Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists最新文献

“Big data”, characterized by ‘volume’, ‘velocity’, ‘variety’, and ‘veracity’, being routinely collected in huge amounts of clinical and administrative healthcare-related data are becoming common and generating promising viewpoints for a better understanding of the complexity for medical situations. Taiwan National Health Insurance Research Database (NHIRD), one of large and comprehensive nationwide population reimbursement databases in the world, provides the strength of sample size avoiding selection and participation bias. Abundant with the demographics, clinical diagnoses, and capable of linking diverse laboratory and imaging information allowing for integrated analysis, NHIRD studies could inform us of the incidence, prevalence, managements, correlations and associations of clinical outcomes and diseases, under the universal coverage of healthcare used. Perioperative medicine has emerged as an important clinical research field over the past decade, moving the categorization of the specialty of “Anesthesiology and Perioperative Medicine”. Many studies concerning perioperative medicine based on retrospective cohort analyses have been published in the top-ranked journal, but studies utilizing Taiwan NHIRD were still not fully visualized. As the prominent growth curve of NHIRD studies, we have contributed the studies covering surgical adverse outcomes, trauma, stroke, diabetes, and healthcare inequality, etc., to this ever growing field for the past five years. It will definitely become a trend of research using Taiwan NHIRD and contributing to the progress of perioperative medicine with the recruitment of devotion from more research groups and become a famous doctrine.

Alvimopan is an US-FDA approved, peripherally acting mu opioid receptor antagonist which when started pre-operatively has been shown to hasten intestinal motility and reduce the duration of post-operative ileus. However the logistics involved in procuring, storing and dispensing the drug and the cost of the drug for fifteen doses as approved by FDA prohibits the use of it on a regular basis.

Objective

T-type channel (TCC) Ca_V3.2 plays a pivotal role in pain transmission. In this study, we examined the effects of intrathecal TCC blockers on Ca_V3.2 expression in a L5/6 spinal nerve ligation (SNL) pain model. The neurotoxicity of TCC blockers were also evaluated.

Methods

Male Sprague-Dawley rats (200–250 g) were used for right L5/6 SNL to induce neuropathic pain. Intrathecal infusion of saline or TCC blockers [mibefradil (0.7 μg/h) or ethosuximide (60 μg/h)] was started after surgery for 7 days. Fluorescent immunohistochemistry and Western blotting were used to determine the expression pattern and protein level of Ca_V3.2. Hematoxylin–eosin and toluidine blue staining were used to evaluate the neurotoxicity of tested agents.

Results

Seven days after SNL, Ca_V3.2 protein levels were upregulated in ipsi-lateral L5/6 spinal cord and dorsal root ganglia (DRG) in immunofluorescence and Western blotting studies. Compared with the saline-treated group, rats receiving mibefradil or ethosuximide showed significant lower Ca_V3.2 expression in the spinal cord and DRG. No obvious histopathologic change in hematoxylin–eosin and toluidine blue staining were observed in all tested groups.

Conclusion

In this study, we demonstrate that SNL-induced Ca_V3.2 upregulation in the spinal cord and DRG was attenuated by intrathecal infusion of mibefradil or ethosuximide. No obvious neurotoxicity effects were observed in all the tested groups. Our data suggest that continuous intrathecal infusion of TCC blockers may be considered as a promising alternative for the treatment of nerve injury-induced pain.

Objective(s)

Previous studies have shown that preincisional epidural morphine, bupivacaine, and ketamine combined with epidural anesthesia (EA) and general anesthesia (GA) provided pre-emptive analgesia for upper abdominal surgery. Recent studies reported that ultralow-dose naloxone enhanced the antinociceptive effect of morphine in rats. This study investigated the benefits of preincisional and postoperative epidural morphine + ropivacaine + ketamine + naloxone (M + R + K + N) treatment for achieving postoperative pain relief in upper abdominal surgery.

Methods

Eighty American Society of Anesthesiology I–II patients scheduled for major upper abdominal surgery were allocated to four groups in a randomized, single-blinded study. All patients received combined GA and EA with a continuous epidural infusion of 2% lidocaine (6–8 mL/h) 30 minutes after pain regimen. After GA induction, in Group I, an epidural pain control regimen (total 10 mL) was administered using 1% lidocaine (8 mL) + morphine (2 mg) + ropivacaine (20 mg; M + R); in Group II, 1% lidocaine 8 (mL) + morphine (2 mg) + ropivacaine (20 mg) + ketamine (20 mg; M + R + K); in Group III, 1% lidocaine (8 mL) + morphine (2 mg) + ropivacaine (20 mg) + naloxone (2 μg; M + R + N); and in Group IV, 1% lidocaine (8 mL) + morphine (2 mg) + ropivacaine (20 mg) + ketamine (20 mg) + naloxone (2 μg; M + R + K + N), respectively. All patients received patient-controlled epidural analgesia (PCEA) with different pain regimens to control subsequent postoperative pain for 3 days following surgery. During the 3-day period following surgery, PCEA consumption (mL), numerical rating scale (NRS) score while cough/moving, and analgesic-related adverse effects were recorded.

