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Essackjee Z, Sloan G. Thiopentone-based total intravenous anaesthesia for a patient with carnitine palmitoyltransferase II deficiency and malignant hyperthermia susceptibility. Anaesth Rep 2024; 12:e12318. [PMID: 39119152 PMCID: PMC11304283 DOI: 10.1002/anr3.12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
In this case report, we discuss the use of a thiopentone infusion for the maintenance of anaesthesia in a patient with confirmed malignant hyperthermia susceptibility and carnitine palmitoyltransferase 2 deficiency. The concurrence of both diagnoses precluded the use of both propofol-based total intravenous anaesthesia and volatile inhalational anaesthesia. This patient had been anaesthetised previously with a triple infusion regimen of thiopentone, midazolam and remifentanil and this was a unique opportunity to compare the two instances. Electroencephalogram-based depth of anaesthesia monitoring was in routine use by the time of the second anaesthetic, and thus, the thiopentone infusion could be adjusted accordingly, resulting in a more rapid emergence time. We hope that this case may serve as an example of suitable anaesthetic alternative should both propofol infusion and inhalational anaesthesia not be an option.
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Affiliation(s)
- Z. Essackjee
- Department of AnaesthesiaSalford Royal HospitalSalfordUK
| | - G. Sloan
- Department of AnaesthesiaSalford Royal HospitalSalfordUK
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Lee SH, Kim S, Sohn JT. Lipid emulsion treatment for local anesthetic systemic toxicity in pediatric patients: A systematic review. Medicine (Baltimore) 2024; 103:e37534. [PMID: 38489714 PMCID: PMC10939516 DOI: 10.1097/md.0000000000037534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Local anesthetic systemic toxicity (LAST) is rare, but fatal; the current widely used treatment is lipid emulsion (LE). The goal of this study was to analyze and review case reports on LE treatment for LAST in pediatric patients. METHODS We performed a systematic review using case reports on LE treatment for LAST in pediatric patients, searching PubMed and Scopus databases to March 2023 using the following keywords: ("local anesthetic toxicity" OR "local anesthetic systemic toxicity" OR LAST") AND ("newborn" OR "infant" OR "child" OR "children" OR "adolescent" OR "pediatric") AND ("lipid emulsion" OR "Intralipid"). RESULTS Our search yielded 21 cases, revealing that nearly 43% patients with LAST were less than 1 year old, and most cases were caused by bupivacaine (approximately 67% cases). "Inadvertent intravascular injection" by anesthesiologists and "overdose of local anesthetics" mainly by surgeons were responsible for 52% and 24% cases of LAST, respectively. LAST occurred in the awake state (52%) and under general anesthesia (48%), mainly causing seizures and arrhythmia, respectively. Approximately 55% of patients received LE treatment in <10 minutes after LAST, mainly improving cardiovascular symptoms. A 20% LE (1.5 mL/kg) dose followed by 0.25 mL/kg/minutes dose was frequently used. LE and anticonvulsants were mainly used in the awake state, whereas LE with or without vasopressors was mainly used under general anesthesia. LE treatment led to full recovery from LAST in 20 cases; however, 1 patient died due to underlying disease. CONCLUSION Consequently, our findings reveal that LE is effective in treating pediatric LAST.
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Affiliation(s)
- Soo Hee Lee
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Changwon Hospital 11, Gyeongsangnam-do, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, Gyeongsangnam-do, Republic of Korea
- Institute of Medical Science, Gyeongsang National University, Jinju-si, Republic of Korea
| | - Sunmin Kim
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Gyeongsangnam-do, Republic of Korea
| | - Ju-Tae Sohn
- Institute of Medical Science, Gyeongsang National University, Jinju-si, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Gyeongsangnam-do, Republic of Korea
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Rasheed MA, Murphy D. Prolonged neuraxial block following spinal anaesthesia in a patient with carnitine palmitoyl transferase II deficiency undergoing caesarean section. Int J Obstet Anesth 2023; 55:103895. [PMID: 37276780 DOI: 10.1016/j.ijoa.2023.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023]
Abstract
Carnitine palmitoyl transferase II (CPT II) deficiency is a rare disorder of fatty acid metabolism in cell mitochondria. There is limited information about the disease process and complications of anaesthesia, particularly in the obstetric population. Due to the increased risks of general anaesthesia in patients with CPT II deficiency, neuraxial anaesthesia is the preferred method of anaesthesia. We describe a patient with CPT II deficiency who had spinal anaesthesia for caesarean section. Subsequently, the patient had prolonged neuraxial blockade, a previously undescribed complication in a patient with CPT II deficiency.
