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Li Y, Sun L, Zhou Q, Lee AJ, Wang L, Zhang R, Wang S. Effects of opioid drugs on immune function in cancer patients. Biomed Pharmacother 2024; 175:116665. [PMID: 38701564 DOI: 10.1016/j.biopha.2024.116665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
Opioid receptor agonists are often used when cancer patients undergo surgery or analgesic treatment. As analgesics in clinical care, opioids can provide intraoperative or to chronic cancer pain relief. Immune function plays an important role in anti-cancer therapy, with cellular immunity, comprised principally of T-lymphocytes and natural killer cells, representing the primary anti-cancer immune response. However, it remains unclear whether immune function is further affected with the use of opioids in already immunocompromised cancer patients. This article provides a review of the effects of commonly used clinical opioids, including morphine, oxycodone, fentanyl and tramadol, on immune function in cancer patients. It provides a summary of current evidence regarding the immunomodulatory effects of opioids in the cancer setting and mechanisms underlying these interactions.
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Affiliation(s)
- Yunqi Li
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China
| | - Lina Sun
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China.
| | - Qinglian Zhou
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China
| | - An Jie Lee
- Biological Sciences, University of California San Diego, La Jolla, CA 92093, United States
| | - Lingyan Wang
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China
| | - Rui Zhang
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China.
| | - Shoushi Wang
- Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao 266042, China.
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Ji N, Zhang Y, Li L, Du J, Tan S, Liu F. Comparison of Recovery Effect for Sufentanil vs. Remifentanil Anesthesia in Elderly Patients Undergoing Curative Resection for Hepatocellular Carcinoma. Pain Ther 2023; 12:1017-1025. [PMID: 37243868 PMCID: PMC10289946 DOI: 10.1007/s40122-023-00522-0] [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: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION The aim of this work is to evaluate the clinical efficacy and safety of sufentanil vs. remifentanil anesthesia in elderly patients undergoing curative resection for hepatocellular carcinoma (HCC). METHODS Medical records of elderly patients aged ≥ 65 years who received curative resection for HCC between January 2017 and December 2020 were retrospectively reviewed. The patients were divided into either the sufentanil group or the remifentanil group according to the method of analgesia used. Vital signs including mean arterial pressure (MAP), heart rate (HR), and arterial oxygen saturation (SpO2), distribution of T-cell subsets (CD3, CD4, and CD8 lymphocytes), distribution of the stress response index [cortisol (COR), interleukin (IL)-6, C-reactive protein (CRP), and glucose (GLU)] were recorded prior to anesthesia (T0), after induction of anesthesia (T1), at the end of surgery (T2), 24 h after surgery (T3), and 72 h after surgery (T4). Postoperative adverse events were collected. RESULTS Repeated measure analysis of variance (ANOVA) showed that after controlling for baseline patient demographic and treatment characteristics as covariates, both between- and within-group effects were significant (all P < 0.01), and the interaction between time and treatments was also significant (all P < 0.01) in the vital signs (MAP, HR, and SpO2), distribution of T-cell subsets (CD3, CD4, and CD8 lymphocytes), and distribution of the stress response index (COR, IL-6, CRP, and GLU), indicating that sufentanil led to stable hemodynamic and respiratory functions, lower reduction of T-lymphocyte subsets, and stable stress response indices compared to remifentanil. There is no significant difference in adverse reactions between the two groups (P = 0.72). CONCLUSIONS Sufentanil was associated with improved hemodynamic and respiratory function, less stress response, less inhibition of cellular immunity, and similar adverse reactions compared with remifentanil.
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Affiliation(s)
- Nan Ji
- Department of Anesthesiology, General Hospital of Central Theater Command of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, Hubei, China
| | - Yan Zhang
- Department of Anesthesiology, General Hospital of Central Theater Command of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, Hubei, China
| | - Lin Li
- Department of Anesthesiology, General Hospital of Central Theater Command of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, Hubei, China
| | - Jinju Du
- Department of Anesthesiology, General Hospital of Central Theater Command of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, Hubei, China
| | - Shigang Tan
- Department of Anesthesiology, General Hospital of Central Theater Command of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, Hubei, China
| | - Fang Liu
- Department of Anesthesiology, General Hospital of Central Theater Command of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, Hubei, China.