Results

Total PCEA consumption for the 3-day observation period was 161.5 ± 17.8 mL, 103.2 ± 21.7 mL, 152.4 ± 25.6 mL, and 74.1 ± 16.9 mL for Groups I, II, III, and IV, respectively. (p < 0.05). The cough/moving NRS scores were significantly lower in Group IV patients than Groups I and III patients at 4 hours, 12 hours, and on Days 1 and 2 following surgery except for Group II (p < 0.05).

Conclusion

Preincisional and postoperative epidural M + R + K + N treatment provides an ideal postoperative pain management than preincisional and postoperative epidural M + R, M + R + K, and M + R + N treatments in upper abdominal surgery.

Objective

The single-use LMA Supreme (Teleflex, Inc., Wayne, PA, USA) and the LMA ProSeal (Teleflex, Inc., Wayne, PA, USA) laryngeal mask airway (LMA) have similar characteristics. To date, studies have not achieved a consensus regarding the oropharyngeal leak pressure (OLP) of the LMA Supreme and LMA ProSeal, and there is little information on their efficacy in laparoscopic cholecystectomy. This study compared the safety and efficacy of the LMA Supreme and LMA ProSeal devices in patients undergoing laparoscopic cholecystectomy.

Method

Eighty-four eligible consenting patients were randomly allocated to the LMA Supreme group or the LMA ProSeal group. Both groups received the standard anesthesia technique. The Supreme or ProSeal LMA was inserted, the cuff was inflated to 60 cmH₂O, and the LMA position was confirmed. Anesthesia was maintained using propofol and 50% oxygen in air. A gastric tube was inserted through the drain tube of the LMA to deflate the stomach, and the first attempt success rate and insertion time were recorded. During surgery, the intra-abdominal pressure was maintained at 12 mmHg. The fiberoptic view of the larynx was determined by passing a flexible fiberoptic bronchoscope. The OLPs, success rate, insertion time, hemodynamic and respiratory parameters, and complications were recorded at different time points.

Results

The mean OLP was significantly lower in the LMA Supreme group than in the LMA ProSeal group (24.9 ± 5.3 cmH₂O vs. 28.4 ± 5.8 cmH₂O; p < 0.01). The first attempt success rate and ease of insertion grading for LMA were higher in the Supreme group. The insertion time was lower in the Supreme group than in the ProSeal group (p < 0.01). The fiberoptic view was better with the ProSeal LMA. The hemodynamic and ventilatory parameters and postoperative sore throat were comparable in both groups.

Conclusion

The LMA ProSeal has a higher OLP than the LMA Supreme. The success rate of first attempt insertion and ease of insertion were better for the LMA Supreme group and the insertion time was lower in the LMA Supreme group. The Supreme and ProSeal LMAs were both effective for positive pressure ventilation in laparoscopic cholecystectomy.

Solid organ transplantation has become the therapy of choice for patients with end-stage organ disease. The frequently transplanted organs in Taiwan include liver, kidney, heart, and lung, and the success rate has improved significantly worldwide for the past decades. However, organ recipients are known to be at a higher risk of post-transplant infections and de novo cancer due to immunosuppression and oncogenic viral infections. Organ recipients are known to be at a two- to fourfold increased risk of cancer and the risks are particularly high for malignancies caused by viral infections, including post-transplant lymphoproliferative disorders via Epstein-Barr virus, Kaposi sarcoma via Kaposi sarcoma herpesvirus, anogenital cancers via human papillomavirus, and hepatocellular carcinoma via hepatitis B and C virus. Population-based cohort studies may help better understand the pattern of infection and cancer risk in transplant recipients and clarify the role of the immune system, infection, and risk factors in the development of malignancy. Improvement of surgical techniques, advancement of immunosuppressant therapy in addition to early detection and prevention of infection, and regular surveillance of de novo cancer after transplantation have become the mainstay of successful organ transplantation.