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Affiliation(s)
- M A Rasheed
- School of Medicine, National University of Ireland, Galway, Ireland.
| | - D Murphy
- Department of Anaesthesia, Critical Care and Pain Medicine, Cork University Hospital, Cork, Ireland
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Liu Z, Yokoyama NN, Song L, Xie J, Sadeghi Z, Wu YX, Yee S, Wu XR, Wang B, Uchio E, Zi X. The Potent Anti-Tumor Effects of Rhodiola Drinking Are Associated with the Inhibition of the mTOR Pathway and Modification of Tumor Metabolism in the UPII-Mutant Ha-Ras Model. Cancers (Basel) 2023; 15:3086. [PMID: 37370698 PMCID: PMC10296277 DOI: 10.3390/cancers15123086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Background: SHR-5 has been used as an "adaptogen" for enhancing physical and mental performance and for fighting stress in the healthy population. The purpose of this study is to determine the chemopreventive efficacy of SHR-5 for superficial bladder cancer and to investigate the underlying mechanisms of action. Methods: UPII-mutant Ha-ras bladder-cancer-transgenic mice, that developed low-grade and noninvasive papillary transitional urothelial cell carcinoma, were fed with 1.25 and 6.25 mg/mL SHR-5 in drinking water for 6 months. The survival of the mice, obstructive uropathy, tumor burden and morphology, and proliferation were evaluated by pathological, molecular, metabolic, and statistical analyses. Results: Approximately 95% or more of the male UPII-mutant Ha-ras mice that drank SHR-5 daily survived over 6 months of age, while only 33.3% of those mice that drank normal water survived over 6 months of age (p < 0.0001); SHR-5 drinking exposure also reduced tumor-bearing bladder weight and urinary tract obstruction and inhibited mTOR signaling in neoplastic tissues. Global metabolic analysis revealed that SHR-5 resulted in increased phenolic metabolites and decreased CoA, a critical metabolic cofactor for lipid metabolism. Conclusions: Our findings highlight the potential of SHR-5 as an anti-aging agent for bladder cancer prevention through reshaping tumor metabolism via the inhibition of the mTOR signaling. Global metabolomics profiling provides a unique and efficient tool for studying the mechanisms of complex herb extracts' action.
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Affiliation(s)
- Zhongbo Liu
- Department of Urology, University of California, Irvine, CA 92868, USA; (Z.L.); (N.N.Y.); (L.S.); (J.X.); (Z.S.); (Y.X.W.); (E.U.)
| | - Noriko N Yokoyama
- Department of Urology, University of California, Irvine, CA 92868, USA; (Z.L.); (N.N.Y.); (L.S.); (J.X.); (Z.S.); (Y.X.W.); (E.U.)
| | - Liankun Song
- Department of Urology, University of California, Irvine, CA 92868, USA; (Z.L.); (N.N.Y.); (L.S.); (J.X.); (Z.S.); (Y.X.W.); (E.U.)
| | - Jun Xie
- Department of Urology, University of California, Irvine, CA 92868, USA; (Z.L.); (N.N.Y.); (L.S.); (J.X.); (Z.S.); (Y.X.W.); (E.U.)
| | - Zhina Sadeghi
- Department of Urology, University of California, Irvine, CA 92868, USA; (Z.L.); (N.N.Y.); (L.S.); (J.X.); (Z.S.); (Y.X.W.); (E.U.)
