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\r\n\tThere will be a chapter on secondary causes of sexual dysfunction disorders related to diabetes, cardiovascular disease, and obesity. A chapter on remedial measures to enhance sexual activity and maintain human relationships will be discussed. As there is a growing number of cancer survivors a chapter on cancer-related sexual dysfunction will be welcomed for including it.
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Cooper",slug:"robert-d.-cooper"}]},{id:"43671",title:"Ecology of Larval Habitats",slug:"ecology-of-larval-habitats",signatures:"Eliška Rejmánková, John Grieco, Nicole Achee and Donald R.\nRoberts",authors:[{id:"151632",title:"Prof.",name:"Nicole",middleName:null,surname:"Achee",fullName:"Nicole Achee",slug:"nicole-achee"},{id:"152601",title:"Prof.",name:"Eliska",middleName:null,surname:"Rejmankova",fullName:"Eliska Rejmankova",slug:"eliska-rejmankova"},{id:"169016",title:"Dr.",name:"John",middleName:null,surname:"Grieco",fullName:"John Grieco",slug:"john-grieco"}]},{id:"43954",title:"From Anopheles to Spatial Surveillance: A Roadmap Through a Multidisciplinary Challenge",slug:"from-anopheles-to-spatial-surveillance-a-roadmap-through-a-multidisciplinary-challenge",signatures:"Valérie Obsomer, Nicolas Titeux, Christelle Vancustem, Grégory\nDuveiller, Jean-François Pekel, Steve Connor, Pietro Ceccato and\nMarc Coosemans",authors:[{id:"131417",title:"Dr.",name:"Valérie",middleName:null,surname:"Obsomer",fullName:"Valérie Obsomer",slug:"valerie-obsomer"},{id:"152754",title:"Prof.",name:"Marc",middleName:null,surname:"Coosemans",fullName:"Marc Coosemans",slug:"marc-coosemans"},{id:"153949",title:"Dr.",name:"Pietro",middleName:null,surname:"Ceccato",fullName:"Pietro Ceccato",slug:"pietro-ceccato"},{id:"153950",title:"Dr.",name:"Gregory",middleName:null,surname:"Duveiller",fullName:"Gregory Duveiller",slug:"gregory-duveiller"},{id:"153952",title:"Dr.",name:"Christelle",middleName:null,surname:"Vancutsem",fullName:"Christelle Vancutsem",slug:"christelle-vancutsem"},{id:"153980",title:"Dr.",name:"Nicolas",middleName:null,surname:"Titeux",fullName:"Nicolas Titeux",slug:"nicolas-titeux"},{id:"154158",title:"Dr.",name:"Steve J",middleName:null,surname:"Connor",fullName:"Steve J Connor",slug:"steve-j-connor"},{id:"167685",title:"MSc.",name:"Jean-Francois",middleName:null,surname:"Pekel",fullName:"Jean-Francois Pekel",slug:"jean-francois-pekel"}]},{id:"43960",title:"Simian Malaria Parasites: Special Emphasis on Plasmodium knowlesi and Their Anopheles Vectors in Southeast Asia",slug:"simian-malaria-parasites-special-emphasis-on-plasmodium-knowlesi-and-their-anopheles-vectors-in-sout",signatures:"Indra Vythilingam and Jeffery Hii",authors:[{id:"151116",title:"Dr.",name:"Indra",middleName:null,surname:"Vythilingam",fullName:"Indra Vythilingam",slug:"indra-vythilingam"},{id:"169006",title:"Dr.",name:"Jeffery",middleName:null,surname:"Hii",fullName:"Jeffery Hii",slug:"jeffery-hii"}]},{id:"44039",title:"Thermal Stress and Thermoregulation During Feeding in Mosquitoes",slug:"thermal-stress-and-thermoregulation-during-feeding-in-mosquitoes",signatures:"Chloé Lahondère and Claudio R. Lazzari",authors:[{id:"151619",title:"Prof.",name:"Claudio",middleName:null,surname:"R. Lazzari",fullName:"Claudio R. Lazzari",slug:"claudio-r.-lazzari"},{id:"151620",title:"Ms.",name:"Chloé",middleName:null,surname:"Lahondère",fullName:"Chloé Lahondère",slug:"chloe-lahondere"}]},{id:"43955",title:"The Anopheles Mosquito Microbiota and Their Impact on Pathogen Transmission",slug:"the-anopheles-mosquito-microbiota-and-their-impact-on-pathogen-transmission",signatures:"Mathilde Gendrin and George K. Christophides",authors:[{id:"154007",title:"Dr.",name:"Mathilde",middleName:null,surname:"Gendrin",fullName:"Mathilde Gendrin",slug:"mathilde-gendrin"},{id:"154008",title:"Prof.",name:"George",middleName:"K",surname:"Christophides",fullName:"George Christophides",slug:"george-christophides"}]},{id:"43829",title:"Bacterial Biodiversity in Midguts of Anopheles Mosquitoes, Malaria Vectors in Southeast Asia",slug:"bacterial-biodiversity-in-midguts-of-anopheles-mosquitoes-malaria-vectors-in-southeast-asia",signatures:"Sylvie Manguin, Chung Thuy Ngo, Krajana Tainchum, Waraporn\nJuntarajumnong, Theeraphap Chareonviriyaphap, Anne-Laure\nMichon and Estelle Jumas-Bilak",authors:[{id:"50017",title:"Prof.",name:"Sylvie",middleName:null,surname:"Manguin",fullName:"Sylvie Manguin",slug:"sylvie-manguin"},{id:"75315",title:"Prof.",name:"Theeraphap",middleName:null,surname:"Chareonviriyaphap",fullName:"Theeraphap Chareonviriyaphap",slug:"theeraphap-chareonviriyaphap"},{id:"88985",title:"Prof.",name:"Anne-Laure",middleName:null,surname:"Michon",fullName:"Anne-Laure Michon",slug:"anne-laure-michon"},{id:"88986",title:"Prof.",name:"Estelle",middleName:null,surname:"Jumas-Bilak",fullName:"Estelle Jumas-Bilak",slug:"estelle-jumas-bilak"},{id:"156016",title:"MSc.",name:"Chung Thuy",middleName:null,surname:"Ngo",fullName:"Chung Thuy Ngo",slug:"chung-thuy-ngo"},{id:"156018",title:"MSc.",name:"Krajana",middleName:null,surname:"Tainchum",fullName:"Krajana Tainchum",slug:"krajana-tainchum"},{id:"156019",title:"Dr.",name:"Waraporn",middleName:null,surname:"Juntarajumnong",fullName:"Waraporn Juntarajumnong",slug:"waraporn-juntarajumnong"}]},{id:"43899",title:"Distribution, Mechanisms, Impact and Management of Insecticide Resistance in Malaria Vectors: A Pragmatic Review",slug:"distribution-mechanisms-impact-and-management-of-insecticide-resistance-in-malaria-vectors-a-pragmat",signatures:"Vincent Corbel and Raphael N’Guessan",authors:[{id:"152666",title:"Dr.",name:"Vincent",middleName:null,surname:"Corbel",fullName:"Vincent Corbel",slug:"vincent-corbel"},{id:"169017",title:"Dr.",name:"Raphael",middleName:null,surname:"N'Guessan",fullName:"Raphael N'Guessan",slug:"raphael-n'guessan"}]},{id:"43851",title:"Perspectives on Barriers to Control of Anopheles Mosquitoes and Malaria",slug:"perspectives-on-barriers-to-control-of-anopheles-mosquitoes-and-malaria",signatures:"Donald R. Roberts, Richard Tren and Kimberly Hess",authors:[{id:"151439",title:"Prof.",name:"Donald",middleName:null,surname:"R. Roberts",fullName:"Donald R. Roberts",slug:"donald-r.