Hidetomo Niwa

Can anesthetic techniques or drugs affect cancer recurrence in patients undergoing cancer surgery

Despite the development of effective chemotherapy and radiotherapy, surgery remains the mainstay treatment of many cancers, requiring anesthesia. Almost all cancer deaths after primary surgery are attributable to recurrence or metastases. Recently it has been hypothesized that the perioperative anesthetic management of cancer patients could potentially affect the risk of recurrence and metastases, which implies a key role for anesthesiologists in choosing anesthetic agents and techniques that optimize the balance between the metastatic potential of the tumor versus its elimination by antimetastatic immune defenses. This review summarizes available experimental information on the potential effects of common anesthetic agents and techniques on cancer metastases and the conflicting retrospective clinical data on regional anesthesia in various types of cancer. A number of prospective, randomized, multicenter, clinical trials are in progress, and their results are eagerly awaited.

Endogenous neuropeptide S tone influences sleep–wake rhythm in rats

Neuropeptide S (NPS) is an endogenous peptide that exerts wakefulness promoting, analgesic, and anxiolytic effects when administered exogenously. However, it remains to be determined if endogenous NPS tone is involved in the control of the diurnal sleep-wake cycle, or spontanous behavior. In this study, we examined the effects of the NPS receptor antagonist [D-Cys((t)Bu)(5)]NPS (2 and 20 nmol, icv) on physiological sleep and spontaneous locomotor behavior. The higher dose of [D-Cys((t)Bu)(5)]NPS decreased the amount of time spent in wakefulness [control 782.5 ± 25.5 min, treatment 751.7 ± 28.1 min; p<0.05] and increased the time spent in NREMS [control 572.6 ± 17.2 min, treatment 600.2 ± 26.1 min; p<0.05]. There was no statistically significant difference in time spent in REMS. There were no behavioral changes including abnormal gross motor behavior in response to [D-Cys((t)Bu)(5)]NPS administration. Collectively these data suggest an involvement of the endogenous NPS/NPS receptor system in physiological sleep architecture.

Rethinking general anesthesia for cesarean section.

In this review, we describe the current consensus surrounding general anesthetic management for cesarean section. For induction of anesthesia, rapid-sequence induction using thiopental and suxamethonium has been the recommended standard for a long time. In recent years, induction of anesthesia using propofol, rocuronium, and remifentanil have been gaining popularity. To prevent aspiration pneumonia, a prolonged preoperative fasting and an application of cricoid pressure during induction of anesthesia have been recommended, but these practices may require revision. Guidelines for difficult airway management were developed first in obstetric anesthesia, and the use of a supraglottic airway is now recognized as an effective rescue device. After the delivery of a fetus, switching from volatile anesthetics to intravenous anesthetics has been recommended to avoid uterine atony. At the same time, intraoperative awareness should be avoided. The rate of persistent wound pain is higher when only general anesthesia was used during cesarean section than with regional anesthesia, and thus it is necessary to provide a sufficient postoperative analgesia using multimodal analgesia, including intravenous patient-controlled analgesia (IV-PCA), transversus abdominis plane (TAP) block, non-steroidal inflammatory drugs, and acetaminophen.

In vitro and in vivo characterisation of the bifunctional MOP/DOP ligand UFP-505.

Targeting more than one opioid receptor type simultaneously may have analgesic advantages in reducing side‐effects. We have evaluated the mixed μ opioid receptor agonist/ δ opioid receptor antagonist UFP‐505 in vitro and in vivo.

