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Table of Contents
COMMENTARY
Year : 2014  |  Volume : 30  |  Issue : 1  |  Page : 19

Vitamin D and anesthesia: Is our present knowledge sufficient?


1 Hospital of the University of Pennsylvania, Philadelphia, USA
2 Department of Anaesthesia, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Date of Web Publication24-Jan-2014

Correspondence Address:
Basavana G Goudra
3400 Spruce Strett, 680 Dulles, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
USA
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Source of Support: None, Conflict of Interest: None


PMID: 24574587

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How to cite this article:
Goudra BG, Singh PM. Vitamin D and anesthesia: Is our present knowledge sufficient?. J Anaesthesiol Clin Pharmacol 2014;30:19

How to cite this URL:
Goudra BG, Singh PM. Vitamin D and anesthesia: Is our present knowledge sufficient?. J Anaesthesiol Clin Pharmacol [serial online] 2014 [cited 2019 Sep 21];30:19. Available from: http://www.joacp.org/text.asp?2014/30/1/19/125688

The therapeutic role of vitamin D in chronic pain associated with sickle cell disease (SCD) is well-established. [1] However, its role in acute pain during SCD crises is investigational and no conclusions can be drawn with the available evidence. [2] Recently, McNally et al., [3] observed that, postoperatively, most patient's with congenital heart disease undergoing corrective surgeries were vitamin D deficient, probably due to low preoperative levels and a significant intraoperative decline. No definitive relationship could be established between the deficiency and analgesic requirements. The authors of present study have focused upon a completely unexplored aspect of vitamin D supplementation on analgesic requirements. [4] There is demonstrable evidence to validate the efficacy of vitamin D in managing the pain of diabetic and other neuropathies. [5],[6] Could it be that vitamin D has adjuvant analgesic properties? In the present study, treatment of vitamin D deficiency led to significant falls in analgesic requirements. [5] It is also possible that sickle cell patients with vitamin D deficiency often have defective bone mineralization, which in turn can lead to chronic pain (requiring treatment) and heightened perioperative analgesic requirements. It would be interesting to see future studies comparing analgesic demands in relation to preoperative vitamin D levels. The authors also found significantly lower heart rate in these patients with increased sedation levels. Interestingly, no narcotic was used in induction or for analgesia and the only sedative used was inhalation agent for induction and maintenance. These findings again pose questions for future research for interaction of inhalation agents in relation to vitamin D levels.

Additionally, anti-inflammatory properties of vitamin D are well-known. [6] This property could potentially lower postoperative pain by suppressing surgical site inflammation. We support the authors in treating preoperative vitamin D deficiency prior to surgery for multiple additional benefits. This, however, with presently available limited evidence does not justify routine testing or correcting vitamin D levels during preanesthetic checkup in patients without SCD undergoing surgery. SCD often predisposes to infections (patients either undergo surgical splenectomy or even auto splenectomy) and vitamin D has well-established role in optimal functioning of immune system. [7] In conclusion, even though the results of the present study need further elucidation of mechanisms, they certainly open the possibility of yet another supplementary option to manage pain of SCD.

 
  References Top

1.Osunkwo I, Ziegler TR, Alvarez J, McCracken C, Cherry K, Osunkwo CE, et al. High dose vitamin D therapy for chronic pain in children and adolescents with sickle cell disease: Results of a randomized double blind pilot study. Br J Haematol 2012;159:211-5.  Back to cited text no. 1
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2.Jackson TC, Krauss MJ, Debaun MR, Strunk RC, Arbeláez AM. Vitamin D deficiency and comorbidities in children with sickle cell anemia. Pediatr Hematol Oncol 2012;29:261-6.  Back to cited text no. 2
    
3.McNally JD, Menon K, Chakraborty P, Fisher L, Williams KA, Al-Dirbashi OY, et al. Impact of anesthesia and surgery for congenital heart disease on the vitamin d status of infants and children: A prospective longitudinal study. Anesthesiology 2013;119:71-80.  Back to cited text no. 3
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4.Tarek Shams, Hamed Al Wadani, Ragaa El-Masry, Ossama Zakaria. Effect of prophylactic vitamin D on anesthetic outcome in children with sickle cell disease. J Anaesth Clin Pharmacol 2014; 30:20-4.  Back to cited text no. 4
    
5.Lee P, Chen R. Vitamin D as an analgesic for patients with type 2 diabetes and neuropathic pain. Arch Intern Med 2008;168:771-2.  Back to cited text no. 5
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6.Arnson Y, Gringauz I, Itzhaky D, Amital H. Vitamin D deficiency is associated with poor outcomes and increased mortality in severely ill patients. QJM. 2012;105:633-9.  Back to cited text no. 6
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7.Christakos S, Hewison M, Gardner DG, Wagner CL, Sergeev IN, Rutten E, et al. Vitamin D: Beyond bone. Ann N Y Acad Sci 2013;1287:45-58.  Back to cited text no. 7
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