Journal of Anaesthesiology Clinical Pharmacology

COMMENTARY
Year
: 2014  |  Volume : 30  |  Issue : 1  |  Page : 19-

Vitamin D and anesthesia: Is our present knowledge sufficient?


Basavana G Goudra1, Preet Mohinder Singh2,  
1 Hospital of the University of Pennsylvania, Philadelphia, USA
2 Department of Anaesthesia, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Correspondence Address:
Basavana G Goudra
3400 Spruce Strett, 680 Dulles, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
USA




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


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 2020 Nov 26 ];30:19-19
Available from: https://www.joacp.org/text.asp?2014/30/1/19/125688


Full Text

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

1Osunkwo 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.
2Jackson 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.
3McNally 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.
4Tarek 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.
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7Christakos 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.