-roberts"},{id:"151656",title:"Mr.",name:"Richard",middleName:null,surname:"Tren",fullName:"Richard Tren",slug:"richard-tren"},{id:"154152",title:"Ms.",name:"Kimberly",middleName:null,surname:"Hess",fullName:"Kimberly Hess",slug:"kimberly-hess"}]},{id:"43874",title:"Residual Transmission of Malaria: An Old Issue for New Approaches",slug:"residual-transmission-of-malaria-an-old-issue-for-new-approaches",signatures:"Lies Durnez and Marc Coosemans",authors:[{id:"152754",title:"Prof.",name:"Marc",middleName:null,surname:"Coosemans",fullName:"Marc Coosemans",slug:"marc-coosemans"},{id:"169018",title:"Dr.",name:"Lies",middleName:null,surname:"Durnez",fullName:"Lies Durnez",slug:"lies-durnez"}]},{id:"44330",title:"Vector Control: Some New Paradigms and Approaches",slug:"vector-control-some-new-paradigms-and-approaches",signatures:"Claire Duchet, Richard Allan and Pierre Carnevale",authors:[{id:"151662",title:"Dr.",name:"Pierre",middleName:null,surname:"Carnevale",fullName:"Pierre Carnevale",slug:"pierre-carnevale"},{id:"169000",title:"Dr.",name:"Richard",middleName:null,surname:"Allan",fullName:"Richard Allan",slug:"richard-allan"},{id:"169008",title:"Dr.",name:"Claire",middleName:null,surname:"Duchet",fullName:"Claire Duchet",slug:"claire-duchet"}]},{id:"43870",title:"New Salivary Biomarkers of Human Exposure to Malaria Vector Bites",slug:"new-salivary-biomarkers-of-human-exposure-to-malaria-vector-bites",signatures:"Papa M. Drame, Anne Poinsignon, Alexandra Marie, Herbert\nNoukpo, Souleymane Doucoure, Sylvie Cornelie and Franck\nRemoue",authors:[{id:"151515",title:"Dr.",name:"Papa Makhtar",middleName:null,surname:"Drame",fullName:"Papa Makhtar Drame",slug:"papa-makhtar-drame"},{id:"151648",title:"Dr.",name:"Franck",middleName:null,surname:"Remoué",fullName:"Franck Remoué",slug:"franck-remoue"},{id:"154034",title:"Dr.",name:"Anne",middleName:null,surname:"Poinsignon",fullName:"Anne Poinsignon",slug:"anne-poinsignon"},{id:"154035",title:"MSc.",name:"Alexandra",middleName:null,surname:"Marie",fullName:"Alexandra Marie",slug:"alexandra-marie"},{id:"154037",title:"Dr.",name:"Souleymane",middleName:null,surname:"Doucoure",fullName:"Souleymane Doucoure",slug:"souleymane-doucoure"},{id:"154038",title:"MSc.",name:"Herbert",middleName:null,surname:"Noukpo",fullName:"Herbert Noukpo",slug:"herbert-noukpo"},{id:"154039",title:"Dr.",name:"Sylvie",middleName:null,surname:"Cornélie",fullName:"Sylvie 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Okware"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8946",title:"Human Papillomavirus",subtitle:null,isOpenForSubmission:!1,hash:"dcd959bb940ca13a13e234d6c569c06d",slug:"human-papillomavirus",bookSignature:"Rajamanickam Rajkumar",coverURL:"https://cdn.intechopen.com/books/images_new/8946.jpg",editedByType:"Edited by",editors:[{id:"120109",title:"Dr.",name:"Rajamanickam",surname:"Rajkumar",slug:"rajamanickam-rajkumar",fullName:"Rajamanickam Rajkumar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],publishedBooksByAuthor:[]},onlineFirst:{chapter:{type:"chapter",id:"79062",title:"Application of Ketamine in Current Practice of Anesthesiology",doi:"10.5772/intechopen.100461",slug:"application-of-ketamine-in-current-practice-of-anesthesiology",body:'The story of ketamine began in the 1950s in Park-Davis and Company’s Laboratories as the search for a cyclohexylamine that would serve as an “ideal” anesthetic agent. This new agent would also have analgesic properties. In March 1956, Dr. Harold Maddox synthesized a compound [N-(1-phenyl-cyclohexyl)-piperidine] known as phencyclidine (PCP) using a new chemical organic Grignard reaction [1]. Several experiments were performed at Parke-Davis labs and Wayne State University; both on animals and in human trials. These experiments made it clear that phencyclidine was capable of producing a potent analgesic and cataleptic state defined as a “characteristic akinetic state with a loss of orthostatic reflexes, but without impairment of consciousness, in which the extremities appear to be paralyzed by motor and sensory failure” [2, 3]. After administering the drug, patients had an increase in blood pressure, respiratory rate, and minute volume while corneal and laryngeal reflexes were conserved. However, increased salivation and nystagmus were noted. With these findings, PCP was deemed to be a useful agent in the setting of anesthesia. However, with further studies, it became apparent that there was a profound and prolonged state of emergence delirium. This discovery would hinder the widespread use of PCP and begin the search for a new related compound [1, 3].
Finally, in 1962, Dr. Calvin Stevens was successfully synthesized a derivative of PCP – CI-581 or ketamine – which was selected to undergo human trials. On August 3 1964, the first human intravenous subanestheic dose of ketamine was successfully administered to volunteer prisoners at Jackson prison in Michigan [1]. About one-third of the patients had reported adverse effects of psychotic reactions which they described as a feeling of floating in outer space and having no feelings in their limbs. Due to this effect, Domino’s wife Toni termed it “dissociative anesthesia” originating the concept of dissociative anesthesia [1, 4]. Dissociative anesthesia would later bed deifined as a state of electrophysiological and functional dissociation between thalamocortical and limbic systems. It was then concluded that ketamine is a potent analgesic and anesthetic with lower potency and shorter duration of action than PCP. Finally, in 1969, ketamine hydrochloride became available as a prescription drug under the name of Ketalar and a year later was approved by the US Food and Drug Administration [2, 3].
