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15 results

  • 20 - Pain and Anesthesia

  • from II - Therapeutic Areas
  • Edited by Russ B. Altman, Stanford University, California, David Flockhart, Indiana University, David B. Goldstein, Duke University, North Carolina
  • Book:
    Principles of Pharmacogenetics and Pharmacogenomics
    Published online:
    05 June 2012
    Print publication:
    23 January 2012, pp 224-237

  • Summary

    Pain is a fundamental biological response to noxious stimuli, comprising both unpleasant physical perceptions and negative emotions. It signals actual or potential tissue damage, and elicits protective responses needed for survival, such as withdrawal (1). There is profound interindividual variability in the response to noxious stimuli, susceptibility to pain, and the response to analgesics. This chapter will review the genetic factors that influence pain and sensitivity, and the response to drugs for acute and chronic pain therapy. Issues associated with analgesics, such as tolerance, dependence, and withdrawal, will not be addressed. Significant advances in understanding the neurobiology of pain have been made using genetic models (1). This chapter will focus on human pain and analgesia.

    General anesthesia, whose goal is to render a patient insensitive to pain and control physiologic responses in the perioperative period, has as its two most basic elements analgesia and hypnosis (“sleep”). Nevertheless, a typical anesthetic comprises drugs from numerous classes, including benzodiazepine anxiolytics, sedative-hypnotics, inhalation anesthetics, opioids, muscle relaxants and their antagonists, and cardiovascular/vasoactive drugs (so-called balanced anesthesia). This chapter will also review the genetic factors that influence the response to anesthetics, with a focus on drug classes not covered in other chapters. Because opioids are central to both anesthesia and pain therapy, these will be a central focus. It is instructive to note that the field of pharmacogenetics had its birth in anesthesiology, with the discovery by Werner Kalow of heritable responses to the muscle relaxant succinylcholine (2, 3).

Anesthetic Pharmacology
  • Basic Principles and Clinical Practice
  • 2nd edition
  • Edited by Alex S. Evers, Mervyn Maze, Evan D. Kharasch
  • Published online:
    11 April 2011
    Print publication:
    10 March 2011
  • In recent years our understanding of molecular mechanisms of drug action and interindividual variability in drug response has grown enormously. Meanwhile, the practice of anesthesiology has expanded to the preoperative environment and numerous locations outside the OR. Anesthetic Pharmacology: Basic Principles and Clinical Practice, 2nd edition, is an outstanding therapeutic resource in anesthesia and critical care: Section 1 introduces the principles of drug action, Section 2 presents the molecular, cellular and integrated physiology of the target organ/functional system and Section 3 reviews the pharmacology and toxicology of anesthetic drugs. The new Section 4, Therapeutics of Clinical Practice, provides integrated and comparative pharmacology and the practical application of drugs in daily clinical practice. Edited by three highly acclaimed academic anesthetic pharmacologists, with contributions from an international team of experts, and illustrated in full colour, this is a sophisticated, user-friendly resource for all practitioners providing care in the perioperative period.