Long non-coding RNA MIR4300HG polymorphisms are associated with postoperative nausea and vomiting: a genome-wide association study.

BACKGROUND: Genetic factors such as single-nucleotide polymorphisms (SNPs) play a key role in the development of postoperative nausea and vomiting (PONV). However, previous findings are not widely applicable to different populations because of population-specific genetic variation. We developed a Japanese-specific DNA microarray for high-throughput genotyping. The aim of the current study was to identify SNPs associated with PONV on a genome-wide scale using this microarray in a sample of Japanese surgical patients. METHODS: Associations between 659,636 SNPs and the incidence of PONV 24 h after surgery in a limited sample of 24 female patients were assessed using the microarray. After imputation of genotypes at 24,330,529 SNPs, 78 SNPs were found to be associated with the incidence of PONV. We chose 4 of the 78 SNPs to focus on by in silico functional annotation. Finally, we genotyped these 4 candidate SNPs in 255 patients using real-time PCR to verify association with the incidence of PONV. RESULTS: The T > C variant of rs11232965 in the long non-coding RNA MIR4300HG was significantly associated with reduced incidence of PONV among genotypes and between alleles (p = 0.01 and 0.007). CONCLUSIONS: We identified a novel SNP (rs11232965) in the long non-coding RNA MIR4300HG that is associated with PONV. The rs11232965-SNP variant (T > C) is protective against the incidence of PONV. TRIAL REGISTRATION: This study was registered at the UMIN Clinical Trials Registry (Identifier: UMIN000022903 , date of registration: June 27, 2016, retrospectively registered.

Association of µ-opioid receptor gene (OPRM1) haplotypes with postoperative nausea and vomiting.

Genetic variants, such as single-nucleotide polymorphisms (SNPs), of the µ-opioid receptor gene (OPRM1) might be associated with individual differences in opioid sensitivity, as well as with the incidence and severity of postoperative nausea and vomiting (PONV). The goal of the present study was to determine, in a cohort of Japanese surgical patients, genotypes and haplotypes of several SNPs in the OPRM1 gene, and their association with PONV during the early (first 24 h) postoperative period. We examined the incidence and severity of PONV, during the first 24 h after surgery, in 85 Japanese patients receiving intravenous patient-controlled analgesia fentanyl analgesia for postoperative pain control. Eight tag SNPs of the OPRM1 gene (rs1799971, A/G; rs510769, G/A; rs4870266, G/A; rs3798683, G/A; rs1323042, A/C; rs609623, C/T; rs9397685, A/G; and rs644261, C/G) were selected based on their minor allele frequency (>10%) and linkage disequilibrium strength (<80%), and genotyped for haplotype analysis and determination of associations with PONV. Only one out of eight investigated SNPs, rs9397685, in the intronic part of the OPRM1 gene was associated with differences in the occurrence and severity of PONV. We also found four common haplotypes with a frequency of >10% in the investigated patients, including GGGAACAC (33%), AGGGACAC (19%), GGGAACGC (12%), and AGAGACAC (10%). The severity of PONV in carriers of the GGGAACGC haplotype was significantly lower than in the carriers of the other haplotypes (P < 0.05). One intronic SNP, rs9397685, and haplotypes constructed from eight SNPs within the OPRM1 gene locus might be involved in the severity of PONV associated with general anesthesia and opioid administration. This novel finding, if validated and verified in larger and additional ethnic cohorts, might contribute to better knowledge of the contribution of the OPRM1 gene to PONV.

[Three cases of ATP-induced bronchospasm during thoracic endovascular aortic repair].

We report three cases (73-year-old, 69-year-old and 76-year-old men) of bronchospasm induced by adenosine triphosphate (ATP) during thoracic endovascular aortic repair (TEVAR). Severe broncospasm occurred soon after administration of ATP to obtain transient asystole during TEVAR. All three cases were complicated with asthma or chronic obstructive pulmonary disease (COPD) before TEVAR, and airway hyper-reactivity was suspected. One case (73-year-old) required postoperative intensive care to treat bronchospasm, and the other two cases recovered during the operation. The possible mechanism of adenosine-induced bronchoconstriction is selective interaction with active mast cells with subsequent release of preformed and newly formed mediators. Careful attention should be paid when ATP is injected during TEVAR in patients with asthma or COPD.

Effect of divided supplementation of remifentanil on seizure duration and hemodynamic responses during electroconvulsive therapy under propofol anesthesia.