Unfortunately, the popularity of ketamine declined as it caused hallucinations and psychotic reactions that were an unpleasant experience for patients. However, in the early 1990s, ketamine made a come-back due to the peak of high-dose opioid anesthesia [3]. Ketamine is becoming widely used among anesthesiologists for both induction and maintenance in anesthetic and subanesthetic doses. Commonly it is used in combination with diazepam, midazolam, or propofol to help reduce hallucinations, psychotic reactions, and emergence delirium [1]. A recent interest has also sparked in opioid free anesthesia using ketamine. Contrary to yesteryears practice, today ketamine is widely used for a variety of different procedures for its valuable anesthetic, analgesic, and even amnestic properties, as we will discuss throughout this chapter.
Ketamine’s chiral carbon center allows for the existence of two different steric configurations - S(+) and R(−) isomers. Each isomer has varying anesthetic, analgesic, dysphoric, and sympathomimetic properties. Several studies have shown that the S(+) isomer is more potent and has a higher NMDA affinity when used intraoperatively for anesthesia compared to the R(−) isomer. In addition, the S(+) isomer causes lower cardiac stimulation, less spontaneous motor activity, better analgesia, faster recovery, fewer psychotomimetic side effects, and decreased incidence of emergence delirium [1, 2].
Ketamine primarily works by inhibition of NMDA receptors and has two different mechanisms through which it exerts its function. NMDA receptors are excitatory amino acid receptors that have been implicated in pain [5]. The first mechanism of NMDA antagonism is as a channel blocker. The second mechanism is through an allosteric mechanism that decreases the opening frequency of the NMDA channel. It can also exert its effect through a variety of other mechanisms such as inhibition of L-type calcium channels, BK channels, HCN channels, and voltage-gated sodium channels. Other mechanisms of actions include monoamine blockade and inhibition of serotonin reuptake [2].
Ketamine has a slow off-rate compared to other anesthetic agents. This means that it continues to exert its effect even after glutamate; the substrate for NMDA receptors, has dissociated. This allows for a better anesthetic effect.
Ketamine has a high lipid solubility allowing it be rapidly taken up by the brain and redistributed to highly perfused tissue with a distribution half-life between 10 and 15 minutes [2]. Its metabolism is highly dependent on the liver using the cytochrome P450 system. Ketamine can be converted into active or inactive metabolites, which are then further hydroxylated to increase water solubility through various CYP450 enzymes. The metabolites are then renally eliminated [1, 6].
Research has shown that ketamine has a dose dependent effect. In this chapter, we will focus on anesthesia and analgesia. Analgesic effects are seen at levels of 100–160 ng/ml. Induction of anesthesia is usually achieved at 9000–25000 ng/ml and can be maintained with 2000–3000 ng/ml. Ketamine’s half-life at anesthetic doses is approximately 79 minutes, and its actions decrease when the drug redistributes from the brain into other tissue. The threshold between consciousness and emergence from anesthesia is 1000 ng/ml. The psychic state is usually seen with doses between 50 and 200 ng/ml. The onset and duration of these psychedelic effects varies based on the route of administration [1, 6].
Because ketamine is both water and lipid soluble, it can be administered intravenously, intramuscularly, orally, and sublingually. However, due to its significant first pass metabolism oral administration yields very little bioavailability. Intravenous administration is the preferred route of administration as it allows for 100% bioavailability. Recommended doses, shown in Table 1, are between 1 and 4.5 mg/kg over the course of 60 seconds for induction. For general maintenance 1–6 mg/kg/hr. and 0.4–1 mg/kg/hr. for continuous sedation is recommended [6]. Ketamine can be given intramuscularly that has a 93% bioavailability and is useful in emergencies, uncooperative patients and burn patients. When administered intramuscularly higher doses, between 6.5–13 mg/kg, are needed. For subanesthetic doses the intravenous dose is between 0.2–0.8 mg/kg and 2–4 mg/kg if given intramuscularly [2].
Intravenous | |
---|---|
Induction | 1–4.5 mg/kg (60s) |
Maintenance (general) | 1–6 mg/kg/hr |
Maintenance (sedation) | 0.4–1 mg/kg/hr |
Subanesthetic | 0.2–0.8 mg/kg |
Intramuscular | |
---|---|
Anesthetic | 6.5–13 mg/kg |
Subanesthetic | 2–4 mg/kg |
Doses of ketamine.
Table 1 summarizes the various suggested doses of ketamine administration depending on route, phase and administration method of anesthesia.
For review, Induction is the transition from an awake state to an anesthetized state with a sole agent such as ketamine or propofol or a combination of drugs [2]. Maintenance involved sustaining this anesthetic [7]. The role of ketamine in induction and maintenance in the practice of anesthesia will be discussed later in this chapter.
In the first ever human trial done with ketamine, a 1–2 mg/kg dose was given to patients, which resulted in analgesia and anesthesia with an onset time of one minute and lasted for about five to ten minutes. Within one to two hours the patients were back to their initial state. An increase in blood pressure and heart rate, hyperactive reflexes, and increase in lacrimation was noticed. A transient respiratory depression was also seen but returned to baseline within seven minutes. Even so, reflexes were preserved throughout. No labs were significantly affected. However, during the recovery period, as with PCP, psychic reactions, mood and affect alterations were observed but laster for a shorter duration and were less severe than the reaction with PCP that subsided within 30 mins after awakening. Many of the effects that were seen with ketamine were not seen with the anesthetics used commonly during that time period [4]. This led to the conclusion that ketamine results in a short-acting and effective induction of anesthesia and analgesia.
Ketamine has been shown to be safe and effective for maintenance sedation in several studies. It decreases airway resistance, improves dynamic compliance, preserves functional residual capacity, tidal volume, and minute ventilation [7]. Another advantage observed was that with ketamine, pharyngeal and laryngeal reflexes were conserved. In addition, ketamine provides an additional benefit in patients with refractory bronchospasms as it decreases audible wheezes, bronchodilator requirements, and hypercarbia making it the drug of choice in patients with bronchospasms [7]. Furthermore, in patients with refractory status asthmasticus, it helps reduce the need for initiation of mechanical ventilation [8]. Ketamine is also a popular induction agent [2]. For induction, ketamine is usually used in combination with other agents such as propofol or diazepam for reduction in emergence excitement, or dissociative effects that often result when ketamine is used [8].
Since ketamine is known for its ability to cause dissociative anesthesia, it has been hypothesized to be particularly beneficial for painful or distressing procedures. For example, endotracheal intubation using ketamine has been successful in some cases with the added advantage of maintaining or even increasing cardiorespiratory tone. We will discuss four methods for endotracheal intubation that have been evaluated. In delayed sequence intubation, dissociative doses of ketamine are given to allow the patient to enter an unconscious state so that proper preparation and pre-oxygenation can be taken before a paralytic is given. With this method, there were reduced adverse events and improved oxygen saturation. In ketamine-only breathing intubation, a dissociative dose of ketamine monotherapy is used in spontaneously breathing patients. This strategy seems to be useful in patients with anatomically difficult airways, physiologic limitations and profound acidosis. With traditional rapid sequence intubation, ketamine was given with the traditional rapid sequence intubation protocol. In review, rapid sequence intubation is when an induction agent and a paralytic are administered simultaneously during endotracheal intubation without the need for bag mask ventilation. This method has an advantage when apnea caused by the paralytic agent is not a concern. Finally, in ketamine for post-intubation analgesia and sedation, ketamine given after intubation provides two benefits - stimulating heart rate and blood pressure and analgesic and sedative properties. This allows for the reduction of conventional sedative use which has been linked to prolonged ICU stay and delirium. Although advantages have been noted, using ketamine for airway management using these strategies should be done with careful planning and caution, as there still is limited evidence [9].
