Precision medicine is ammunition for anesthesiologists to improve patient outcomes during the perioperative period:genetic variability of beta-blockers and opioids
- VernacularTitle:围手术期精准医疗有助于麻醉医师改善患者预后:β受体阻滞剂与阿片类药物的遗传变异性
- Author:
Spencer CHRISTOPHER
;
Yang JIANJUN
;
Zuo ZHIYI
- Keywords:
Precision medicine;
Perioperative period;
Beta-blockers;
Opioids
- From:
The Journal of Clinical Anesthesiology
2017;33(9):918-924
- CountryChina
- Language:Chinese
-
Abstract:
The evolving practice of precision medicine allows physicians to make disease treat-ments and prevention decisions based on a patient's individual genetic and molecular profile.In recent years,gene sequencing and related techniques are becoming more affordable and more accessible to healthcare providers,and their use in various medical fields continues to expand.In particular,there are numerous opportunities for the use of precision medicine in the perioperative setting.For example, individual polymorphisms in alpha and beta adrenergic receptors can improve the efficacy of beta blockade,or predispose a patient to adverse drug reactions including hypotension and bradycardia. Likewise,particular polymorphisms in opioid receptors can increase or decrease the effectiveness of various opioid medications for achieving adequate postoperative analgesia.In addition,mutations in the cytochrome P4502D6 (CYP2D6)enzyme can drastically affect the clinical response to a particular subset of beta blockers and opioids by accelerating or decelerating their metabolism and clearance. Preoperative genetic testing would allow anesthesiologists to identify these and other relevant molecu-lar characteristics in their patients,and choose appropriate perioperative therapies accordingly in order to maximize clinical outcomes while minimizing the incidence of adverse events.It is the time for anes-thesiologists and perioperative care providers to practice precision medicine.