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Luan T, Li Y, Sun L, Xu S, Wang H, Wang J, Li C. Systemic immune effects of anesthetics and their intracellular targets in tumors. Front Med (Lausanne) 2022; 9:810189. [PMID: 35966857 PMCID: PMC9365985 DOI: 10.3389/fmed.2022.810189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
According to the result released by the World Health Organization (WHO), non-communicable diseases have occupied four of the top 10 current causes for death in the world. Cancer is one of the significant factors that trigger complications and deaths; more than 80% cancer patients require surgical or palliative treatment. In this case, anesthetic treatment is indispensable. Since cancer is a heterogeneous disease, various types of interventions can activate oncogenes or mutate tumor suppressor genes. More and more researchers believe that anesthetics have a certain effect on the long-term recurrence and metastasis of tumors, but it is still controversial whether they promote or inhibit the progression of cancer. On this basis, a series of retrospective or prospective randomized clinical trials have been conducted, but it seems to be difficult to reach a conclusion within 5 years or longer. This article focuses on the effects of anesthetic drugs on immune function and cancer and reviews their latest targets on the tumor cells, in order to provide a theoretical basis for optimizing the selection of anesthetic drugs, exploring therapeutic targets, and improving the prognosis of cancer patients.
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Affiliation(s)
- Ting Luan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, China
| | - Yi Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Lihui Sun
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Zhongke Jianlan Medical Research Institute, Beijing, China
| | - Siqi Xu
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Zhongke Jianlan Medical Research Institute, Beijing, China
| | - Haifeng Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, China
- *Correspondence: Haifeng Wang,
| | - Jiansong Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, China
- Jiansong Wang,
| | - Chong Li
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Zhongke Jianlan Medical Research Institute, Beijing, China
- Chong Li,
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Kang Z, Zhu G, Su C, Zeng K, Li S, Wu X. Differential effects of remifentanil and sufentanil anesthesia on post-operative pain and cognitive functions. Int Immunopharmacol 2022; 108:108888. [DOI: 10.1016/j.intimp.2022.108888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/21/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023]
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Wei S, Xi J, Cao S, Li T, Xu J, Li W, Bi Y. Laparoscopic radical resection combined with neoadjuvant chemotherapy in treatment of colorectal cancer: clinical efficacy and postoperative complications. Am J Transl Res 2021; 13:13974-13980. [PMID: 35035739 PMCID: PMC8748148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the clinical efficacy of laparoscopic radical resection combined with neoadjuvant chemotherapy (NACT) in the treatment of colorectal cancer and its influence on postoperative complications. METHODS The clinical data of 90 patients with colorectal cancer admitted to our hospital from June 2019 to June 2021 were retrospectively analyzed. According to different treatment methods, patients were divided into a control group (laparoscopic radical resection) and a study group (combined NACT before radical resection), with 45 cases in each group. The efficacy and complications were compared between the two groups after treatment. RESULTS Postoperatively, the early oral feeding, anal exhaust time, and hospitalization time of the patients in the study group were significantly shorter than those in the control group (P<0.05). The study group had significantly lower cancer metastasis rate, recurrence rate, infection rate, and smaller tumor diameters than the control group (P<0.05). The levels of tumor markers (CEA, CA242, CA199, and CA724) were reduced significantly in both groups after treatment, with lower results observed in the study group (P<0.05). The average survival time of patients in the study group was significantly longer than that of the control group (16.04±3.64 vs 11.88±2.53 months; t=6.295, P<0.001). The two groups showed no significant differences in the incidence of complications (P>0.05). CONCLUSION Laparoscopic radical resection of colorectal cancer combined with NACT is a preferred technique for the treatment of colorectal cancer. It effectively facilitates the postoperative recovery, reduces the levels of tumor markers, boosts the short-term curative effect, and prolongs the average survival time, without obvious complications.