A major advantage of ketamine, unlike many other anesthetic agents, is hemodynamic stability. It is also generally well tolerated in both pediatric and geriatric patients. As mentioned previously, ketamine when given in a combination with propofol for induction significantly improves hemodynamic stability within the first ten minutes [10]. This advantage makes ketamine extremely beneficial in managing hemodynamically unstable patients such as those who have suffered severe trauma. For example, in which ketamine has been useful is in the management of burn patients especially during the acute phase of injury. During the acute phase, the burn victims are undergoing significant fluid shifts leading to cardiovascular and respiratory insufficiency [11].
Inflammation is a normal mechanism that the body uses to fight infection caused by viruses and bacteria. This mechanism is initiated by pro-inflammatory cytokines that are released by the immune cells. These pro-inflammatory cytokines (IL-1, IL-6, IL-8, IL-12, IFN-γ, IL-18, and Tumor Necrosis Factor (TNF) [12]. However, inflammation can also be disadvantageous in that it can lead to pain and swelling in the acute setting. Concentrations of proinflammatory cytokines during the perioperative period may significantly impact surgical outcome. Ketamine has been shown to modulate the perioperative cytokine response and plays a significant anti-inflammatory role. It inhibits the systemic response without affecting the healing process that is necessary during the postoperative state [12]. One such mechanism is the reduction of leukocyte migration through endothelial monolayers. It is well studied that neutrophils play a key role in defense against foreign pathogens. Upon activation, neutrophils need to cross endothelial cell layers. Researchers investigated the effects of ketamine on leukocytes and endothelial cells independently and together. In a dose-dependent fashion, ketamine suppressed migration when leukocytes alone were treated. Interestingly, when the endothelial cells were treated with ketamine, there was no significant reduction in migration. However, when both leukocytes and endothelial cells were treated, the suppression in migration was much higher than when only leukocytes were treated [13]. One possible mechanism that may achieve this is is the inhibition of the up-regulation of CD18 and CD26L on neutrophils. CD18 and CD26L are stimulated during inflammation and are important cell surface markers for adhesion of neutrophils to endothelial cells promoting neutrophil migration [14].
It has also been suggested that this effect might be mediated by the suppression of microglial activation in the CNS or the inhibition of large conductance calcium activated potassium channels in the microglia. Specifically, there is a reduction in postoperative pro-inflammatory cytokines such as serum IL-6, TNF-a, nuclear factor kb, CRP and nitric oxidase synthase [15]. In addition, an increase in postoperative serum IL-10 levels, an anti-inflammatory cytokine. Ketamine was also shown to impair neutrophil chemotaxis, inhibit superoxide radical production, inhibit differentiation of immature dendritic cells, and increase Treg cell concentration [16]. Ketamine may also alter the oxidative stress response in patients. When ketamine was administered, patients had lower total thiol molecules and a lower total antioxidant capacity. They also had higher lipid peroxidation, and higher superoxide dismutase and glutathione peroxidase activity [17].
Ketamine has several effects on brain activity that can be monitored by EEG. When subanesthetic doses are given, the complexity of EEG changes is elevated relative to the baseline. At anesthetic doses the pattern alternates between a high and low complexity. Eventually the pattern stabilizes at a high complexity that is similar to baseline. This shows that ketamine can induce a fragmented state that shows alternating patterns of conscious and anesthetic states. A bolus of ketamine induces unconsciousness causing a change from slow waves to a gamma-burst wave pattern on the EEG, which later evolved into a stable gamma pattern most likely due to decreasing plasma ketamine levels [18]. In addition, in hippocampal and cortical neurons, ketamine can increase activity of extrasynaptic GABA-a receptors which generate tonic inhibitory currents. Ketamine has been shown to increase potency of low concentration of GABA at these receptors as well [19]. Secondary effects on the dopamine system due to ketamine alters the firing rate of mesocortical and mesolimbic dopamine neurons causing an increase in extracellular dopamine in the striatum and prefrontal cortex which has been hypothesized to be a contributing factor the psychotic-like behaviors observed with ketamine [20].
Another interesting aspect of ketamine is that its effect varies depending on other anesthetic agents used with it or if it is used as a sole agent. For example, in a study done with rats it was found that when ketamine was added to ongoing sevoflurane or propofol, on EEG there was either no change or a shift to higher frequencies. However, when ketamine was given alone there was a simultaneous increase in both lower and higher frequencies. Also, when ketamine is used as a sole anesthetic agent patients can experience dissociative effects. However, at the same time ketamine is also found to be neuroprotective in preventing or mitigating postoperative delirium. This might explain why ketamine is being used both as an experimental model of psychiatric diseases as well as a proposed treatment for psychiatric diseases [21].
Ketamine’s unusual cataplectic properties make it a dissociative anesthetic. At low doses, it causes alteration in visual and auditory stimuli and feelings of detachment from one’s surroundings that manifest themselves as delirium, hallucinations, delusions, and confusion [20]. This leads to a potential for abuse and explains why ketamine is a class III-controlled substance and often referred to as “Special K”. Long term effects of repeated ketamine use may lead to flashbacks, attentional and other cognitive dysfunctions, and decreased sociability. On the other hand, its continued use is reinforced by the other psychotropic effects. Therefore, some anesthesiologist may choose to avoid ketamine especially when it comes to patients with Post Traumatic Stress Disorder (PTSD) [15]. However, a recent study presented a trial of repeated intravenous ketamine administration for patients with PTSD. Infusion of ketamine demonstrated a clear superiority in reduction of symptoms compared to midazolam. More research on this aspect of ketamine is needed to help guide its use in anesthesia in patients with PTSD [10]. Caution should also be used when using ketamine for anesthesia in schizophrenic patients. This is because ketamine has been found to induce hallucinations, delusions and thought disorders, resembling an active schizophrenic episode of their illness. These episodes are also resistant to haloperidol, the drug traditionally used to treat active episodes [22].
Interestingly, ketamine and its metabolites modulate distinct neural circuits to produce dissociation and analgesia. The channel blocking effect of ketamine at the NMDA receptors may partially explain its dissociative properties. This is because ketamine blocks excitatory NMDA receptors on fast-spiking cortical interneurons more effectively than those on pyramidal neurons. This results in markedly dysregulated pyramidal neuronal activity. The relative inactivity of cortical interneurons leads to glutamate-mediated pyramidal–pyramidal neuronal facilitation. Consistent with this notion, lamotrigine, an antiepileptic medication that reduces cortical glutamate release and pyramidal neuron facilitation, suppresses the dissociative properties of ketamine. In the same fashion, midazolam reduces pyramidal neuron facilitation by downstream activity resulting from binding at gamma amino-butyric acid receptors on pyramidal neurons [23]. This could explain why ketamine causes a feeling of dissociation when it is used as an anesthetic agent.
