Masui. The Japanese journal of anesthesiology
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As we have no information whether target-controlled infusion (TCI) for propofol, using pharmacokinetic parameters obtained without chronic renal failure, is available to estimate the drug concentration, we examined the blood concentration of propofol on the patients with chronic renal failure to evaluate the reliability of TCI of propofol. ⋯ TCI system for propofol provided a good estimation of the blood concentration of propofol in patients with chronic renal failure undergoing living-related renal transplantation.
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In Japan, the re-organization of obstetrical medical system is needed and this project is ongoing under Japanese government initiative. However the ratio of using neuraxial analgesia (NA) during labor in Japan has been low and, increased demand for NA during labor is anticipated in near future. ⋯ However, there is no official training program for OB anesthesiologists in Japan. This article reports the clinical practice of the OB anesthesia in one of the biggest hospitals in the United State, the Cleveland Clinic, from the view of an OB anesthesia clinical fellow.
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We experience individual differences in pain and sensitivity to analgesics clinically. Genetic factors are known to influence individual difference. ⋯ Fentanyl was less effective in subjects with the G allele of the OPRM1 A118G SNP than those with the A allele, and subjects with the G allele required more fentanyl for adequate postoperative pain control than those with the A allele. In the future, identifying SNPs might give us information to modulate the analgesic dosage of opioid individually for better pain control.
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Extracellular adenosine 5'triphosphate (ATP) has been recognized as a neurotransmitter and/or neuromodulater in the nervous systems, through acting on specific receptors, P2 purinergic receptors on the cell surface. P2 purinergic receptors are divided into two classes; P2X receptors, which are ATP-gated cation channels and subdivided into seven subtypes, and P2Y receptors, which are heptahelical G-protein coupled receptors and subdivided into eight subtypes. Recent studies revealed that ATP and its receptors are involved in peripheral and central nociceptive transmissions, including the mechanism of neuropathic pain. ⋯ Further, some of the SNPs have been revealed to cause changes of receptor functions. Our recent study showed one of these SNPs tends to be associated with the pain sensitivity induced by the cold stimuli. Association studies of these polymorphisms in the gene encoding P2X and P2Y receptors with the pain sensitivity and effects of analgesics may provide novel and useful suggestions for personalized pain managements.
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Intensity of postoperative pain and postoperative analgesic requirements are widely varied among patients. The most determinant significant aspect of postoperative pain is the site and type of surgery. For example, open abdominal surgery usually causes intense postoperative pain. ⋯ In addition, genetic factors also can contribute to such differences. For example, a single nucleotide polymorphism A118G of human micro-opioid receptor gene (OPRM1) may decrease analgesic efficacy of opioids and increase postoperative opioid requirements. Full elucidation of genetic factors that can affect pain sensitivity and/or opioid sensitivity may open new avenues for personalized pain treatment.