Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2012
ReviewPediatric dermatologic procedures performed outside the operating room.
Pediatric dermatologic procedures performed outside of the operating room are often painful and frequently require general anesthesia. Laser procedures constitute a relatively small but significant group of the growing number of these encounters. This article reviews relevant dermatological pathophysiology, current treatment modalities and collates currently available evidence to inform the best practice in anesthetic care of these patients. ⋯ Anesthesiologists are increasingly providing care for children undergoing dermatologic out-of-operating room procedures. Similar general considerations for out-of-operating room anesthesia equally apply to children undergoing these procedures. There are few recently reported data pertaining to this patient population and further work is needed.
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Curr Opin Anaesthesiol · Aug 2012
ReviewComputational genetic discoveries that could improve perioperative medicine.
The review examines the rationale and translational utility of computational genetic studies using murine models of biomedical traits. ⋯ The results have generated new treatments for alleviating incisional pain and narcotic drug withdrawal symptoms, which are now in clinical trials. A recent study identified allelic differences affecting chronic pain responses in mice and humans, which may enable a new 'personalized' approach to treating chronic pain.
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Curr Opin Anaesthesiol · Aug 2012
ReviewFundamental concepts of epigenetics for consideration in anesthesiology.
Epigenetics dictate how the genetic blueprint is ultimately expressed and, therefore, is fundamental to our understanding of disease etiology and cellular responses and consequences to exposure of stimuli, such as anesthetics and perioperative stress. The goal of this review is to provide a concise overview of the fundamental concepts in epigenetics and discuss how epigenetics may be incorporated into research studies in anesthesiology. ⋯ Epigenetic mechanisms underlie many human pathological conditions and impact clinical management in a variety of contexts. Although epigenetic research related to anesthesiology is sparse at the present, the full understanding of the mechanism of action of analgesics, interindividual variations in responses to anesthetics and consequences of exposure to anesthetic drugs will likely require the evaluation and integration of epigenetic information into current research paradigms.
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Curr Opin Anaesthesiol · Aug 2012
ReviewInduced changes in protein receptors conferring resistance to anesthetics.
Although general anesthetics have been provided effectively for many years, their exact molecular underpinnings remain relatively unknown. In this article, we discuss the recent findings associated with resistance to anesthetic effects as a way of shedding light on these mechanisms. ⋯ Information about the possible targets and molecular nature of anesthetic action is being derived from studies of anesthetic resistance in γ aminobutyric acid receptors, tandem pore potassium channels, and an apparently wide variety of protein systems within the nematode, Caenorhabditis elegans.
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This review will discuss the most recent developments in pharmacogenetics of commonly used perioperative medications, new collaboration networks in the field of personalized medicine, and future clinical implications of pharmacogenetics. ⋯ In the near future, pharmacogenetic approaches may facilitate personalized perioperative intervention trials.