PURPOSE: Although a reduced dose of propofol combined with remifentanil is often used in anesthesia for electroconvulsive therapy (ECT), there have been few studies in which the optimal technique for injection of remifentanil was examined in detail. The aim of this study was to evaluate the effects of single and divided injection of remifentanil combined with propofol on seizure duration and hemodynamic responses during ECT. METHODS: Twenty-six ASA I-II patients were enrolled in this study and received a total of 78 ECTs. Each patient received propofol 1.2 mg/kg (group P), remifentanil 1 µg/kg followed by propofol 0.5 mg/kg (group R1), and remifentanil 1 µg/kg followed by propofol 0.5 mg/kg and thereafter remifentanil 2 µg/kg (group R2). Succinylcholine 1 mg/kg was used for muscle paralysis after loss of consciousness. RESULTS: Although mean motor seizure durations were significantly longer in groups R1 and R2 than in group P (P < 0.05), they were similar in groups R1 and R2. Although the percentage increases in mean arterial pressure after ECT were significantly smaller in groups P (P < 0.01) and R2 (P < 0.05) than in group R1, they did not significantly differ between groups P and R2. CONCLUSIONS: Divided use of remifentanil at 1 and 2 µg/kg combined with propofol 0.5 mg/kg produces an acceptable outcome in both seizure duration and hemodynamic stability during ECT compared with the standard hypnotic doses of propofol alone or remifentanil 1 µg/kg followed by propofol 0.5 mg/kg.

[A case of coronary stent thrombosis occurring repeatedly in the perioperative period].

A 60-year-old man with angina was scheduled for total gastrectomy, splenectomy, and cholecystectomy. Bare-metal stents were implanted into his left anterior descending coronary artery four weeks before the operation. Aspirin and clopidogrel were administered until one week before the operation and then injection of to 15,000 units of heparin per day was given. Anesthesia was maintained with sevoflurane, remifentanil and fentanyl. At 330 minutes after starting the operation, 2-mm ST segment elevation was observed and it recovered immediately. After the operation, new 9-mm ST segment elevation in leads V2-V6 was observed. Emergent cardiac catheterization showed occlusion of the coronary artery with in-stent thrombosis. An additional stent was implanted and 10,000 units of heparin per day was injected. After five days, new stent thrombosis occurred and an additional stent was implanted. Administration of aspirin, clopidogrel and cilostazol was started immediately. Anesthesiologists should pay attention to the kind of coronary stent, consider the timing of the operation, and continue administration of aspirin.

[Case of laryngeal edema occurring after tracheal extubation presumably due to antihypertensive medications].

A 61-year-old woman underwent microlaryngeal surgery for a vocal cord polyp. Anesthesia was induced with propofol, and vecuronium was given after loss of consciousness. The trachea was intubated smoothly with a Portex tracheal tube with a 6.0 mm in inner diameter and the cuff was inflated to the minimal occlusion volume. Anesthesia was maintained with O2-air-sevoflurane. The surgical procedure was completed without any troubles. Immediately after tracheal extubation, she developed dyspnea with stridor. As marked laryngeal edema was found by direct vision with the aide of a laryngoscope, reintubation was performed and methylprednisolone was administered intravenously. She was extubated on the next day, after confirmation of the tracheal tube cuff leak following the reduction in the cuff pressure. At this time, fiberoptic bronchoscopy revealed that the laryngeal edema had disappeared. For the past history, she had taken amlodipine for 10 years and candesertan for 2 months, and had often experienced dyspnea. It should be kept in mind that preoperative antihypertensive medications might have an impact on occurrence of perioperative laryngeal edema.

Severe hyperglycemic shock associated with hepatic portal venous gas.

We report a case of hyperglycemic shock associated with hepatic portal venous gas. A 79-year-old woman with post-stroke depression developed severe tachycardiac atrial fibrillation and hypotension due to hypovolemia caused by severe hyperglycemia, as well as showing disseminated intravascular coagulation (DIC). Continuous intravenous infusion of insulin and volume loading with normal saline gradually achieved normalization of the serum glucose level and hemodynamic stability. However, the DIC did not resolve, and abdominal computed tomography (CT) revealed hepatic portal venous gas (HPVG) in the left lobe of the liver. Surgery was thus considered mandatory. However, because severe hemodynamic lability occurred again immediately after the CT examination, and persisted, surgery could not be performed, and the patient died of septic shock due to bowel perforation. It was concluded that the underlying causes of DIC should be sought promptly, without delay.