotechnology in Anesthesia and Pain – A Review. Theranostics
Brain Disord. 2018; 4(1): 555627. DOI: 10.19080/TBSND.2018.04.555627
Nanomedicine is monitoring, repair, construction, and control of human biological systems at the molecular level, using engineered nanodevices and nanostructures. Nano-robots (Nanobots) are nanosized, artificially fabricated, controllable devices. They freely travel in human body and interact with specific cells at molecular level. Its benefits include disease prevention, imaging, prenatal, virtual reality, individual medicine, emergency medicine, anaesthesia & ICU, research, medical monitoring, medical records, nano-biopharmacy, drug delivery and cancer treatment. It would be applicable to general anaesthesia, regional anaesthesia, pain, cancer therapy and insight into consciousness.
A nanometer is a billionth of a meter (10-9). A size of 0.1- 100 nm is used for this technology. Richard Feynman (Nobel laureate) hypothesized the concept in his book- There‘s Plenty of Room At the Bottom (1959). Eric Drexler described nanotechnology in Engines of Creation: The coming Era of Nanotechnology (1986). The term Nano technology refers to rresearch & development at the atomic, molecular, or macromolecular level (0.1 – 100nm) to create structures, devices and systems with novel function (NNI). Nanomedicine is monitoring, repair, construction, and control of human biological systems at the molecular level, using engineered nanodevices and nanostructures. Nano-robots (Nanobots) are nanosized, artificially fabricated, controllable devices. They freely travel in human body and interact with specific cells at molecular level. They can perform multiple cellular level functions, including replacing, repairing DNA that is damaged in the cell as we age and may also be diseased. They are self-replicating and could even be programmed to build other nanobots. Types of nanobots include - Single action nanobots, Disease specific nanobots, Drug carrier nanobots, Inhaled drugs nanobots, Chromallocytes, Vasculoids - blood like, Respirocytes - RBC like, Clottocytes - platelets like, Microbivores – virus/bacteria killers and cancer curers.
It includes disease prevention, imaging, prenatal, virtual reality, individual medicine, emergency medicine, anaesthesia & ICU, research, medical monitoring, medical records, nano-biopharmacy, drug delivery and cancer treatment.
At Canary Islands they developed an Automatic controlled anesthesia system which detects hypnotic state based on EEG & BIS and supplies appropriate dose of antiesthetic. It is a computer software program which saves time, an aesthetic drug and their doses . Examples include Nano formulated drugs like anesthetic drugs and diclofenac, Biosensor for monitoring depth of anesthesia, Nanotube capnograph sensor, Real time non invasive glucose and electrolyte monitoring.
With nanotechnology, an antidote to bupivacaine overdose is possible. There is a formation of pi-pi complexes between bupivacaine and a pi-electron-rich injectable nanoparticle. This complex would be devoid of clinical effects of bupivacaine and would thus render toxic bupivacaine harmless. So, it could be possible to counteract high spinal as soon as it is realised.
Lidocaine-loaded poly (carpo-lactone)-poly (eethylene
glycol)-poly (carpo-lactone) (PCL-PEG-PCL) Nano particles in
hydrogel was prepared of size 200 nm. This has been shown to be
ssuperior in terms of onset of anesthesia and efficacy. Once drug is
injected, it is directed through Nano-computer to the specific site
where action is required. It is kept at that site for wanted time and
removed from body when not required.
Chronic pain affects 1.5 billion people worldwide. Problems
in pain management include economic burden, subjective scale
of pain measurement, side effects of opiods, drug interaction,
sedation and GI problem. Biomarker for pain is an objective scale.
a. TNF nanoplates- Gold nanorods decorated with small inhibitor RNA that target TNF mRNA. Primary intermediary in neuropathic pain .
b. Tramadol hydrochloride –Loaded PLGA Nano partices
c. Intrathecal Gold-Coated Fe3O4
d. Polymeric Nanocarriers for Spinal Cord Injury –
e. Nanofluidic Membrane Technology for Next –Generation
f. Loperamide HCL- Encapsulated Anti- ICAM- 1 are
immunoliposomes for peripheral pain and inflammation.
They ttarget specific peripheral opioid receptors and have
no side effects of opioid. They are very helpful in acute post
operative pain, arthriticss and neuropathic pain .
g. Citronellal /b-CD Complex: Effects on Noninflammatory
Chronic Muscle Pain and have antihyperalgesic effect .
h. Oral Transmucosal Fentanyl Citrate(OTFC) for cancer
pain- Selectively target opioid receptors in brain, spinal cord,
smooth muscle and bypass GI tract. Thus, they have no side
effects and are helpful in opioid tolerant individuals .
i. Saxitoxin- potent anesthetic, bundled with liposomes.
Single, multisequence nanobot capable of all transport function
of blood including circulation of respiratory gases, glucose,
hormones, cytokines, waste products & cellular components. They
conform to the shape of natural blood cells and do not need heart
pump. It can be a complete replacement of blood .
They are aartificial platelets that control bleeding 100 to 1000
times faster. The number required is very less for desired activities.
Specifically programmed motile colonocytes would even be able
to ddetect internal bleeding and spontaneously seal the site. Thus, giving the hope for avoiding emergency surgeries, reduces the ICU
mortality, no bleeding diathesis and no DIC syndrome .
Oregano phosphorous poisoning is ccommonly encountered
in ICUs and atropine is one of the primary therapeutic drugs.
Nanotechnology has enabled formulation of inhaled atropine in
form of dry powder which can be used in field conditions event by
lay man. It can be ssupplied with pesticide and can be used in case
of accidental poisoning .
Nanotechnology will continue to have profound and positive
impact on humanity. Will serve as cornerstone in this ongoing
& noble endeavor of safe anesthesia and pain relief. It would be
applicable to general anaesthesia, regional anaesthesia, pain,
cancer therapyy and insight into consciousness. Disadvantages
include high cost, complicated fabrication, toxicity, terrorism and