Masui. The Japanese journal of anesthesiology
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The influence of surgery and anesthesia on aspects of malignant tumor has received considerable attention in recent years. It is suggested that in vitro studies, clinically available anesthetics, such as intravenous anesthetics, local anesthetics and opioids have, more or less, possible antitumor potential against human malignant tumor cells. ⋯ Moreover, animal studies indicate that the addition of spinal block and optimum postoperative analgesia independently reduce the metastatic burden by blocking the stress response under inhalational anesthesia alone. Considering inconclusive results, especially in human, about evaluating the influence of anesthetics on malignant tumor, further studies in basic and clinical settings are required to study the effects of anesthetics on malignant tumor.
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It has been known widely that sensitivity to pain and opioid analgesics varies widely among individual subjects. Because of this variability, a dose of an opioid analgesic that can produce satisfactory pain relief without adverse effects in some patients might cause underdosing or overdosing in other patients, which is often problematic in the clinic. ⋯ Further, many technologies of genotyping polymorphisms, most often single nucleotide polymorphisms (SNPs), have been developed and advanced, leading to accelerated understanding of many associations between various genetic polymorphisms and sensitivity to pain and opioids. In this article, we review the evidence of these associations accumulated thus far.
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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.