There is also evidence that ketamine has neuroprotective effects. It is thought that this occurs due to the inhibition of calcium influx that occurs with ketamine administration. This calcium influx inhibition helps prevent ischemia and apoptosis providing a protective benefit to neurons. When ketamine was compared with other anesthetic agents such as midazolam, fentanyl, and propofol there was a reduction of spreading depolarizations with ketamine administration. Spreading depolarizations can cause neurovascular decoupling and potentiate the secondary phase of brain damage. Therefore, it is hypothesized that when ketamine is used, the suppression of these spreading depolarization allows for the maintenance of the electrochemical gradient and prevents neurovascular decoupling. This works together to have neuroprotective effects. However, the opposite effects could occur if repeated high doses are given as ketamine has the potential to cause neurotoxicity particularly in the developing brain. When ketamine is given in repeated high doses, there is an increase in a subunit of NMDA receptors, NR1. This allows the opposite effect, increasing the influx of calcium leading to apoptosis [8].
Traditionally, it was thought that ketamine increased intracranial pressure. In recent years, this theory has been rejected. Ketamine has successfully been used to reduce intracranial pressure. One study examined the effects of ketamine on intubated and sedated pediatric population at a regional trauma center with elevated ICP >18 mmHg resistant to first tier therapies. The results of 82 ketamine administrations in 30 patients were analyzed. Overall, following ketamine administration, ICP decreased by 30% (from 25.8 ± 8.4 to 18.0 ± 8.5 mm Hg) (p < 0.001) and Cerebral Perfusion Pressure (CPP) increased from 54.4 ± 11.7 to 58.3 ± 13.4 mm Hg (p < 0.005). In Group 1, ICP decreased significantly following ketamine administration and increased by >2 mm Hg during the distressing intervention in only 1 of 17 events. In Group 2, when ketamine was administered to lower persistent intracranial hypertension, ICP decreased by 33% (from 26.0 ± 9.1 to 17.5 ± 9.1 mm Hg) (p < 0.0001) following ketamine administration. They concluded that in ventilator-treated patients with intracranial hypertension, ketamine effectively decreased ICP and prevented untoward ICP elevations during potentially distressing interventions, without lowering blood pressure and CPP. In addition, these results refute the notion that ketamine increases ICP. Ketamine is a safe and effective drug for patients with traumatic brain injury and intracranial hypertension, and it can be used safely in trauma emergency situations [24].
Ketamine’s ability to promote central sympathetic stimulation and inhibition of neuronal catecholamine reuptake has brought upon its resurgence as an excellent sedation maintenance drug [7]. These effects favor hemodynamic stability. A prospective double-blind controlled study compared the use of ketamine vs. fentanyl for sedation in the ICU. It was observed that patients on ketamine had an increased MAP and a decreased incidence of shock. This characteristic is what makes it an excellent choice for induction of anesthesia for potentially unstable cardiac patients, especially when combined with midazolam. This benefit was observed in patients with septic cardiomyopathy [8].
In addition, clinicians have adapted ‘ketofol,’ a combination of ketamine and propofol especially for sedation cases. Propofol when used alone can cause myocardial depression and systemic vasodilation that both lead to hypotension, especially in a fasting patient. When propofol was used alone, it causesd a 20% reduction in systolic blood pressure in the first 5 and 10 minutes compare to ‘ketofol’ [10].
In addition, Ketamine tends to relax bronchiole smooth muscles. Thus, it can protect asymptomatic patients with asthma from developing bronchospasm and it can also effectively relieve bronchospasm in patients who already have respiratory problems before anesthesia. In addition, it has been used as an analgo-sedative in patients with status asthmaticus, not responding to the usual therapeutic options; as this can reduce the need for mechanical ventilation [8]. A review of prospective and observational studies showed a noticeable increase in chest wall dynamics in patients with status asthmaticus. They noticed that patients receiving ketamine continuous infusion also had reducible wheezing and even reduced bronchodilator requirement [7]. It should also be noted that unlike opioids, it does not increase histamine release; further reducing the possibility of bronchospasm [8].
These benefits extend to the pediatric population. Research has shown ketofol use as an induction agent as an alternative to propofol led to better laryngeal mask airway (LMA) insertion in children. In addition, during the LMA the use of ketofol showed faster induction time, lower injection pain, better jaw relaxation, better full mouth opening, and less incidence and duration of apnea when compared to using propofol alone [25]. Another study showed that induction with adjunctive use of ketamine and propofol, 1 mg/kg ketamine at induction and 5 mg/kg/h propofol infusion for maintenance for MRI sedation in children resulted in better induction quality, lower propofol infusion rate for maintenance, and faster time to full recovery [26]. Ketofol seems to have an effect that is dependent on the ratio of propofol to ketamine. In a clinical trial performed, it was determined that a 10:1 propofol ketamine ratio seems to have the greatest benefit during surgery due to better hemodynamic stability maintenance and faster recovery time [27].
With the opioid epidemic in recent years, clinicians are exploring options to provide pain relief with reduced or no opioid administration. Although opioids provide excellent analgesia, they can also produce unpleasant adverse effects such as nausea, vomiting, tolerance, pruritis, hyperalgesia, urinary retention, constipation, respiratory depression and have an extremely high potential for abuse. Approximately 2 million Americans use opioids for recreational purposes. According to the United State National Institute of Drug Abuse, overdose deaths involving prescription opioids rose from 3442 in 1999 to 17029 in 2017. Studies have shown that patients who consume high doses of opioids in the inpatient setting have a higher probability of report of increase opioid use after discharge. This is especially true for patients who leave the hospital with a prescription for opioids [28].
With regards to cancer pain control, the role of opioids has come into question in recent years as new data emerges about opioids, such as Morphine having pro tumor effects. Morphine may stimulate proliferation, facilitate metastasis, and promote angiogenesis leading to increased tumor burden. However, generalizations about these effects should not be extended to all opioids as research is still ongoing on this topic [29].
In recent years, clinicians are fast adopting Early Recovery After Surgery (ERAS) protocols that have an increased focus on a multimodal approach to pain control to reduce the consumption or even exposure to opioids. In the preoperative setting drugs such as celecoxib, acetaminophen and gabapentin are being utilized to begin pain control even before surgical incision is made. In the operating room Ketamine, among others such as Dexmedetomidine, Intravenous Lidocaine, Intravenous Magnesium, are some of the drugs on the forefront to achieve opioid free or opioid reduced pain relief.