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Affiliation(s)
- Shengchao Wei
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan, Shandong, China
| | - Jie Xi
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan, Shandong, China
| | - Shuai Cao
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan, Shandong, China
| | - Tao Li
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan, Shandong, China
| | - Jiacheng Xu
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan, Shandong, China
| | - Wei Li
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan, Shandong, China
| | - Yuhe Bi
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan, Shandong, China
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Wei X, Wang M, Ma X, Tang T, Shi J, Zhao D, Yuan T, Xie Z, Shen Y. Treatment of postoperative delirium with continuous theta burst stimulation: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e048093. [PMID: 34400453 PMCID: PMC8370542 DOI: 10.1136/bmjopen-2020-048093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Postoperative delirium is one of the most common postoperative complications among elderly patients (65 years old or older). However, there are no effective treatments for this condition. Recent research suggests that continuous theta burst stimulation (cTBS), a non-invasive brain stimulation, can reduce pain level, improve cognitive function and affective symptoms in multiple diseases or dysfunctions, including anxiety disorders, major depressive disorder, sleep disorders and pain. But the potential benefits of cTBS in reducing postoperative delirium have not been investigated. Therefore, we propose determining whether cTBS can prevent and/or treat postoperative delirium in senior patients. METHODS AND ANALYSIS The study will be a double-blind, randomised controlled trial. Participants (65 years old or older) undergoing scheduled orthopaedic surgery (≥2 hours, general anaesthesia) will be randomised to receive either cTBS or sham stimulation with a focal figure-of-eight coil over the right dorsolateral prefrontal cortex at 80% of the resting motor threshold. Every patient will receive 2-3 sets of stimulations during postoperative days (40 s per session, 3 sessions per set, 1 set per day). Participants will be assessed twice daily by a research assistant blinded to allocation. The primary outcome will be the incidence of postoperative delirium measured by the Confusion Assessment Method on postoperative days 1, 2 and 3. The secondary outcomes will be the severity and duration of postoperative delirium, cognitive function, pain, sleep quality, activities of daily living, length of hospital stay, discharge-to-facility or home, and rate of complication and mortality during the hospital stay. ETHICS AND DISSEMINATION Ethical approval has been obtained from the ethics committee of Shanghai 10th People's Hospital. The principal investigator will submit a research progress report to the ethics committee regularly. All participants will provide written informed consent. Study results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04661904.
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Affiliation(s)
- Xiaoyi Wei
- Department of Psychiatry, Shanghai Tenth People's Hospital, Shanghai, China
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Meijuan Wang
- Department of Psychiatry, Shanghai Tenth People's Hospital, Shanghai, China
| | - Xin Ma
- Department of Psychiatry, Shanghai Tenth People's Hospital, Shanghai, China
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Tianyi Tang
- Department of Psychiatry, Shanghai Tenth People's Hospital, Shanghai, China
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Jingqing Shi
- Department of Psychiatry, Shanghai Tenth People's Hospital, Shanghai, China
| | - Di Zhao
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tifei Yuan
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhongcong Xie
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Yuan Shen
- Department of Psychiatry, Shanghai Tenth People's Hospital, Shanghai, China
- Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China
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Zhao J, Kang Z, Xie W, Lin H, Liu Y. Effects of Depth of Anesthesia Monitored by IoC on Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer. Mol Ther Methods Clin Dev 2020; 18:304-311. [PMID: 32637458 PMCID: PMC7330423 DOI: 10.1016/j.omtm.2020.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/27/2020] [Indexed: 11/26/2022]
Abstract
Index of consciousness (IoC) consisting of IoC1 and IoC2, is a new analgesia monitoring indicator in anesthesia evaluation in the laparoscopic radical resection of colorectal cancer. Although the precise anesthetic dosage adjusted by IoC1 has been confirmed to enhance the recovery and reduce the complications of anesthesia, the most appropriate range of IoC2 during anesthesia remains unclear. To investigate the correlation between IoC2 and peri-operative indicators of patients during laparoscopic radical resection of colorectal cancer, the current randomized, controlled, and single-blinded clinical trial was performed. Participants were divided randomly into three groups with different anesthesia depth monitored by IoC2 during their laparoscopic radical resections. Primary outcomes included the dosage of remifentanil. Secondary outcomes included other physiological indexes and complications. The remifentanil dosage and the awakening time increased as IoC2 decreased. The incidences of hypotension and hypoxemia decreased with the elevated IoC2, but the risk of intra-operative awareness also increased. The impact caused by anesthesia to the immune system and health-related life quality of the patients descended with reduced anesthetic level. The IoC2 range of 35–45 could represent the most appropriate anesthetic depth during laparoscopic radical resection, which provides a new perspective for the clinical treatment of colon cancer.