Ketamine suppresses the proliferation of rat C6 glioma cells

The present study investigated the effects of N-methyl-D-aspartate receptor (NMDAR) antagonist ketamine, on the growth of gliomas. To analyze the effects of ketamine treatment, rat C6 glioma cells arising from astrocytes, and RNB cells representing non-malignant astrocytes, were examined. In ketamine-treated C6 cells, the gene expression changes associated with cell proliferation following ketamine treatment were evaluated using a cDNA microarray. A cell proliferation assay was performed to analyze the dose-dependent proliferation of C6 glioma and RNB cells following culture (72 h) with ketamine treatment (0-100 µM). Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assays were performed following cell incubation with/without ketamine, to confirm if the ketamine-induced cell death of C6 glioma and RNB cells were due to apoptosis. In addition, cell proliferation and TUNEL assays were performed following cell incubations with a selective NMDAR antagonist, D-2-amino-5-phosphonovaleric acid (D-AP5). Analysis of the cDNA microarray indicated that the growth of C6 glioma cells were suppressed by the effects of ketamine. Furthermore, results of the proliferation assay confirmed that ketamine treatment inhibited C6 cell proliferation, most notably at a dose of 30 µM (n=7, 66.4%; P<0.001). The TUNEL assay results revealed that ketamine induced an apoptotic effect on C6 glioma cells, with a significant effect on the rate of death observed at all tested concentrations (3, 10, 30 and 100 µM). Results of the aforementioned proliferation and TUNEL assay experiments were reproduced when ketamine was replaced with a selective NMDAR antagonist, D-AP5. However, the NMDARantagonist-induced effects were not observed in RNB cell cultures. Although it would be premature to apply the results from the present study to human cases, these results indicated that ketamine is an anesthetic candidate providing potential benefit for glioma resection.

A case report of sudden thrombocytopenia detected only by in vitro analysis

We experienced an unexpected thrombocytopenia detected only in vitro during radical prostatectomy for a 66-year-old patient. Thrombocytopenia with platelet aggregation was observed in a blood sample obtained using a heparinized syringe (not by ethylene diamine tetra-acetic acid tube). Although we could not exclude platelet agglutination in vivo, no thrombosis or coagulation disorder was observed. We changed the anti-coagulant in the arterial catheter carrier fluid (saline) from heparin to argatroban, and continued with the operation. No embolic complications were observed during the perioperative period. Although pseudothrombocytopenia or heparin-induced thrombocytopenia was highly suspected in the present case, we were not able to confirm which of the two developed. Multi-directional attention and care may be required for perioperative unexpected thrombocytopenia.

Can tissue dielectric constant measurements assess circulating blood volume changes in patients undergoing haemodialysis

The tissue dielectric constant (TDC) method uses an open‐ended coaxial probe to achieve non‐invasive measurement of water content in skin. The aim of our study was to test the hypothesis that the changes in circulating blood volume would be associated with the changes in TDC values in patients undergoing haemodialysis.

Pilot Study of Changes in Presepsin Concentrations Compared With Changes in Procalcitonin and C-Reactive Protein Concentrations After Cardiovascular Surgery

OBJECTIVE The authors investigated the presepsin-concentration profile after cardiac surgery compared with those of procalcitonin (PCT) and C-reactive protein (CRP). DESIGN A single-center, prospective, observational clinical study. SETTING Hirosaki University Hospital. PARTICIPANTS Patients who underwent cardiovascular surgery without preoperative infection and end-stage kidney disease requiring dialysis. The patients also were subdivided into 2 groups with respect to the use of cardiopulmonary bypass (CPB). MEASUREMENTS AND MAIN RESULTS Presepsin, PCT, and CRP were measured 4 times: before the induction of anesthesia (baseline), postoperative day (POD) 0, POD 1, and POD 2. Data are expressed as median (25th, 75th interquartiles). A total of 33 patients were examined: 22 patients with CPB and 11 without CPB. For the entire patient series, the presepsin concentrations on POD 0 (220 [166-445] pg/mL), POD 1 (328 [210-581] pg/mL), and POD 2 (310 [202-368] pg/mL) were increased significantly (p < 0.05) compared with baseline (176 [123-275] pg/mL). The PCT and CRP concentrations on POD 1 (0.57 [0.27-1.29] ng/mL and 5.4 [3.1-8.8] mg/dL) and POD 2 (0.64 [0.33-1.43] ng/mL and 11.8 [4.4-17.0] mg/dL) also were increased significantly (p < 0.05) compared with baseline (0.04 [0.03-0.06] ng/mL and 0.07 [0.03-0.22] mg/dL). However, the median concentrations of presepsin up to POD 2 were less than the reported cut-off value (600 pg/mL) to detect infections, whereas those of PCT were above the reported cut-off value (0.5 ng/mL). The increases in presepsin and PCT concentrations were independent of the use of CPB. CONCLUSIONS Cardiovascular surgery significantly increased presepsin concentrations, earlier than PCT and CRP.