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Edinoff AN, Derise OC, Sheppard AJ, Miriyala S, Virgen CG, Kaye AJ, Niakan M, Cornett EM, Kaye AD. The Influence of Analgesic Modalities on Postoperative Cancer Recurrence. Anesth Pain Med 2022; 12:e123463. [PMID: 35433388 PMCID: PMC8995873 DOI: 10.5812/aapm.123463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 11/16/2022] Open
Abstract
The potential for cancer cells to grow and to metastasize depends on complex interactions between inflammatory signals and pathways, immune cells, and elements of the stromal tissue in which they invade. Related to the nature of many cancers, the probability of recurrence can potentially be quite high for some patients. Immunology, lifestyle modifications, timing of disease, genetics, age, gender, and race are only a handful of ways the likelihood of cancer recurrence can be influenced. The quantity, or density, of certain immunological cells or factors, plays a role in the propagation of cancer cells. Opioids are often used in cancer patients for acute postoperative and chronic pain management. While they can produce significant pain relief, the type of analgesic utilized is important, as it may influence cancer propagation. In this regard, certain opioids have been found to increase T regulatory cells while suppressing NK cell function. Morphine may promote tumor neovascularization and expansion. Fentanyl administration significantly diminishes NK-cells and CD8+ cytotoxic T-cells. In a recent meta-analysis, propofol-based anesthesia improved both cancer-free survival and overall survival. COX inhibitors have also shown promise in persevering cancer immune function, as in literature involving ketorolac and celecoxib. In summary, inhaled anesthesia and opioids may contribute to a pro-tumor metastasis environment also known as cancer propagation; whereas propofol and COX inhibitors may provide a better alternative to reduce cancer recurrence and propagation.
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Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
- Corresponding Author: Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA.
| | - Olivia C. Derise
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Aaron J. Sheppard
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Sumitra Miriyala
- School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
| | - Celina G. Virgen
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Aaron J. Kaye
- Department of Anesthesiology, Medical University of South Carolina, Charleston, SC, USA
| | - Mohammad Niakan
- Pain Research Center, Department of Anesthesiology Intensive Care and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology Intensive Care and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA
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Olapour A, Rashidi M, Javaher Foroush F, Akhoondzadeh R, Hosseini N. Effect of Nebulized Heparin on Weaning off Intubated Patients with Acute Respiratory Distress Syndrome (ARDS) Admitted to Intensive Care Unit (ICU): A Randomized Clinical Trial. Anesth Pain Med 2021; 11:e115938. [PMID: 35075409 PMCID: PMC8782059 DOI: 10.5812/aapm.115938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) treatment is based on supportive care such as mechanical ventilation, prophylaxis of stress ulcer, prophylaxis of deep vein thrombosis (DVT), nutritional support, and treatment of underlying disease. Objectives: We aimed to investigate the effects of nebulized heparin on weaning off intubated ARDS patients admitted to the intensive care unit (ICU). Methods: In this double-blind clinical trial study, 60 patients with ARDS receiving routine care according to the ARDS protocol were randomly assigned into two groups: intervention group (receiving nebulized heparin 5000 u/BD for one week) and control group (receiving nebulized sterile water 2 cc/BD for one week). The respiratory index (PaO2/FiO2), pulmonary shunt percentage (measured by ABG), tidal volume, minute ventilation, admission duration in the ICU, and days of mechanical ventilation required were recorded for each patient for one week. Results: There was no significant difference in demographic data between the two groups. Inhaled heparin in patients with ARDS could significantly increase the respiratory index (PaO2/FiO2) and decrease pulmonary shunt percentage, minute ventilation, and tidal volume. It also significantly reduced the number of admission days in the ICU and the need for mechanical ventilation. Conclusions: The result of the present study showed that inhaled heparin in intubated ARDS patients admitted to the ICU improved respiratory and pulmonary status and reduced the need for mechanical ventilation and admission days in the ICU. Nebulizing heparin, as an anti-inflammatory and anti-coagulant agent, is an effective and safe medication for ARDS patients on mechanical ventilation.
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Affiliation(s)
- Alireza Olapour
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahboobe Rashidi
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Fatemeh Javaher Foroush
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Akhoondzadeh
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nastaran Hosseini
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Aranke M, Pham CT, Yilmaz M, Wang JK, Orhurhu V, An D, Cornett EM, Kaye AD, Ngo AL, Imani F, Farahmand Rad R, Varrassi G, Viswanath O, Urits I. Topical Sevoflurane: A Novel Treatment for Chronic Pain Caused by Venous Stasis Ulcers. Anesth Pain Med 2021; 11:e112832. [PMID: 34221949 PMCID: PMC8241821 DOI: 10.5812/aapm.112832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/14/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022] Open
Abstract
In the US, an estimated 1 - 2% of chronic venous insufficiency (CVI) patients (of 6 - 7 million nationwide) develop at least one venous stasis ulcer (VSU) during their illness. Of these, approximately 40% develop subsequent ulcers, making VSU prognostically poor. Current management of VSU is costly, with poor prognosis, high recurrence rate, inadequate pain management, and significantly reduced quality of life (QoL). Topical volatile anesthetic agents, such as sevoflurane, offer improved pain relief and symptom control in patients suffering from chronic VSU. The immediate impact of topical sevoflurane in reducing pain associated with ulcer bed debridement has several implications in improving the quality of life in patients with CVI induced ulcers and in the prognosis and healing of the ulcers. This review summarizes a topical formulation of a volatile anesthetic and its implications for the management of VSUs.
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Affiliation(s)
- Mayank Aranke
- Texas Tech University Health Sciences Center, School of Medicine, Harvard TH Chan School of Public Health, Lubbock, Texas, USA
| | - Cynthia T Pham
- Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | | | | | - Daniel An
- Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Elyse M. Cornett
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Alan David Kaye
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Anh L Ngo
- Pain Specialty Group, Portsmouth, NH, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Farahmand Rad
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Omar Viswanath
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
- Valley Pain Consultants – Envision Physician Services, Phoenix, AZ, USA
- University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Ivan Urits
- LSU Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
- Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA, USA
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