In 2019 a study to evaluate the effect of Opioid Free Anesthesia (OFA) on post-operative morphine consumption and the post-operative course was initiated. Ketamine was used in both arms of OFA and Opioid Anesthesia (OA) for induction. A statistically significant result of reduced supplemental opioid consumption in the OFA group was observed (0.001). It should be noted, however, that ketamine was used in conjunction with lidocaine and dextromethorphan in the OFA group. In addition, the reduction in opioids used may also be due to reduced opioid tolerance. It was noted that postoperative pain scores did not differ between groups, indicating that OA and OFA provided comparable analgesia [30].
Multiple studies on the role of NMDA receptor antagonists in preventive analgesia have been reviewed. Preventive analgesia a concept in which the administration of a drug at any point in the perioperative period and the presumed associated reduction in central sensitization may reduce pain, analgesic consumption, or both beyond the clinical activity of the target drug. Their systemic review showed that ketamine and dextromethorphan produced significant preventive analgesic benefit in 58% and 67% of studies, respectively. In addition, a direct analgesic benefit of the drug occurred in the early postoperative period [5]. It can then be inferred that if pain is controlled early in surgery, then there may be reduced need for additional analgesic medications, including opioids.
A randomized, prospective, double blinded placebo- controlled study investigating the efficacy of preemptive ketamine infusions in patients with chronic pain undergoing elective back surgery was conducted. These patients had a history of at least 6 weeks (about 1 and a half months) of opiate use. They demonstrated that intraoperative preventative ketamine reduced opiate consumption in the acute postoperative period by 37% in these patients. In addition, it seemed that these patients who received ketamine infusions had a reduced pain sensation in the PACU (post anesthesia care unit) and even 6 weeks in the post operative period, leading to a reduction in morphine consumption [31]. As previously discussed, this reduction in pain sensation is due to reduction central sensitization
Ketamine is being favored in bariatric surgery as obese patients tend to have obstructive sleep apnea and obesity hypoventilation syndrome that can be difficult to manage during induction and emergence of anesthesia. Due to its favorable stability on the cardiovascular system, respiratory system and gastrointestinal systems as detailed above. While only in a single case study, an opioid free anesthetic delivered to an obese lady with BMI of 50.1. She received an initial bolus of ketamine 5 mg·kg−1 was followed by a continuous infusion at 5 μg·kg−1 min−1. She underwent surgery without complication, rapidly met all extubation criteria, was never hypoxic, and was ambulating unassisted after 90 minutes in the recovery room without pain. She received ketorolac and IV Acetaminophen as the multimodal regimen. No opioids were used [33]. This case study lays the foundation for an excellent randomized double blinded study to improve outcomes in bariatric surgery. Furthermore TIVA with propofol, ketamine and dexmedetomidine (59 patients) vs. opioids and volatile anesthetics (60 patients) and their effects on postoperative nausea and vomiting (PONV) has been studied. Patients in both groups had similar clinical characteristics, surgical procedure, and PONV risk scores and required similar amounts of postoperative opioid. 37.3% in the Opioid group compared to only 20% group reported PONV with a statistically difference (0.02). It was concluded that opioid-free TIVA is associated with a significant reduction in relative risk of PONV compared with balanced anesthesia [34].
Overall, OFA has gained in popularity to enhance early recovery and so spare opioids for the postoperative period. Pain is an extremely complex interaction of biological, cognitive, behavioral, cultural and environmental factors. Whether it is possible to deliver a safe and stable anesthesia without intraoperative opioids to many patients undergoing various surgical procedures. OFA still raises questions. Accurate monitoring to measure intraoperative nociception and guide the use of adjuvants is not available. Also, there is a need for procedure specific strategies as well as indications and contraindications to the technique. OFA does not seem to reduce the amounts of opioids prescribed at discharge which needs to be addressed and thought about by health care professionals.
Ketamine has made a strong resurgence as a versatile drug in the field of anesthesia. We reviewed the history of anesthesia from its discovery to its application as an anesthetic. In addition, we aimed to demonstrate how ketamine has favorable properties with regards to hemodynamics, its neuroprotective properties, psychomodulator effects, and anti-inflammatory effects. These favorable properties have made it one of the drugs on the forefront of the opioid free anesthesia concept discussed in this chapter. We remain excited about the ongoing research on Ketamine’s role in treatment of patient with Post Traumatic Stress Disorder and various other applications in the field of Anesthesia.
We want to acknowledge Dr. Alex Bekker, MD, PhD, Chairman of Department of Anesthesiology for the encouragement and support.
The authors declare no conflict of interest.
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This chapter discusses the basic design methods for two fluid heat exchangers.",book:{id:"5395",slug:"heat-exchangers-design-experiment-and-simulation",title:"Heat Exchangers",fullTitle:"Heat Exchangers - Design, Experiment and Simulation"},signatures:"Cüneyt Ezgi",authors:[{id:"187086",title:"Prof.",name:"Cüneyt",middleName:null,surname:"Ezgi",slug:"cuneyt-ezgi",fullName:"Cüneyt Ezgi"}]},{id:"48647",title:"Modeling and Design of Plate Heat Exchanger",slug:"modeling-and-design-of-plate-heat-exchanger",totalDownloads:9652,totalCrossrefCites:9,totalDimensionsCites:17,abstract:null,book:{id:"4563",slug:"heat-transfer-studies-and-applications",title:"Heat Transfer",fullTitle:"Heat Transfer Studies and Applications"},signatures:"Fábio A.S. Mota, E.P. Carvalho and Mauro A.S.S. Ravagnani",authors:[{id:"35110",title:"Prof.",name:"Mauro",middleName:null,surname:"Ravagnani",slug:"mauro-ravagnani",fullName:"Mauro Ravagnani"}]},{id:"53559",title:"Design of Heat Transfer Surfaces in Agitated Vessels",slug:"design-of-heat-transfer-surfaces-in-agitated-vessels",totalDownloads:4510,totalCrossrefCites:3,totalDimensionsCites:4,abstract:"The project on heat transfer surfaces in agitated vessels is based on the determination of the heat exchange area, which is necessary to abide by the process conditions as mixing quality and efficiency of heat transfer. The heat transfer area is determined from the overall heat transfer coefficient (U). The coefficient (U) represents the operation quality in heat transfers being a function of conduction and convection mechanisms. The determination of U is held from the Nusselt’s number, which is related to the dimensionless Reynolds and Prandtl’s, and from the fluid’s viscosity relation that is being agitated in the bulk temperature and the viscosity in the wall’s temperature of heat exchange. The aim of this chapter is to present a summary for the literature concerning heat transfer in agitated vessels (equipped with jackets, helical coils, spiral coils, and vertical tube baffles) and also the many parameters of Nusselt’s equation for these surfaces. It will present a numerical example for a project in an agitated vessel using vertical tube baffles and a 45° pitched blade turbine. Subsequently, the same procedure is held