Translational perioperative and pain medicine最新文献

{"title":"Current Concepts in the Prevention of Perioperative Myocardial Injury.","authors":"Christian Bohringer, Duc Le, Hong Liu","doi":"10.31480/2330-4871/127","DOIUrl":"10.31480/2330-4871/127","url":null,"abstract":"<p><p>Perioperative myocardial injury is frequently caused by tachycardia from excessive sympathetic nervous system activity resulting from the surgical stimulation (type 2) rather than by rupture of atherosclerotic plaques with superimposed thrombosis (type 1). The elevated sympathetic nervous system activity results in tachycardia that induces demand ischemia within the myocardium and damages the heart muscle. A rise in troponin has been shown to be a reliable predictor of adverse cardiovascular events when measured in a population at risk. This holds true even when the troponin rise is isolated and other markers for myocardial damage like prolonged ischemic type chest pain, new electrocardiogram changes or evidence of new myocardial damage on echocardiography and other cardiac imaging studies are absent. Treatments that prevent tachycardia by successfully controlling elevated sympathetic tone, like dexmedetomidine and thoracic epidural blockade with local anesthetic reduce troponin release and have been shown to prevent myocardial damage. Intravenous lidocaine and magnesium can also prevent tachycardia. Beta blockers reduce myocardial injury, but are associated with an increase in hypotension and ischemic stroke. Any method of attenuating sympathetic nervous system activity, may however, require treatment with intravenous fluids and vasopressors to prevent hypotension. Rupture of atherosclerotic plaques with superimposed coronary thrombosis is a far less common cause of myocardial infarction in the perioperative period than elevated sympathetic tone. This explains why prophylactic statins in previously statin-naïve patients do not reduce major adverse cardiovascular event rates. Antiplatelet agents are also ineffective in reducing adverse cardiovascular events in the perioperative period. Clinicians, therefore, need to focus their attention on heart rate control and the attenuation of the stress response to surgery, rather than on atherosclerotic plaque stability and antiplatelet drugs in order to successfully prevent perioperative myocardial injury.</p>","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":" ","pages":"279-287"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47698348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Management for Heart Transplantation in Adults with Congenital Heart Disease.","authors":"Koichi Yuki","doi":"10.31480/2330-4871/120","DOIUrl":"https://doi.org/10.31480/2330-4871/120","url":null,"abstract":"<p><p>As the outcome of patients with congenital heart disease (CHD) has improved, the number of adults with congenital heart disease (ACHD) outnumbered pediatric population with CHD. Heart failure is responsible for 40% of mortality among ACHD, and the number of heart transplantation for ACHD is gradually increasing. However, the early mortality rate of heart transplantation is significantly higher in ACHD than in non-ACHD. Understanding the unique characteristics of heart transplantation in ACHD is critical. In contrast to their early outcome their long-term survival is better in ACHD than in non-CHD patients, and they are likely to present to anesthesia care after heart transplantation for various reasons. Understanding specific issues in post-transplant anesthesia care is another important aspect.</p>","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":"7 3","pages":"248-252"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37908843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should we Routinely Reverse Neuromuscular Blockade with Sugammadex in Patients with a History of Heart Transplantation?","authors":"Koichi Yuki,&nbsp;Rebecca Scholl","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cases of cardiac arrest after administration of neostigmine as a neuromuscular reversal agent have been reported in the literature. Sugammadex is a new neuromuscular reversal agent that acts via a different mechanism than acetylcholinesterase inhibitors. Here we reviewed the currently available literature on the use of sugammadex and potential considerations of using sugammadex in patients with a history of heart transplantation. Based on our currently available information, sugammadex administration in heart transplant patients should warrant similar caution and preparation for cardiovascular collapse as acetylcholinesterase inhibitors.</p>","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":"7 2","pages":"185-189"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37628254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>In Vitro</i> Model of Stretch-Induced Lung Injury to Study Different Lung Ventilation Regimens and the Role of Sedatives.","authors":"Yusuke Mitsui,&nbsp;Sophia Koutsogiannaki,&nbsp;Miho Fujiogi,&nbsp;Koichi Yuki","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Currently lung injury is managed conservatively through supportive care including mechanical ventilation. However, mechanical ventilation can also cause additional lung injury due to over-stretch along with atelectasis and cytokine release. Here we developed an in vitro mechanical ventilation model using cyclic stretch of lung epithelial cells to mimic high and low tidal volume (TV) ventilation strategy, so that we could use this platform for pathophysiology analysis and screening for therapeutic drugs.