Current clinical pharmacology
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Curr Clin Pharmacol · Jan 2015
ReviewAnesthetic pharmacology and perioperative considerations for the end stage liver disease patient.
The number of patients with end stage liver disease is growing worldwide. This is likely a result of advances in medical science that have allowed these patients to lead longer lives since the incidence of diseases such as alcoholic cirrhosis and viral hepatitis have remained stable or even decreased in recent years, at least in more developed nations. Many of these patients will require anesthetic care at some point. ⋯ An understanding of pharmacokinetic principles provides the anesthesiologist with a scientific foundation for achieving therapeutic objectives associated with the use of any drug; however, pathologic conditions often alter the expected kinetic profile of many drugs. Anesthesia providers caring for these patients must be aware of the altered pharmacokinetics that may occur in these patients. We review normal liver physiology, pathophysiology of liver disease in general, and how liver failure affects the pharmacokinetics and pharmacodynamics of anesthetic agents; providing some specific examples.
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Curr Clin Pharmacol · Jan 2015
ReviewAnesthetic pharmacology and perioperative considerations for heart transplantation.
From uncertain beginnings over four decades ago, heart transplantation is now the definitive therapy for end-stage heart failure. This review will attempt to comprehensively cover the broad gamut of anesthetic, hemodynamic, antimicrobial, immunosuppressive and hemostatic agents used by the cardiothoracic anesthesiologist in the perioperative management of patients with endstage heart disease.
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Curr Clin Pharmacol · Jan 2015
ReviewLung transplantation: perioperative pharmacology and anesthetic considerations.
In the past two decades, lung transplantation has become an increasingly important surgical option for the patient with end stage lung disease. Compared with the other solid organ transplants (heart, liver and kidney), lung transplantation carries immense clinical and logistic challenges; long-term organ viability is particularly problematic, with an expected five-year mortality of 40-50%. The number of lung transplants performed in the U. ⋯ From appropriate patient selection, to optimal organ selection, surgical procedure, and immediate and long-term postoperative care, the medical process involves multiple healthcare providers and requires a very well-organized and committed healthcare system to achieve optimal surgical results. Understanding the pharmacology involved in the care of the lung transplant patient is of utmost importance to achieve appropriate organ preservation, immunosuppression, hemodynamic stability, and adequate anesthetic depth, while avoiding drug toxicity and side effects. The purpose of this review is to summarize the pharmacokinetics and pharmacodynamics of the medications most commonly administered to this patient population, throughout the perioperative period.
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The goal of this review is to address the medical implications of placebos and placebo effects in future medical practice. The applications of placebos have become increasingly relevant due to a recent abundance of clinical research that has been conducted on the mechanisms under which a placebo response is formed. With current research on placebo, the thoughts of using placebo effects as an effective form of co-treatment for patients with disorders such as pain, depression or Parkinson's disease might become a feasible proposition. This review focuses on crucial studies that have been done in this area of research with regard to the physiological and psychological mechanisms that are associated with the formation of a placebo effect, as well as emphasizing the patient-clinician relationship and the importance of this relationship for a successful treatment regimen.