with a turbine radial impeller, in order to compare the heat transfer efficiencies.",book:{id:"5395",slug:"heat-exchangers-design-experiment-and-simulation",title:"Heat Exchangers",fullTitle:"Heat Exchangers - Design, Experiment and Simulation"},signatures:"Vitor da Silva Rosa and Deovaldo de Moraes Júnior",authors:[{id:"187128",title:"Ph.D.",name:"Vitor",middleName:null,surname:"Rosa",slug:"vitor-rosa",fullName:"Vitor Rosa"},{id:"188792",title:"Dr.",name:"Deovaldo",middleName:null,surname:"Moraes Júnior",slug:"deovaldo-moraes-junior",fullName:"Deovaldo Moraes Júnior"}]},{id:"40354",title:"Calculation Methods for Heating and Ventilation System of Electrical Machines",slug:"calculation-methods-for-heating-and-ventilation-system-of-electrical-machines",totalDownloads:5436,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"3091",slug:"heat-transfer-phenomena-and-applications",title:"Heat Transfer Phenomena and Applications",fullTitle:"Heat Transfer Phenomena and Applications"},signatures:"Otilia Nedelcu and Corneliu Ioan Sălişteanu",authors:[{id:"142213",title:"Dr.",name:"Otilia",middleName:null,surname:"Nedelcu",slug:"otilia-nedelcu",fullName:"Otilia Nedelcu"},{id:"154781",title:"Dr.",name:"Ioan Corneliu",middleName:null,surname:"Salisteanu",slug:"ioan-corneliu-salisteanu",fullName:"Ioan Corneliu Salisteanu"}]}],onlineFirstChaptersFilter:{topicId:"826",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"80334",title:"Zero Emission Hydrogen Fuelled Fuel Cell Vehicle and Advanced Strategy on Internal Combustion Engine: A Review",slug:"zero-emission-hydrogen-fuelled-fuel-cell-vehicle-and-advanced-strategy-on-internal-combustion-engine",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.102057",abstract:"Global energy consumption has gradually increased as a result of population growth, industrialization, economic development, and rising living standards. Furthermore, as global warming and pollution worsen, the development of renewable energy sources is becoming more essential. Hydrogen is one of the most promising clean and sustainable energy carriers because it emits only water as a byproduct without carbon emission and has the highest energy efficiency. Hydrogen can be produced from a variety of raw resources, including water and biomass. Water electrolysis is one of many hydrogen production technologies that is highly recommended due to its eco-friendliness, high hydrogen generation rate, and high purity. However, in terms of long-term viability and environmental effect, Polymer Electrolyte Membrane water electrolysis has been identified as a potential approach for producing high-purity, high-efficiency hydrogen from renewable energy sources. Furthermore, the hydrogen (H2) and oxygen (O2) produced are directly employed in fuel cells and other industrial uses. As a result, an attempt has been made in this work to investigate hydrogen synthesis and utilization in fuel cell vehicles. Low-temperature combustion technology has recently been applied in engine technology to reduce smoke and NOx emissions at the same time. The advantages and limitations of homogeneous charge compression ignition, partially premixed charge compression ignition, premixed charge compression ignition, and reactivity regulated compression ignition are described separately in low-temperature combustion strategy.",book:{id:"11164",title:"Diesel Engines and Biodiesel Engines Technologies",coverURL:"https://cdn.intechopen.com/books/images_new/11164.jpg"},signatures:"Babu Dharmalingam, Ramakrishna Reddy Ramireddy, Santhoshkumar Annamalai, Malinee Sriariyanun, Deepakkumar Rajagopal and Venkata Ramana Katla"},{id:"82176",title:"Replacement of Diesel Fuel by DME in Compression Ignition Engines: Case for India",slug:"replacement-of-diesel-fuel-by-dme-in-compression-ignition-engines-case-for-india",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.104969",abstract:"Decarbonising of transport, industrial and all sectors of economy is a necessity to stop or reverse global warming. Use of batteries, fuel-cells, hybrid topographies with smaller IC engines and use of alternative fuels like methanol, ethanol, DME in the IC engines are some of the ways through which emission of green-house gases can reduced/eliminated. Diesel engines are highly efficient due to higher compression ratios and are used in the heavy-duty transportation vehicles. DME is a single molecule fuel having high cetane number and which can be used as a drop-in fuel on the diesel engines albeit with retro-fitment of these engines with a new pressurized fuel system. DME with a chemical formula CH3-O-CH3 can be produced by different feedstocks such as coal, natural gas, biomass and bio-waste and municipal solid waste. India has a large reserve of high ash coal and generates high quantities of biomass and MSW, all of which can be converted to DME by use of clean production technologies. India’s transport and industrial sectors consume about 100 billion liters of diesel fuel per year produced entirely from imported petroleum. This amount of diesel can be replaced by indigenously produced DME from locally available coal, biomass and MSW.",book:{id:"11164",title:"Diesel Engines and Biodiesel Engines Technologies",coverURL:"https://cdn.intechopen.com/books/images_new/11164.jpg"},signatures:"Anirudh Gautam and Ankita Singh"},{id:"81979",title:"The Influence of Exhaust Gas Recirculation on Performance and Emission Characteristics of a Diesel Engine Using Waste Plastic Pyrolysis Oil Blends and Conventional Diesel",slug:"the-influence-of-exhaust-gas-recirculation-on-performance-and-emission-characteristics-of-a-diesel-e",totalDownloads:7,totalDimensionsCites:0,doi:"10.5772/intechopen.105011",abstract:"Through an experimental study, this work focused on finding the influence of exhaust gas recirculation (EGR) on waste plastic pyrolysis oils (WPPOs) with diesel as a base comparison fuel. The results show the amount of carbon monoxide emissions seemed to decrease at low engine loads up to intermediate loads of (50%), thereafter continued to increase significantly but marginally. Among fuels tested, blend WPPOB100 reported the highest BSFC, at 0% EGR flow rate. The value was 0.4751g/kW.hr. compared with 0.7235 g/kW.hr. at 30% EGR flow rate. Increased blend ratio had a direct decrease in brake power linearly. At 30% engine load, CD, WPPOB10, WPPOB20, WPPOB30 and WPPOB40 recorded values of 2.125 kW, 2.15 kW, 2.05 kW, 1.98 kW, 1.86 kW and 1.75 kW, respectively. Exhaust gas temperature (EGT) at 30% EGR flow rate, blend WPPOB10 had the highest reduction in temperature compared with the any other WPPO blends at 320°C. Increased blend ratio and EGR percentage flow rate increased smoke emissions within the test fuels blends. At 15% EGR flow rate, the following data were recorded: 7.53%, 7.1%, 6.72%, 6.25%, 6.0% and 5.4% for CD, WWPO10, WPPO20, WPPO30, WPPO40 and WPPO100, respectively.",book:{id:"11164",title:"Diesel Engines and Biodiesel Engines Technologies",coverURL:"https://cdn.intechopen.com/books/images_new/11164.jpg"},signatures:"Semakula Maroa and Freddie L. Inambao"},{id:"81895",title:"Performance and Emission Characteristics of Hydrogenation Derived Renewable Diesel as Diesel Engine Fuel",slug:"performance-and-emission-characteristics-of-hydrogenation-derived-renewable-diesel-as-diesel-engine-",totalDownloads:12,totalDimensionsCites:0,doi:"10.5772/intechopen.104820",abstract:"Growing anxieties about the continued depletion of fossil fuel reserves, improving the performance of diesel engines, and mandates to reduce greenhouse gas emissions have made the search for alternative fuels for diesel engines more imperative. Hydrogenation Derived Renewable Diesel (HDRD) is recognized as a sustainable, reliable, and cost-effective alternative to petroleum-based diesel (PBD) fuel