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Liu L, Li B, Cao Q, Zhao B, Gao W, Chen Y, Yu S. Effects of Additional Intraoperative Administration of Sufentanil on Postoperative Pain, Stress and Inflammatory Responses in Patients Undergoing Laparoscopic Myomectomy: A Double-Blind, Randomized, Placebo-Controlled Trial. J Pain Res 2020; 13:2187-2195. [PMID: 32943911 PMCID: PMC7468475 DOI: 10.2147/jpr.s257337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Although pain after laparoscopic surgery is assumed to be minor, many women still suffer from unexpected postoperative pain. Thus, we aimed to assess whether additional intraoperative administration of sufentanil could help to improve postoperative pain and related agitation, stress, and inflammation response in patients undergoing laparoscopic myomectomy. Patients and Methods Forty female patients with uterine myoma scheduled for laparoscopic myomectomy under general anesthesia were randomized to receive sufentanil (group T, n=20) or normal saline (group C, n=20) 1h before the end of the surgery. The postoperative pain, agitation, stress, inflammation, and adverse effects were measured. Results As the primary outcome, the visual analog scale (VAS) pain score was significantly reduced in group T as compared with group C at each measured time point in a post-anesthesia care unit (PACU), VAS 5 min (31.5 ± 2.7 vs 40.6 ± 5.6) (P<0.001), VAS 30 min (36.5 ± 4.5 vs 46.0 ± 2.9) (P<0.001), VAS 1h (37.8 ± 4.0 vs 48.6 ± 5.5) (P<0.001). The secondary outcomes, including the sedation agitation scale (SAS) scores, plasma concentrations of epinephrine and norepinephrine, and the levels of plasma interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-α) in group T were remarkably lower than those in group C (P < 0.001). The cough cases in group T also showed a significant reduction in comparison with group C (P < 0.05). In addition, the anesthetic recovery time, including the spontaneous breathing recovery time and extubation time, were not significantly different between the two groups, as were the cases of respiratory depression and postoperative delirium (P > 0.05). Conclusion For patients undergoing laparoscopic myomectomy, administration of sufentanil 1 h before the end of surgery shows excellent analgesic and sedative effects, alleviated postoperative stress and inflammatory responses, reduced incidence of cough, without prolonging anesthetic recovery time and increasing adverse reactions.
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Affiliation(s)
- Lian Liu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Bingyu Li
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Quan Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Bo Zhao
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Wenwei Gao
- Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Yuan Chen
- Department of Academic Research, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Shihua Yu
- Department of Anesthesiology, Renmin Hospital of Hannan District, Wuhan, Hubei 430090, People's Republic of China
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Peng Y, Yang J, Guo D, Zheng C, Sun H, Zhang Q, Zou S, Zhang Y, Luo K, Candiotti KA. Sufentanil postoperative analgesia reduce the increase of T helper 17 (Th17) cells and FoxP3 + regulatory T (Treg) cells in rat hepatocellular carcinoma surgical model: A randomised animal study. BMC Anesthesiol 2020; 20:212. [PMID: 32847505 PMCID: PMC7448519 DOI: 10.1186/s12871-020-01129-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 08/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background Surgery-related pain and opioids might exacerbate immune defenses in immunocompromised cancer patients which might affect postoperativd overall survival. Sufentanil is a good postoperative pain control drug,the present study aimed to figure out whether it effect T cell immunity in rat hepatocellular carcinoma surgical model. Methods A rat hepatocellular carcinoma (HCC) models was established by N-nitrosodiethylamine. Forty-eight of them were randomly divided into 3 equal groups: surgery without postoperative analgesia (Group C), surgery with morphine postoperative analgesia (Group M), surgery with sufentanil postoperative analgesia (Group S). Each animal underwent a standard left hepatolobectomy, and intraperitoneally implanted with osmotic minipumps filled with sufentanil, morphine or normal saline according to the different group. The food and water consumptions, body weight changes, locomotor activity and mechanical pain threshold (MPT) were observed. The ratio of CD4+/CD8+, proportions of Th1, Th2, Th17 and Treg cells in blood were detected using flow cytometry. The liver function and the rats’ survival situation of each group were observed. Results The food and water consumption, locomotor activity and MPT of group C declined than those of group S and M on d1, d2, d3 (P < 0.05). The CD4+/CD8+ ratio and the proportion of Th1 cells were significantly higher while the proportion of Th2, Th17 and Treg cells were significantly lower in group S and group M compared with group C. The rats of group S have higher CD4+/CD8+ ratio on d3, while lower proportion of Treg cells on d7 compared with group M. The plasma ALT and AST values in group C were significantly higher than that of group S and group M on both d3 and d7. There were not significant differences in mortality rate between 3 groups. Conclusions Sufentanil and morphine postoperative analgesia in HCC rats accepted hepatectomy could relieve postoperative pain, promote the recovery of liver function after surgery, alleviate the immunosuppressive effect of pain. Furthermore, Compared to morphine, sufentanil might have a slighter effect on CD4+/CD8+ ratio and Treg frequencies. Therefore, sufentanil postoperative analgesia is better than morphine in HCC hepatectomy rats.
