Genetic Factors Associated with Morphine Consumption in Women Undergoing Laparoscopic Cholecystectomy: A Prospective Cohort Study.

Introduction: Morphine has been a crucial analgesic agent used perioperatively in various surgical procedures. Genetic factors can lead to morphine dose requirement interpatient variability. Our objective was to determine the contribution of genetic polymorphisms in human µ-opioid receptor gene (OPRM1), ATP binding cassette gene (ABCB1) and rs2952768 to the variation of the perioperative morphine consumption in women undergoing laparoscopic cholecystectomy. Methods: This is a prospective cohort study that included 102 adult Arab females undergoing laparoscopic cholecystectomy. The exposures were carrying the genetic variants of OPRM1, ABCB1 and rs2952768. Our primary outcome was total morphine or morphine equivalent dose required perioperatively. The secondary outcomes were pain score during the first 24 hours and adverse drug reactions. A standardized, general anaesthesia was used for all subjects. In addition to the genetic factors, we also investigated non-genetic factors influencing post-operative pain sensitivity and morphine consumption. Results: Both (rs1799971, A>G) in OPRM1 and (rs2952768, T>C) showed statistically significant association with intra-operative total morphine dose requirements. Patients carrying the "G" allele in OPRM1 had a significantly higher total morphine mean rank dose compared to the AA genotype [62.9 vs 47.1, p=0.008]. Furthermore, patients homozygous for the rs2952768 (T>C) minor allele "CC" had a higher mean rank compared to the other genotypes [72.7 vs 50.1, p=0.046]. Conclusion: OPRM1 (rs1799971) and rs2952768 are associated with variation of intra-operative morphine consumption in laparoscopic cholecystectomy. Clinical Trial Identifier: This study was registered at ClinicalTrials.gov, NCT04621864. https://clinicaltrials.gov/ct2/show/NCT04621864.

Is it time for routine use of the retromolar fiberscope?

PURPOSE: This study aimed to determine the effectiveness, safety, and oral intubation time (IT) using a retromolar Bonfils fiberoptic scope compared with a conventional Macintosh laryngoscope. MATERIALS AND METHODS: Sixty patients (16-60 years old, American Society of Anesthesiology I/II) scheduled for general anesthesia for elective ear-nose-throat and plastic surgery were randomly divided into a Bonfils group (Group B, n = 30) and a Macintosh group (Group M, n = 30). Exclusion criteria included Mallampati IV, thyromental distance ≤4 cm, mouth <4 cm, cervical spine problems, body mass index >35, sleep apnea, reflux esophagitis, coronary artery disease, intracranial vascular malformation, elevated intracranial pressure, bleeding disorders, allergies to planned drugs, and patient refusal. Mallampati scoring, mouth opening, and thyromental distance were used for airway assessment. The time needed for successful intubation (IT), number of attempts, number of failures, systolic (SBP), diastolic (DBP), mean blood pressure (MBP), heart rate (HR) and Oxygen saturation (O2) and damage to the lips, dentures, and pharyngeal or laryngeal structures were recorded. Continuous variables are presented as mean ± standard deviation and categorical variables are presented as frequency and percentage. Chi-square tests and Student's t-tests were used to compare the groups. P < 0.05 was considered statistically significant. RESULTS: The groups were comparable regarding demographic data, preoperative airway parameters, IT, the number of attempts, O2, and the incidence of complications (P > 0.05). However, Bonfils intubation was associated with more stable HR, SBP, DBP and MBP (P < 0.05). CONCLUSION: The Bonfils fiberoptic scope is comparable to a Macintosh laryngoscope but assures better hemodynamic stability. In difficult cases, the Bonfils scope is a better choice because of its ability to navigate.

Occurrence and sources of natural and anthropogenic lipid tracers in surface soils from arid urban areas of Saudi Arabia.

Soil particles contain a variety of natural and anthropogenic organic components, and in urban areas can be considered as local collectors of pollutants. Surface soil samples were taken from ten urban areas in Riyadh during early winter of 2007. They were extracted with dichloromethane-methanol mixture and the extracts were analyzed by gas chromatography-mass spectrometry. The major compounds were unresolved complex mixture (UCM), plasticizers, n-alkanes, carbohydrates, n-alkanoic acids, hopanes, n-alkanols, and sterols. Vegetation detritus was the major natural source of organic compounds (24.0 ± 15.7%) in samples from areas with less human activities and included n-alkanes, n-alkanoic acids, n-alkanols, sterols and carbohydrates. Vehicular emission products and discarded plastics were the major anthropogenic sources in the soil particles (53.3 ± 21.3% and 22.7 ± 10.7%, respectively). The anthropogenic tracers were UCM, plasticizers, n-alkanes, hopanes and traces of steranes. Vegetation and human activities control the occurrence and distribution of natural and anthropogenic extractable organic matter in this arid urban area.