for compression ignition (CI) engines. This may be because the physicochemical properties of HDRD are similar to that of PBD fuel. The current effort examines the performance and emission characteristics of HDRD in unmodified CI engines. Performance emissions characteristics such as power, torque, brake specific fuel consumption, thermal efficiency, nitrogen oxides, carbon monoxide, carbon dioxide, particulate matter, and exhaust gas temperature were interrogated and compared with that of PBD fuel in a CI engine. The outcome of the study shows that HDRD is better than biodiesel and a sustainable replacement for PDB fuel to achieve improved performance and reduced emissions of CI engines. Going forward, more investigations are needed to further simplify the preparation and democratize the utilization of HDRD as CI fuels for various applications.",book:{id:"11164",title:"Diesel Engines and Biodiesel Engines Technologies",coverURL:"https://cdn.intechopen.com/books/images_new/11164.jpg"},signatures:"Omojola Awogbemi, Daramy Vandi Von Kallon and Josiah Pelemo"},{id:"81114",title:"Research and Innovation to Improve the Efficiency of Modern Diesel Engines",slug:"research-and-innovation-to-improve-the-efficiency-of-modern-diesel-engines",totalDownloads:9,totalDimensionsCites:0,doi:"10.5772/intechopen.102759",abstract:"Modern diesel engines are one of the main mobile energy sources and are characterized by a high degree of workflow completeness, design, and manufacturing technology. The chapter summarizes the authors’ experience in improving diesel engines, increasing specific volume power, and reliability, ensuring a low level of environmental pollution emissions. The results of research using industry 4.0 technologies for systematization, choice of directions, and the search for rational ways to improve the efficiency of diesel engines are presented. The application of anergo-exergy method for analyzing the efficiency of the working process of the engine and its systems is considered. Taking into consideration the operating conditions, technical solutions are proposed to improve the reliability of the most heat-stressed parts of high-powered engines. The possibilities for a comprehensive assessment of the fuel efficiency and environmental qualities of diesel engines have been expanded taking into account CO2 emissions when using traditional, alternative, and hybrid diesel fuel.",book:{id:"11164",title:"Diesel Engines and Biodiesel Engines Technologies",coverURL:"https://cdn.intechopen.com/books/images_new/11164.jpg"},signatures:"Andriy Marchenko, Igor Parsadanov, Volodymyr Pylyov, Oleksandr Osetrov, Linkov Oleh, Serhii Kravchenko, Oleksandr Trynov, Denys Meshkov, Serhii Bilyk, Anatolii Savchenko, Inna Rykova and Rasoul Aryan"},{id:"81849",title:"A Comparative Evaluation of Biodiesel and Used Cooking Oil as Feedstock for HDRD Application: A Review",slug:"a-comparative-evaluation-of-biodiesel-and-used-cooking-oil-as-feedstock-for-hdrd-application-a-revie",totalDownloads:23,totalDimensionsCites:0,doi:"10.5772/intechopen.104393",abstract:"The search for clean energy for transportation fuel across the globe has grown in intensity. The use of biodiesel as a fuel for compression ignition (CI) engines has shown some deficiencies, e.g., poor storage, and poor pour point. The carbon chain of biodiesel is one of the factors to be considered; the longer carbon chain length leads to decreased ignition delay, which leads to the formation of OH during the premixed combustion phase. The major challenges that render biodiesel inefficient are discussed, like higher viscosity, lower energy content, higher nitrogen oxide (NOX) emissions, lower engine speed and power, injector coking, engine compatibility, high cost, and higher engine wear. The novelty of this work is that it shows that biodiesel conversion to green diesel is possible using a biowaste heterogeneous catalyst to obtain quality and high yield of HDRD with lower cost. This renewable energy (HDRD) possesses properties that are directly compatible with CI engines and transportation engines. This research reviewed biodiesel and UCO as feedstocks for the production of HDRD, including the cost–benefit of these feedstocks. Hydrogenation of biodiesel has the potential to overcome the drawbacks of conventional chemically catalyzed processes.",book:{id:"11164",title:"Diesel Engines and Biodiesel Engines Technologies",coverURL:"https://cdn.intechopen.com/books/images_new/11164.jpg"},signatures:"Josiah Pelemo, Kayode Timothy Akindeji, Freddie L. Inambao, Omojola Awogbemi and Emmanuel Idoko Onuh"}],onlineFirstChaptersTotal:12},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:90,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:33,numberOfPublishedChapters:330,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:14,numberOfPublishedChapters:145,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:9,numberOfPublishedChapters:139,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:122,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:21,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:10,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:"2753-6580",doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"August 2nd, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:33,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,annualVolume:11410,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,annualVolume:11411,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,annualVolume:11413,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Bacterial Infectious Diseases",value:3,count:2},{group:"subseries",caption:"Parasitic Infectious Diseases",value:5,count:4},{group:"subseries",caption:"Viral Infectious Diseases",value:6,count:7}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:2},{group:"publicationYear",caption:"2021",value:2021,count:4},{group:"publicationYear",caption:"2020",value:2020,count:3},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:229,paginationItems:[{id:"318170",title:"Dr.",name:"Aneesa",middleName:null,surname:"Moolla",slug:"aneesa-moolla",fullName:"Aneesa Moolla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/318170/images/system/318170.png",biography:"Dr. Aneesa Moolla has extensive experience in the diverse fields of health care having previously worked in dental private practice, at the Red Cross Flying Doctors association, and in healthcare corporate settings. She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419588",title:"Ph.D.",name:"Sergio",middleName:"Alexandre",surname:"Gehrke",slug:"sergio-gehrke",fullName:"Sergio Gehrke",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038WgMKQA0/Profile_Picture_2022-06-02T11:44:20.jpg",biography:"Dr. Sergio Alexandre Gehrke is a doctorate holder in two fields. The first is a Ph.D. in Cellular and Molecular Biology from the Pontificia Catholic University, Porto Alegre, Brazil, in 2010 and the other is an International Ph.D. in Bioengineering from the Universidad Miguel Hernandez, Elche/Alicante, Spain, obtained in 2020. In 2018, he completed a postdoctoral fellowship in Materials Engineering in the NUCLEMAT of the Pontificia Catholic University, Porto Alegre, Brazil. He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. In addition, he is also a Collaborating Professor in several Postgraduate programs at different universities all over the world.",institutionString:null,institution:{name:"Universidad Católica San Antonio de Murcia",country:{name:"Spain"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\r\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\r\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Orthodontist, Assoc Prof in the Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. 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