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Affiliation(s)
- Yanhua Peng
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Jinfeng Yang
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China.
| | - Duo Guo
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Chumei Zheng
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Huiping Sun
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Qinya Zhang
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Shuangfa Zou
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Yanping Zhang
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami-Miller School of Medicine, Miami, FL, 33136, USA
| | - Ke Luo
- Department of Anesthesiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Keith A Candiotti
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami-Miller School of Medicine, Miami, FL, 33136, USA
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Cui X, Zhu C, Chen P, Qu M, Zhang B, Li H. Effect of pectoral nerve block type II under general anesthesia on the immune function of patients with breast cancer. Am J Surg 2020; 220:938-944. [PMID: 32184007 DOI: 10.1016/j.amjsurg.2020.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND To investigate whether the use of Pecs II block benefit patients with the respect to the immune functions. METHODS Totally 196 patients were included in this study. These patients were randomized to two groups, general anesthesia alone group (G group) and Pectoral nerve (Pecs) II block under general anesthesia group (PG group). RESULTS It was found that remifentanil consumption was less in PG group than it in G group. PG group showed a higher proportion of NK cells in peripheral blood mononuclear cell (PBMC) and an improved killing activity than G groups after surgery. We also found that postoperative interleukin (IL)-2 concentration in the plasma of PG group was dramatically higher than it of G group. Interestingly, there was even no significant change between preoperative and postoperative IL-2 levels in PG group, suggesting the less inhibitory effect of Pecs II block on immune system of those patients. CONCLUSIONS In conclusion, these results indicate that Pecs II block use in patients may have an enhanced immunity compared with general anesthesia method.
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Affiliation(s)
- Xiuling Cui
- Department of Anesthesiology, Cangzhou Central Hospital, No 16 Xinhua Road, Cangzhou, 061000, Hebei, China.
| | - Cuinv Zhu
- Department of Anesthesiology, Cangzhou Hospital of Integrated TCM-WM·Hebei, No 31 Huanghe Road, Cangzhou, 061000, Hebei, China
| | - Peng Chen
- Department of Anesthesiology, Cangzhou Central Hospital, No 16 Xinhua Road, Cangzhou, 061000, Hebei, China
| | - Min Qu
- Department of Anesthesiology, Cangzhou Central Hospital, No 16 Xinhua Road, Cangzhou, 061000, Hebei, China
| | - Bowei Zhang
- Hubei Medical College, Shiyan, 442000, Hubei, China
| | - Hongtao Li
- Quality Control Office, Cangzhou Central Hospital, No 16 Xinhua Road, Cangzhou, 061000, Hebei, China
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Longhini F, Bruni A, Garofalo E, De Sarro R, Memeo R, Navalesi P, Navarra G, Ranieri G, Currò G, Ammendola M. Anesthetic Strategies in Oncological Surgery: Not Only a Simple Sleep, but Also Impact on Immunosuppression and Cancer Recurrence. Cancer Manag Res 2020; 12:931-940. [PMID: 32104075 PMCID: PMC7020923 DOI: 10.2147/cmar.s237224] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/01/2020] [Indexed: 12/18/2022] Open
Abstract
Tumor recurrences or metastases remain a major hurdle in improving overall cancer survival. In the perioperative period, the balance between the ability of the cancer to seed and grow at the metastatic site and the ability of the patient to fight against the tumor (i.e. the host antitumor immunity) may determine the development of clinically evident metastases and influence the patient outcome. Up to 80% of oncological patients receive anesthesia and/or analgesia for diagnostic, therapeutic or palliative interventions. Therefore, anesthesiologists are asked to administer drugs such as opiates and volatile or intravenous anesthetics, which may determine different effects on immunomodulation and cancer recurrence. For instance, some studies suggest that intravenous drugs, such as propofol, may inhibit the host immunity to a lower extent as compared to volatile anesthetics. Similarly, some studies suggest that analgesia assured by local anesthetics may provide a reduction of cancer recurrence rate; whilst on the opposite side, opioids may exert negative consequences in patients undergoing cancer surgery, by interacting with the immune system response via the modulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, or directly through the opioid receptors on the surface of immune cells. In this review, we summarize the main findings on the effects induced by different drugs on immunomodulation and cancer recurrence.
