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Fulltext A preliminary report on anaesthesia for thoracoscopic oesophagectomy

Sia AT

Med J Malaysia, 1997 Dec;52(4):433-7.
PMID: 10968123

The anaesthetic experience in three patients undergoing thoracoscopic oesophagectomy is discussed. The indications for surgery and the premorbid states are outlined. The necessity for one-lung ventilation, with its attendant cardiopulmonary effects, the difficulty of patient access and the assessment of blood loss were the main problems encountered. Pulmonary morbidity was high in the post-operative period despite the avoidance of thoracotomy. Two patients developed persistent vocal cord paralysis. In conclusion, the role of thoracoscopic oesophagectomy needs further evaluation.
Innate Immune and Neuronal Genetic Markers Are Highly Predictive of Postoperative Pain and Morphine Patient-Controlled Analgesia Requirements in Indian but Not Chinese or Malay Hysterectomy Patients

Barratt DT, Sia AT, Tan EC, Somogyi AA

Pain Med, 2021 Nov 26;22(11):2648-2660.
PMID: 34015137 DOI: 10.1093/pm/pnab172

OBJECTIVE: Pain severity and opioid requirements in the postoperative period show substantial and clinically significant inter-patient variation due mainly to factors such as age, surgery type, and duration. Genetic factors have not been adequately assessed except for the neuronal OPRM1 rs1799971 and COMT rs4680, whereas the contribution of innate immune signaling pathway genetics has seldom been investigated.
SETTING: Hospital surgical ward.
SUBJECTS: Women (107 Indian, 184 Malay, and 750 Han Chinese) undergoing total hysterectomy surgery.
METHODS: Morphine consumption, preoperative pain, and postoperative pain were evaluated in relation to genetic variability comprising 19 single-nucleotide polymorphisms (SNPs) in 14 genes involved in glial activation, inflammatory signaling, and neuronal regulation, plus OPRM1 (1 SNP) and COMT (3 SNPs).
RESULTS: Pre- and postoperative pain and age were associated with increased and decreased morphine consumption, respectively. In Chinese patients, only 8% of the variability in consumption could be explained by these nongenetic and genetic (BDNF, IL1B, IL6R, CRP, OPRM1, COMT, MYD88) factors. However, in Indian patients, 41% of morphine consumption variability could be explained by age (explaining <3%) and variants in OPRM1 rs1799971, CRP rs2794521, TLR4 rs4986790, IL2 rs2069762, COMT rs4818, TGFB1 rs1800469, and IL6R rs8192284 without controlling for postoperative pain.
CONCLUSIONS: This is the highest known value reported for genetic contributions (38%) to morphine use in the acute postoperative pain setting. Our findings highlight the need to incorporate both genetic and nongenetic factors and consider ethnicity-dependent and nonadditive genotypic models in the assessment of factors that contribute to variability in opioid use.
Ethnic differences in pain perception and patient-controlled analgesia usage for postoperative pain

Tan EC, Lim Y, Teo YY, Goh R, Law HY, Sia AT

J Pain, 2008 Sep;9(9):849-55.
PMID: 18550441 DOI: 10.1016/j.jpain.2008.04.004

There are reports suggesting that sensitivity to and tolerance of both clinical and experimental pain differ among ethnic groups. We examined self-rated pain score and morphine usage in 1034 women who underwent elective lower cesarian section (LSCS) for their deliveries. Data on pain scores and amount of total morphine use according to patient-controlled analgesia were collected every 4 hours. Overall, lowest pain scores were recorded 12 hours after surgery and highest at 24 hours. Morphine consumption was highest within the first 4 hours and lowest between 12 and 16 hours. There were statistically significant ethnic group differences in pain scores (P = 1.7 x 10(-7)) and morphine usage (P = 2.8 x 10(-15)) between ethnic groups, with Indians having the highest mean pain score and using the highest amount of morphine. The ethnic differences in pain score and morphine self-administration persisted after controlling for age, body mass index, and duration of operation.

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