</p><p><strong>Method: </strong>We subjected MLE-15 cells to the following treatments. 1) No treatment, 2) lipopolysaccharide (100 ng/mL) stimulation for 24 hours, 3) mechanical stretch initiated at 6-hour time point for 18 hours, 4) LPS stimulation at time point 0 hour, and mechanical stretch was added at 6-hour time point for 18 hours. Biaxial cyclic stretch with a triangular wave was given via the Flexcell FX-6000 tension system to mimic low and high TV. Anesthetics dexmedetomidine and propofol were also tested.</p><p><strong>Result: </strong>Our high TV mimic stretch increased cell death, while low TV mimic stretch did not affect the degree of cell death. Using this system, we examined the effect of sedatives commonly used in intensive care units on cell death and found that dexmedetomidine attenuated necrosis associated with stretch.</p><p><strong>Conclusion: </strong>We described the in vitro cyclic stretch system mimicking high and low TV ventilation. High TV mimetic was associated with increased cell death. Dexmedetomidine attenuated the degree of cell death.</p>","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":"7 3","pages":"258-264"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38047402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision Organ Function Protection for Enhanced Recovery after Surgery","authors":"Lu Jing, Yao Xiu-Xiu, W. Jinfeng, Wang Zhi-ping, Yin Qin, Cheng Wei, Zeng Yin-ming","doi":"10.31480/2330-4871/105","DOIUrl":"https://doi.org/10.31480/2330-4871/105","url":null,"abstract":"The concept of enhanced recovery after surgery (ERAS) has gained gratifying achievements in clinical practice, but there are still many disputes and incompatibilities in its application. The reasons for this phenomenon are multifaceted, is evident at multilevels and needs further exploration and improvement. By combining previous studies and our clinical experience, we propose an enhanced concept of ERAS, i.e., precision organ function protection (POFP) for ERAS to promote lasting rehabilitation of patients after surgery. We prefer to use “important organ function outcomes” (IOFOs) as the clinical target of ERAS. Perioperative optimal organ function preservation by using a series of techniques can help patients recover quickly and return to baseline function as soon as possible. This concept has greatly expanded the connotation of the traditional ERAS, whose core idea was reducing stress, providing analgesia and humane care.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42730502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Benefits of Opioid Free Anesthesia and the Precautions Necessary When Employing It.","authors":"C. Bohringer, C. Astorga, Hong Liu","doi":"10.31480/2330-4871/104","DOIUrl":"https://doi.org/10.31480/2330-4871/104","url":null,"abstract":"The use of opioids in the perioperative period is associated with respiratory depression, impaired gastrointestinal function, post-operative nausea and vomiting (PONV), pruritus, urinary retention, delirium and the potential for developing opioid addiction. Currently the United States is experiencing an epidemic of prescription opioid abuse and deaths from overdose. Many addicts develop their addiction during a routine surgical admission to hospital. More people now die from overdose of synthetic prescription opioids than from heroin and other street drugs. Public education campaigns teaching family members of addicts to reverse opioid induced respiratory depression with naloxone are currently underway. Preventing the development of addiction in the first place during and after the surgical admission however will be more successful at saving lives. Primary prevention of opioid addiction is possible when non-opioid analgesic drugs are used. Employing alternative analgesic drugs in the peri-operative period that have a lower addiction potential and less respiratory depression has therefore become a matter of great national importance. Many powerful non-opioid analgesics are currently available that have more favorable side effect profiles and a lower potential for developing addiction. However, these medications are currently not used as often in routine clinical practice as they should be. Replacing opioids with other analgesics will not only reduce the development of opioid addiction but will also lead to better perioperative outcomes and enhanced patient recovery. This article briefly reviews the opioid alternatives that can significantly reduce or even entirely eliminate the perioperative use of opioids in the majority of surgical procedures.