ULTRASOUND-GUIDED SCIATIC POLITEAL NERVE BLOCK: A COMPARISON OF SEPARATE TIBIAL AND COMMON PERONEAL NERVE INJECTIONS VERSUS INJECTING PROXIMAL TO THE BIFURCATION.

OBJECTIVE: Block of the sciatic nerve at the popliteal fossa can be performed using the ultrasound machine; it may be proximally or distally to the bifurcation of the sciatic nerve using lateral, medial, or posterior approaches. It is frequently used for surgeries below the knee specially the foot and ankle operations. PURPOSE: This study compares one and two injections of the sciatic nerve in the popliteal fossa with ultrasound-guided block in foot or ankle surgeries. METHODS: Forty patients received ultrasound-guided sciatic nerve block with the nerve stimulator, using the posterior approach. The patients were enrolled into two groups (20 patients each), group 1: received one injection at 2 cm cephalad to the bifurcation of the sciatic nerve, and group 2: received two injections caudate to the sciatic bifurcation; one for tibial nerve and the other for common peroneal nerve. All patients received 20 ml of levobupivacaine 0.5%. The block performance time, block efficacy, success rate, complications and patient's satisfaction were evaluated. RESULTS: Block the tibial and common peroneal nerves separately (two injections) distal to the point of bifurcation of the sciatic nerve has a significantly (P < 0.05) faster time to complete sensory block of tibial and common peroneal nerves compared to a pre-bifurcation sciatic nerve block (one injection). The complete motor block, block time performance, success rate and patient's satisfaction were not significantly different between groups (P > 0.05). CONCLUSION: The block of tibial and common peroneal nerves separately distal to the sciatic nerve bifurcation is superior to single injection block of sciatic nerve above the bifurcation in the popliteal fossa as regard complete sensory block time.

Remifentanil infusion prolongs spinal anesthesia.

Spinal anesthesia was given to a patient undergoing transurethral resection ofprostate (TURP). A total of 3.2 ml of bupivacaine 0.5% mixed with fentanyl 20 mcg were used. The patient started experiencing sensation after 150 min. Remifentanil intravenous infusion prolonged the duration of anesthesia for an additional 105 minutes.

Use of the Bonfils Intubation Fiberscope in patients with limited mouth opening.

Airway management of patients with very limited mouth opening remains a challenge for the anaesthetist. We describe the use of the Bonfils Intubation Fiberscope for awake intubation in two patients with a very limited mouth opening. In the first case, a 60-year-old 80 kg female, scheduled for a right modified radical mastectomy for infiltrating ductal carcinoma (15 mm mouth opening, a short thick neck, limited neck extension, and a Mallampati class 4 airway), the Bonfils was advanced via the retromolar technique. In the second patient, a 34-year-old male, scheduled for a surgical tracheotomy for right tonsillar cancer, due to a neoplastic infiltration of the right temporomandibular joint (7 mm mouth opening and limited neck movement), the Bonfils was advanced using the midline approach. The Bonfils is a reusable, rigid, straight fiberoptic device with a curved tip, is 5 mm in diameter, and has several advantages: it is quick and easy to use, more cost effective than a flexible fiberscope, and is safe in expert hands, thanks to its smaller diameter. Our conclusion is that awake BIF intubation is a reliable, atraumatic, and well-tolerated procedure to secure a safe airway in patients with a limited mouth opening.

Uneventful epidural analgesia in a patient with severe thrombocytopenia.

Epidural analgesia is the most effective method for analgesia in labor. It has, however, contraindications and carries many serious side effects. Though coagulopathy is an absolute contraindication for epidural and axial blocks, yet there are no absolute limits for platelet counts that stand in the way of providing epidural analgesia. In a patient who is writhing in pain due to severe uterine contractions, and in whom there exists a recent normal platelet screening and no history of bleeding disorders, it is internationally acceptable between anesthetists to provide epidural analgesia without waiting for a new platelet screening.