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Affiliation(s)
- Federico Longhini
- Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Rosalba De Sarro
- Department of Clinical and Experimental Medicine, Section of Cardiology, G. Martino General Hospital, University of Messina, Messina, Italy
| | - Riccardo Memeo
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari 70124, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, University Hospital of Padua; Department of Medicine, University of Padua, Padua, Italy
| | - Giuseppe Navarra
- Department of Human Pathology of Adult and Evolutive Age, Surgical Oncology Division, University Hospital of Messina, Messina 98100, Italy
| | - Girolamo Ranieri
- Interventional Oncology Unit with Integrated Section of Translational Medical Oncology, National Cancer Research Centre, IstitutoTumori "Giovanni Paolo II", Bari 70124, Italy
| | - Giuseppe Currò
- Department of Health Science, General Surgery Unit, University "Magna Graecia" Medical School, Catanzaro 88100, Italy
| | - Michele Ammendola
- Department of Health Science, General Surgery Unit, University "Magna Graecia" Medical School, Catanzaro 88100, Italy
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Chen X, Hu Z, Yan W, Ma Y, He M, Ren X. Comparative effects of target-controlled infusion of anesthetic sufentanil and remifentanil on inflammatory factors and oxidative stress indicators in patients of colorectal cancer. EUR J INFLAMM 2019. [DOI: 10.1177/2058739219863288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study was designed to compare the recovery of target-controlled infusion of sufentanil and remifentanil in patients of colorectal cancer. In total, 104 patients were randomly divided into sufentanil and remifentanil groups. One group was given target-controlled infusion of sufentanil, while the other group received remifentanil. Inflammatory factors and oxidative stress indicators were measured at 10 min before induction of anesthesia (T1), 1 h (T2), 24 h (T3), and 72 h (T4) after surgery. Adverse reactions were also compared. The extubation and recovery time of sufentanil group were longer than remifentanil group. The levels of CRP, IL-8, and IL-4 in sufentanil group and remifentanil group increased continuously. CRP contents at T3, T4, and IL-8 and IL-4 contents at T2, T3, and T4 of remifentanil group were lower ( P < 0.05). The incidence of adverse reactions in sufentanil group was 15.4%, which was significantly ( P < 0.05) lower than remifentanil group (28.8%). The recovery and extubation time of sufentanil were longer than remifentanil, while the remifentanil can effectively reduce the levels of inflammatory factors and oxidative stress.