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":"7 1 1","pages":"152-157"},"PeriodicalIF":0.0,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49474407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physicians in Promoting Stroke Awareness: A Multidisciplinary Effort","authors":"Lou Yanqin, Xiong Lize","doi":"10.31480/2330-4871/102","DOIUrl":"https://doi.org/10.31480/2330-4871/102","url":null,"abstract":"We hypothesized that the use of social media could make the material more accessible to a lay audience. Catching an audience’s attention requires a quick and interesting presentation. Educational initiatives disseminated this way may be useful in promoting general medical knowledge, such as earlier recognition of stroke signs and immediate action once a stroke is suspected. Toward this goal, Dr. Jing Zhao at Fudan University and Dr. Renyu Liu at University of Pennsylvania collaborated in 2016 to create Stroke 120, a fantastic tool suitable for use in China for stroke awareness education [9,10]. They created various educational materials, including an animated video to help people understand and remember the signs and symptoms of stroke. The video was subsequently translated into more than 12 local dialects and promoted in corresponding regions [9,10].","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44830343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management Considerations in Complicated Peripartum Cardiomyopathy","authors":"H. Linda, Niazi Azfar, A. Sabry","doi":"10.31480/2330-4871/101","DOIUrl":"https://doi.org/10.31480/2330-4871/101","url":null,"abstract":"","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45610317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of Chronic Opioid Therapy on Perioperative Complications and Long-Term Surgical Recovery","authors":"Da Liu, Matthew DiMeglio, M. Dimartino, Jihane Hajj, M. Mukhanova, Karima Rai, Mazell Winikor, K. Laudanski","doi":"10.31480/2330-4871/099","DOIUrl":"https://doi.org/10.31480/2330-4871/099","url":null,"abstract":"With chronic opioid use becoming an increasingly common occurrenceamong the general population, perioperative specialties must adapt to the physiologic changes caused by long-term opioids. However, data on the clinicalanesthetics implications of long-term opioid use is scarce. This review intends to survey the literature addressing the molecular mechanisms of long-term opioid use as well as their interaction with various organ systems.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":"6 1","pages":"120 - 128"},"PeriodicalIF":0.0,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44458362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salvinorin A as a Potential Medication for Stroke","authors":"Grothusen John, Liu Renyu","doi":"10.31480/2330-4871/098","DOIUrl":"https://doi.org/10.31480/2330-4871/098","url":null,"abstract":"This article is an overview of our effortstowards developing salvinorin A, which is a non–opioid kappa opioid receptor (KOR) agonist and an active component from the plant Salvia divinorum, for clinical usein the treatment of acute stroke. The intrinsic characteristics of salvinorin A, which include rapid onset of action, easy passage through the blood brain barrier with intranasal administration, high potency in regards to neurological protection and awelldocumented mechanism of action involving KOR agonism, makes it a promising potential therapeutic agent for acute stroke. Further studies are warranted to develop this compound for clinical use. What is SA? SA is a non-opioid, highly selective Kappa Opioid Receptor (KOR) agonist. It is an active component from Salvia divinorum which is a perennial herb that has been consumed by humans for recreational and religious ritual purposes for several centuries [5]. Thus, we could say that in effect, SA has undergone lengthy testing in human populations. Unlike other KOR agonists, SA produces no frank hallucinatory or dysphoric effects. In a clinical trial in healthy human subjects, no persisting adverse effects related to SA were observed [6]. Due to the existence of an ester linkage in the structure of SA, and numerous esterase enzymes in the body, the pharmacological effects of SA are short-lived. Traditional opioid ligands have nitrogen in their structure, and since there is no nitrogen in the molecule of SA, it is considered as the first non-nitrogenous or non-opioid KOR agonist. Our initial interest in SA started from its unique molecular structure and potential pharmacological effects, stemming from our experience in the perioperative arena seeking novel medications with quick onset and offset characteristics. A Potent Cerebral Vascular Dilator Using a piglet model with a surgically installed transparent cranial window, we were surprised to have noticed that SA is a very potent cerebral vascular dilator. As seen in Figure 1, we found that upon addition of SA, a normal cerebral artery on the surface of the piglet brain became dilated within seconds of SA administration (Figure 1). Interestingly, there was no significant change in systemic blood pressure with SA administration. We demonstrated that SA not only can dilate the pial artery under normal conditions, but also under the vasoconstricted conditions induced by hypocarbia and endothelin, indicating that SA could be used to dilate brain vessels in pathological conditions [7]. Such cerebral vascular dilation effects have been proven to be through KOR activation since such effects can be blocked by a non-specific (naloxone) and specific KOR antagonist (norbinaltorphimine) [7]. Introduction Stroke, including ischemic and hemorrhagic stroke, is one of the leading causes of death and life-long disability worldwide, despite recent advances in thrombolytic therapy and mechanical thrombectomy [1,2]. Scientists, clinicians and pharmaceutical companies h","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47816551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}