Clinical pharmacology and therapeutics
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Clin. Pharmacol. Ther. · Jul 2008
ReviewA continuum for using placebo interventions in regional anesthesia and analgesia studies.
The anesthesiologist Henry K. Beecher is commonly associated with his crusade for informed consent for research. Less recognized is his contribution to the development of principles of randomized controlled trials through his emphasis on surgery as placebo to minimize bias. This article reviews Beecher's contribution and how it should be applied to modern studies of perioperative analgesia.
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Clin. Pharmacol. Ther. · Jul 2008
ReviewRegulatory challenges facing closed-loop anesthetic drug infusion devices.
Closed-loop anesthetic drug infusion devices show great promise for improving the consistency and safety of general anesthesia. Despite the numerous reports demonstrating the feasibility and potential advantages of these systems in a research setting, a wide range of regulatory, business, and clinical issues will need to be resolved before a closed-loop anesthesia delivery product can be successfully introduced into the market and incorporated into general practice.
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Clin. Pharmacol. Ther. · Jul 2008
ReviewSimulated drug administration: an emerging tool for teaching clinical pharmacology during anesthesiology training.
A thorough understanding of the dose-response relationship is required for optimizing the efficacy of anesthetics while minimizing adverse drug effects. Nowadays, except for the inhaled anesthetics (for which end-tidal concentrations can be measured online), most of the drugs used in clinical anesthesia are administered using standard dosing guidelines, without giving due consideration to their pharmacokinetics and dynamics in guiding their administration. Various studies have found that introducing pharmacokinetics and pharmacodynamics as part of the inputs in clinical anesthesiology could lead to better patient care. ⋯ Clinical pharmacology is one of the most challenging topics to teach in anesthesiology. The development of simulators to illustrate the time course of a drug's disposition and effect provides online visualization of pharmacokinetic-pharmacodynamic information during the clinical use of anesthetics. The aim of this review is to discuss the importance of simulation as a clinical pharmacology teaching tool for trainees in anesthesiology.
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In 1947, a second power of anesthesia was described: "With anesthetic agents we seem to have a tool for producing and holding at will, and at little risk, different levels of consciousness--a tool that promises to be of great help in studies of mental phenomena." In 1995, anesthetic manipulation was coupled with neuroimaging, paving the way for detailed assessments of the relationship between the structure and the functioning of the brain. Anesthesia combined with neuroimaging thus provides a unique tool for investigating the neural correlates of human cognition.
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The mechanism of the analgesic action of acetaminophen involves the serotonergic system. This study explores how acetaminophen interferes with serotonergic descending pain pathways. Eighteen rapid metabolizers of tropisetron were included in this double-blind cross-over study. ⋯ After CPT, AUC (%*min) of Ap (1,561+/-429) was larger than before CPT (393+/-382, P<0.05); these effects were totally inhibited by tropisetron. Acetaminophen reinforces descending inhibitory pain pathways; it suggests a supraspinal target for acetaminophen's antinociceptive action. This study also confirmed that there is a central serotonergic mechanism of action for acetaminophen that is not stimulus-dependent.