Masui. The Japanese journal of anesthesiology
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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.
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There are gene polymorphisms changing the expression or activation of the serotonin (5-HT) receptors, which are associated with pain. This review showed an availability of 5-HT2A receptor gene polymorphism in analgesic sensitivity. To search gene polymorphisms related to analgesic sensitivity is important to further effective pain management. In future 5-HT2A receptor gene polymorphisms, together with polymorphisms of other genes, may greatly contribute to effective postoperative pain management and personalized medicine.
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Visual disturbance including visual loss is a rare but devastating complication after non-ophthalmic surgery. Reported incidence of visual disturbances ranged from 0.028 to 0.2% after spine surgery and from 0.0009 to 25.6% after cardiac surgery. ⋯ After cardiac surgery, anterior ischemic optic neuropathy is most prevalent and risk factors included age, diabetes, long cardiopulmonary bypass time and anemia. Anesthesiologists and surgeons should be aware of this complication and further investigations regarding etiology, prevention and managements on postoperative visual disturbances would be required.
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It is difficult to maintain well-balanced stability of respiratory and hemodynamic functions in critically ill patients. The PiCCO system (Pulsion Medical Systems, Munich, Germany) for hemodynamic and respiratory monitoring has been available clinically in Japan since 2000. ⋯ The PiCCO system is mainly used in intensive care for patients with sepsis, septic shock and cardiogenic shock. Further clinical investigations are required to confirm that estimating PiCCO parameters such as ITBVI, EVLWI and PVPI may help to better characterize, guide, and improve the treatment of critically ill patients.
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Pulse oximeter expressed by SpO2 is used for monitoring respiratory state during operation and in ICU. Perfusion index (PI) and pleth variability index (PVI) as new indexes are calculated from pulse oximeter (Masimo SET Radical-7, Masimo Corp., USA, 1998) waveforms. And these indices were used as parameters to evaluate the circulatory state. ⋯ It might thus be of future value in assessment of perioperative changes in peripheral perfusion. PVI is a measure of a dynamic change in PI that occurs during complete respiratory cycle. It might be thought that PVI, an index automatically derived from the pulse oximeter waveform analysis, had potentially clinical applications for noninvasive hypovolemia detection and fluid responsiveness monitoring.