| | - Yi Xi Wu
- Department of Urology, University of California, Irvine, CA 92868, USA; (Z.L.); (N.N.Y.); (L.S.); (J.X.); (Z.S.); (Y.X.W.); (E.U.)
| | - Sarah Yee
- Department of Urology, University of California, Irvine, CA 92868, USA; (Z.L.); (N.N.Y.); (L.S.); (J.X.); (Z.S.); (Y.X.W.); (E.U.)
| | - Xue-Ru Wu
- Veterans Affairs New York Harbor Healthcare System, New York, NY 10010, USA;
| | - Beverly Wang
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA 92868, USA;
| | - Edward Uchio
- Department of Urology, University of California, Irvine, CA 92868, USA; (Z.L.); (N.N.Y.); (L.S.); (J.X.); (Z.S.); (Y.X.W.); (E.U.)
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92868, USA
| | - Xiaolin Zi
- Department of Urology, University of California, Irvine, CA 92868, USA; (Z.L.); (N.N.Y.); (L.S.); (J.X.); (Z.S.); (Y.X.W.); (E.U.)
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92868, USA
- Veterans Affairs Long Beach Healthcare System, Long Beach, CA 90822, USA
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Chen D, Zhou X, Yan P, Yang C, Li Y, Han L, Ren X. Lipid metabolism reprogramming in colorectal cancer. J Cell Biochem 2023; 124:3-16. [PMID: 36334309 DOI: 10.1002/jcb.30347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
The hallmark feature of metabolic reprogramming is now considered to be widespread in many malignancies, including colorectal cancer (CRC). Of the gastrointestinal tumors, CRC is one of the most common with a high metastasis rate and long insidious period. The incidence and mortality of CRC has increased in recent years. Metabolic reprogramming also has a significant role in the development and progression of CRC, especially lipid metabolic reprogramming. Many studies have reported that lipid metabolism reprogramming is similar to the Warburg effect with typical features affecting tumor biology including proliferation, migration, local invasion, apoptosis, and other biological behaviors of cancer cells. Therefore, studying the role of lipid metabolism in the occurrence and development of CRC will increase our understanding of its pathogenesis, invasion, metastasis, and other processes and provide new directions for the treatment of CRC. In this paper, we mainly describe the molecular mechanism of lipid metabolism reprogramming and its important role in the occurrence and development of CRC. In addition, to provide reference for subsequent research and clinical diagnosis and treatment we also review the treatments of CRC that target lipid metabolism.
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Affiliation(s)
- Dan Chen
- Department of Pathology & Cancer Research Center, Yanbian University Medical College, Yanji, China.,Key Laboratory of Pathobiology, Yanbian University, State Ethnic Affairs Commission, Yanji, China
| | - Xuebing Zhou
- Department of Pathology & Cancer Research Center, Yanbian University Medical College, Yanji, China.,Key Laboratory of Pathobiology, Yanbian University, State Ethnic Affairs Commission, Yanji, China
| | - PengYu Yan
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunyu Yang
- Department of Pathology & Cancer Research Center, Yanbian University Medical College, Yanji, China.,Key Laboratory of Pathobiology, Yanbian University, State Ethnic Affairs Commission, Yanji, China
| | - Yuan Li
- Department of Pathology & Cancer Research Center, Yanbian University Medical College, Yanji, China.,Key Laboratory of Pathobiology, Yanbian University, State Ethnic Affairs Commission, Yanji, China
| | - Longzhe Han
- Key Laboratory of Pathobiology, Yanbian University, State Ethnic Affairs Commission, Yanji, China.,Department of Pathology, Affiliated Hospital of Yanbian University, Yanji, China
| | - Xiangshan Ren
- Department of Pathology & Cancer Research Center, Yanbian University Medical College, Yanji, China.,Key Laboratory of Pathobiology, Yanbian University, State Ethnic Affairs Commission, Yanji, China
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