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Affiliation(s)
- Xiaohui Chen
- Department of Anesthesiology, Gansu Provincial Hospital, Gansu, P.R. China
| | - Zhongyuan Hu
- Department of Anesthesiology, Gansu Provincial Hospital, Gansu, P.R. China
| | - Wenjun Yan
- Department of Anesthesiology, Gansu Provincial Hospital, Gansu, P.R. China
| | - Yabing Ma
- Department of Anesthesiology, Gansu Provincial Hospital, Gansu, P.R. China
| | - Man He
- Department of Anesthesiology, Gansu Provincial Hospital, Gansu, P.R. China
| | - Xiaoqiang Ren
- Department of Orthopedics, Zhangye People’s Hospital Affiliated to Hexi University, Gansu, P.R. China
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Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence. J Transl Med 2018; 16:8. [PMID: 29347949 PMCID: PMC5774104 DOI: 10.1186/s12967-018-1389-7] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/15/2018] [Indexed: 12/22/2022] Open
Abstract
Background The relationship between surgery and anesthetic-induced immunosuppression and cancer recurrence remains unresolved. Surgery and anesthesia stimulate the hypothalamic–pituitary–adrenal (HPA) axis and sympathetic nervous system (SNS) to cause immunosuppression through several tumor-derived soluble factors. The potential impact of surgery and anesthesia on cancer recurrence was reviewed to provide guidance for cancer surgical treatment. Methods PubMed was searched up to December 31, 2016 using search terms such as, “anesthetic technique and cancer recurrence,” “regional anesthesia and cancer recurrence,” “local anesthesia and cancer recurrence,” “anesthetic technique and immunosuppression,” and “anesthetic technique and oncologic surgery.” Results Surgery-induced stress responses and surgical manipulation enhance tumor metastasis via release of angiogenic factors and suppression of natural killer (NK) cells and cell-mediated immunity. Intravenous agents such as ketamine and thiopental suppress NK cell activity, whereas propofol does not. Ketamine induces T-lymphocyte apoptosis but midazolam does not affect cytotoxic T-lymphocytes. Volatile anesthetics suppress NK cell activity, induce T-lymphocyte apoptosis, and enhance angiogenesis through hypoxia inducible factor-1α (HIF-1α) activity. Opioids suppress NK cell activity and increase regulatory T cells. Conclusion Local anesthetics such as lidocaine increase NK cell activity. Anesthetics such as propofol and locoregional anesthesia, which decrease surgery-induced neuroendocrine responses through HPA-axis and SNS suppression, may cause less immunosuppression and recurrence of certain types of cancer compared to volatile anesthetics and opioids.
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Zhu J, Zhang XR, Yang H. Effects of combined epidural and general anesthesia on intraoperative hemodynamic responses, postoperative cellular immunity, and prognosis in patients with gallbladder cancer: A randomized controlled trial. Medicine (Baltimore) 2017; 96:e6137. [PMID: 28272202 PMCID: PMC5348150 DOI: 10.1097/md.0000000000006137] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study is supposed to investigate the effects of combined epidural and general anesthesia on intraoperative hemodynamic responses, postoperative cellular immunity, and prognosis in patients with gallbladder cancer (GBC). METHODS One hundred forty-four GBC patients were selected and randomly divided into the general anesthesia (GA) group and the combined epidural-general anesthesia (CEGA) group. Before anesthesia induction (t0), at intubation (t1), at the beginning of surgery (t2), 5 minutes after pneumoperitoneum (t3), at the end of surgery (t4), after recovery of spontaneous breathing (t5), after regaining consciousness (t6), and after extubation (t7), the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and the depth of anesthesia (bispectral index [BIS]) were detected. Blood samples were separately collected 30 minutes before anesthesia induction (T1), 2 hours after the beginning of surgery (T2), at the end of surgery (T3), 1 day after surgery (T4), 3 days after surgery (T5). The survival rates of T cell subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and natural killer (NK) cells were determined by flow cytometry. Postoperative nausea and vomiting (PONV), visual analog scale (VAS), and sedation-agitation scale (SAS) were performed to assess postoperative adverse reactions. A 3-year follow-up was conducted. RESULTS Compared with the GA group, the CEGA group had significant lower SBP values at t5 and t6, lower DBP values at t1, t3, t4, and t5, lower HR values at t1 and t5, and higher BIS values at t4, t5, t6, and t7. No PONV was observed in the CEGA group. In comparison to the GA group, the VAS was markedly increased and survival rates of CD3+, CD4+, and CD4+/CD8+ cells were increased at T2, T3, T4, and T5 in the CEGA group. The 1-year, 2-year, and 3-year survival rates were not evidently different between the CEGA group and the GA group. CONCLUSION Our study provides evidence that the combined epidural-general anesthesia might attenuate intraoperative hemodynamic responses and improve postoperative cellular immunity, so that it might be a more available anesthesia method for GBC patients.
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