(Anesth Analg. 2019 Jan 8. doi: 10.1213/ANE.0000000000003975) Numerous studies have evaluated the risks and benefits of intrathecal fentanyl when added to bupivacaine during cesarean delivery. While potential advantages of intrathecal fentanyl over intrathecal morphine include faster onset and less cephalad spread, some have feared an increased risk of respiratory depression, a “ceiling effect” at doses >0.25 μg/kg, and increased postoperative intravenous opioid requirement. In order to clarify the benefits, harms, and optimal dosing of this opioid for cesarean delivery, these authors systematically reviewed evidence regarding the efficacy and safety of fentanyl when used as an additive to intrathecal bupivacaine with and without morphine.

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(Anesth Analg. 2020;130:111–125) Cesarean delivery procedures have become more popular over the past few decades, and spinal anesthesia is a commonly used method of anesthesia for that operation. A majority of surveyed members of the Society for Obstetric Anesthesia and Perinatology stated that they preferred to administer hyperbaric 0.75% bupivacaine spinal anesthesia for cesarean deliveries, while a smaller percentage of anesthesiologists reported adding fentanyl, morphine, or a combination of both to an intrathecal bupivacaine solution. The addition of intrathecal opioids to spinal anesthesia medication has been reported to be effective for pain relief in some cases, but researchers are still unsure of the benefits, drawbacks, and optimal dosages of these medications. These investigators conducted their systematic review and meta-anlaysis to analyze the effectiveness of fentanyl both alone and in combination with morphine when added to intrathecal bupivacaine anesthesia during a cesarean delivery.

Genomic instability in the tumor tissue has been correlated with tumor progression. In the present study, chromosomal aberrations (CAs) in peripheral blood lymphocytes (PBLs) of breast tumor patients were studied to assess whether chromosomal instability (CIN) in PBLs correlates with aggressiveness of breast tumor (i.e., disease stage) and has any prognostic utility. Cultured blood lymphocyte metaphases were scored for aberrations in 31 breast cancer patients and 20 healthy age and sex-matched controls. A variety of CAs, including aneuploidy, polyploidy, terminal deletions, acentric fragments, double minutes, chromatid separations, ring chromosome, marker chromosome, chromatid gaps, and breaks were seen in PBLs of the patients. The CAs in patients were higher than in controls. A comparison of the frequency of metaphases with aberrations by grouping the patients according to the stage of advancement of disease did not reveal any consistent pattern of variation in lymphocytic CIN. Neither was any specific chromosomal abnormality found to be associated with the stage of cancer. This might be indicative of the fact that cancer patients have constitutional CIN, which predisposes them to the disease, and this inherent difference in the level of genomic instability might play a role in disease progression and response to treatment.

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