Genomics relevant to the neuroanaesthesiologist

Chidambaran, Vidya

doi:10.4103/2348-0548.174735

Cited by 2 publications

(1 citation statement)

References 109 publications

(98 reference statements)

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“…Model cerebralne protekcije hiperbaričkim kisikom (HBO) protiv ishemijske ozljede mozga jedan je od zadnjih u nizu pretkliničkih istraživanja 38 . Recentna istraživanja u području neuroanestezije ulaze u varijacije DNK nukleotida, polimorfizma pojedinog proteina i njegovog specifičnog odgovora na djelovanje anestetika, u cerebralnu protekciju i otpornost na cerebralnu ishemiju 39 . Nagli razvoj tehnologije, znanosti, a samim tim i neuroanesteziološke struke pratila je kako intelektualna tako i organizacijska logistika.…”

Section: Razvoj Suvremene Neuroanestezijeunclassified

Povijest neuroanestezije

Murselovic¹,

Kovač²

2023

Med. Flum. (Online)

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Razvoj neuroanestezije neraskidivo je povezan s razvojem neurokirurgije. Zbog spoznaje da neuroanestezija ima svoje specifičnosti zbog same prirode neurokirurgije, kao zasebno polje anestezije razvija se na prijelazu 19. u 20. stoljeće. Tek napretkom tehnologije i znanosti, napose u drugoj polovici 20. stoljeća, neuroanestezija iskazuje svoj puni potencijal. Klinička struka prolazi svoj put od spoznaje da fiziološke parametre (puls i tlak) treba kontinurano pratiti i zapisivati, zahvaljujući dr. Harveyu Cushingu, do praćenja učinka anestetika na vrijednosti EEG-a, intrakranijalnog tlaka, cerebralnog protoka krvi i metabolizma mozga. Zahvaljujući brojnim vrsnim stručnjacima, kao što su Albert Faulconer, John Mitchenfelder, James Cotrell i Roy Cucchiara, neuroanestezija je postala uža specijalnost unutar anesteziologije, sa svojim društvima, svojim časopisima i stručnim skupovima.

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Section: Razvoj Suvremene Neuroanestezijeunclassified

Povijest neuroanestezije

Murselovic¹,

Kovač²

2023

Med. Flum. (Online)

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PHARMACOGENETIC ASPECTS OF THE USE OF PERIOPERATIVE DRUGS IN PEDIATRICS. Review

Кhaitovych

Kysil²,

Zhovnir³

2022

Med. Sci. of Ukr.

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Relevance. It is known that in children the frequency of perioperative critical events due to the introduction of drugs is more than 5%. For example fentanyl, which is used as an adjunct to surgical anesthesia, is a major factor in increasing the number of deaths from opioid overdoses. Among the areas of reducing the frequency of severe adverse reactions to perioperative drugs - taking into account the pharmacogenetic variations of the patient. Objective is to consider current data on pharmacogenetic aspects of pharmacokinetics and pharmacodynamics of perioperative drugs. Methods. Analysis of the data presented in PubMed by keywords "pharmacogenetics", "general anesthetics", "analgesics", "muscle relaxants", "children". Search depth – 7 years (2014-2020), with a retrospective deepening of some positions until 2002. Results. The pharmacogenetic aspects of the pharmacokinetics of perioperative drugs are related to the genes of the enzymes that metabolize them and their transporters. Current data on the prevalence of polymorphic alleles of CYP2C9 genes (provides metabolism of nonsteroidal anti-inflammatory and anticonvulsant drugs) and CYP2D6 (metabolizes opioids, antidepressants, antiemetics) in Europe and, in particular, in Ukraine were presented. Thus, the inactive allele CYP2C19 * 2 was found in 13%, while the allele of increased activity CYP2C19 * 17 - in 25% of the population of Ukraine; allele with lost CYP2D6 function (CYP2D6 * 4) - in 18.6% of Ukrainians. Homozygotes with CYP2C9 * 3 polymorphism metabolize nonsteroidal anti-inflammatory drugs much more slowly than wild-type carriers, which may lead to their accumulation and side effects. The analgesic effect of codeine occurs only after it is metabolized in the liver by CYP2D6 to morphine. Respiratory depression, apnea and death may occur in patients with excessive metabolic rate even after a single dose of codeine; however, was noted the ineffectiveness of ondansetron due to a decrease in its concentration in the blood in thesepatients. Concomitant use of midazolam and fentanyl may prolong the effect of fentanyl by competing metabolism of midazolam by the hepatic enzyme CYP3A4, especially in patients with low metabolism. Plasma butyrylcholinesterase deficiency reduces succinylcholine inactivation in 1 in 1,500 people. Changing the genotype of uridine diphosphate glycosyltransferase causes increased glucuronidation of morphine, which may lead to a decrease in its effectiveness. As an example of pharmacogenetic changes in pharmacodynamics can be considered malignant hyperthermia, which occurs due to exposure to volatile anesthetics and depolarizing muscle relaxants in mutations in the RYR1 gene. Carriers of the minor allele (G) of the 5HT2A rs6313 gene require less propofol and 40% less time to start induction of anesthesia. Conclusions. The efficacy and safety of perioperative drugs are largely related to the pharmacogenetic aspects of their pharmacokinetics, especially mutations in genes of enzymes of the metabolism. Mutations in the genes of volatile anesthetic receptors and depolarizing muscle relaxants when their used cause a risk of malignant hyperthermia. The application of pharmacogenetics is the need to titrate drugs that have significant variability of action depending on the genotype. It is advisable to avoid the use of drugs with a high risk of pharmacogenetic reactions, if other alternative drugs are available.

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Genomics relevant to the neuroanaesthesiologist

Cited by 2 publications

References 109 publications

Povijest neuroanestezije

Povijest neuroanestezije

PHARMACOGENETIC ASPECTS OF THE USE OF PERIOPERATIVE DRUGS IN PEDIATRICS. Review

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