The Correlation between Genetic Polymorphism of OPRM1 (A118G) and MDR1 (C3435T) with Analgesia and the Adverse Effects by Epidural Morphine / 대한마취과학회지

BACKGROUND: The effect of a single nucleotide polymorphism (SNP) of the micro-opioid receptor gene at nucleotide position 118 (OPRM1:118A > G) and the MDR1 gene (exon 26: C3435T) have an influence on the interindividual variability of clinical opioid pain therapy. This study aims to evaluate the correlation among pain control and side effects of epidural morphine and these pharmacogenetic modulators. METHODS: 194 patients who were undergoing abdominal surgery were included in the study. Patients received a morphine 2 mg bolus and 2 mg/day via epidural route. The VAS score and opioid side effects were checked at postoperative 6, 24 and 48 hr. Patients were genotyped for the known SNPs of the OPRM1 and MDR1. RESULTS: For the SNP of OPRM1, the mutated genotype frequency (homo-wild, heterozygous, and homo-mutants) were 36.8, 47.9 and 15.3%, respectively, and the mutated genotype frequencies for the MDR1 SNP were 46.7, 40.2 and 13.1%, respectively. There were no significant differences in the VAS scores and side effects among the three groups of OPRM1 and MDR1. Yet carriers of the mutated allele 3435 TT, CT of the MDR1 gene showed marginally greater significant sedation effects than did non-carriers (CC) (P = 0.065, the OR was 1.78, 95% CI 0.98-3.24, P = 0.059) and also a lower incidence of analgesic usage (P =0.058). CONCLUSIONS: In our data there was a large difference in OPRM1 SNP allele frequency for the Korean population compared to other populations. The SNP of OPRM1 and MDR1 genes did not have significant altered clinical morphine analgesia and side effects via the epidural route. But the SNP of MDR1 gene is more sensitive genetic predictor of the clinical side effects (especially for sedation) and analgesic effects by opioid.

Comparison of Epidural Anesthesia with 0.5% Levobupivacaine and 0.5% Ropivacaine for Cesarean Section / 대한마취과학회지

BACKGROUND: Ropivacaine and levobupivacaine, both single S-enantiomers, show less toxicity on the central nervous and cardiovascular system than racemic bupivacaine. Earlier studies have shown that levobupivacaine and bupivacaine are almost equipotent while ropivaciane was 60% less potent than bupivacaine. The aim of this prospective, double blinded study was to compare the clinical efficacy and safety of epidural anesthesia produced by 0.5% levobupivacaine and 0.5% ropivacaine for a cesarean section. METHODS: Sixty-two parturients undergoing an elective cesarean section were randomized to receive either epidural levobupivacaine 0.5% 20 ml (n = 31) or epidural ropivacaine 0.5% 20 ml (n = 31). Surgery was commenced when the sensory block had reached the dermatome level, T6. The onset, duration, quality of the sensory and motor block and abdominal muscle relaxation were evaluated. The blood pressure and heart rate of the mother and neonatal outcome, as assessed by the Apgar score and umbilical pH, were also recorded. RESULTS: There was no difference in the onset time, the segmental spread of sensory block and analgesic supplement between the two groups. However, levobupivacaine produced a longer duration of sensory block than ropivacaine (levobupivacaine 224.1 +/- 66.6 min, ropivacaine 176.5 +/- 32.8 min, P < 0.05). The onset time (except Bromage scale 2), intensity and duration of the motor block and muscle relaxation were similar in both groups. There was no difference in the maternal and neonatal outcomes between the two groups. CONCLUSIONS: 0.5% levobupivacaine and 0.5% ropivacaine produced equivalent efficacy and safety in epidural anesthesia for a cesarean section, but levobupivacaine resulted in a longer duration of sensory block.

Radial Artery Approach for Transcatheter Arterial Chemoembolization in Patients with Hepatocellular Carcinoma

PURPOSE: To evaluate the feasibility and usefulness of the transradial approach for intra-arterial chemoembolization therapy in patients with hepatocellular carcinomas. MATERIALS AND METHODS: Twenty-nine patients with hepatocellular carcinoma who underwent intra-arterial chemoembolization via the radial artery approach were involved in this study. All underwent Allen's test to check ulnar arterial patency. In all cases, we used the radial approach hepatic artery (RHA) catheter designed by ourselves, evaluating the selection ability of the hepatic artery using an RHA cathter, the number of punctures, the procedure time, and compression time at the puncture site as well as complications occurring during and after the procedure. RESULTS: Except for three in which puncture failure, brachial artery variation or hepatic artery variation occurred, all procedures were successful. The mean number of punctures was 3.5, and the average duration of the whole procedure was one and half hours. This gradually decreased as the number of procedures increased. The average duration at a compression of puncture site was 12 minutes. There were no major complications. Minor complications included minimal intimal dissection of the radial artery (3.8%), reversible vasospasm of the radial artery (7.7%), hematoma at a puncture site (7.7%) and transient neurologic deficit (3.8%). CONCLUSION: The transradial approach using an RHA catheter for intra-arterial chemoembolization therapy in patients with hepatocellular carcinomas was technically feasible, with acceptable levels of safety. It may be a good alternative to absolute bed rest with a sand bag after the femoral approach.

Development of the Single Nodular VX-2 Carcinoma Model in Rabbit Liver: Tissue Chip Implantation under Ultrasonographic Guidance

PURPOSE: To implant tissue chips in New Zealand rabbits, and thus redurce the frequency with which scattered VX2 carcinoma nodules and early metastasis develop in these animals. MATERIALS AND METHODS: VX2-carcinoma tissue chips of two different sizes were implanted under ultrasonographic guidance. In each of 12 New Zealand rabbits (group 1), there 1-mm tissue chips were implanted in the liver using an 18-gauge needle, and in the same way, one 3-mm chip with an added gelfoam pellet was implanted in the proximal lumen of the liver of each of ten other New Zealand rabbits (group 2). Three weeks after implantation, the animals underwent dvalphase CT scanning and were sacrificed, and the Number and size of tumor nodules, and metastasis were evaluated either macro-or microscopically. RESULTS: In ten rabbits in group I, a total of 21 nodules (16 in the liver, 5 in the peritoneal wall) were observed, which in nine rabbits in group 2, a total of ten nodules-all in the liver-were present. CT scans depicted tumor nodules in 50% of group-I rabbits, and in 29% those in group 2. Mean tumor diameter was 12 +/-9 mm in group 1 and 6.4 +/-3 mm in group 2. Histologic examination indicated the presence of nodular VX2 carcinoma, with varying degrees of central necrosis, a feature more prominent in group 2. CONCLUSION: To provide a well-localized tumor nodule in rabbit liver, tissue chip implantation of VX2 carcinoma, especially with added gelfoam, is a good alternative to intraparenchymal injection of tumor suspension.