Precision medicine is ammunition for anesthesiologists to improve patient outcomes during the perioperative period:genetic variability of beta-blockers and opioids / 临床麻醉学杂志

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.

Superior vena cava syndrome: a rare complication of percutaneous nephrolithotripsy laser lithotripsy

To describe a case of acute superior vena cava syndrome during percutaneous nephrolithotomy [PCNL], and to review the associated clinical features, management and complications. Clinical features: A 34-year-old man, diagnosed as right renal calculi and nodal tachycardia, was admitted to receive percutaneous nephroscope laser lithotripsy. Shortly after stone disintegration, he suffered acute hypoxic and hypotension, and showed cyanoderma of face and chest skin, ocular proptosis, jugular filling and ventricular fibrillation. Dopamine and adrenaline was intravenously injected. The patient was turned over to supine position and external cardiac massage and electric defibrillation were carried out immediately. The patient finally cardioverted. His vital signs subsequently became stable and cyanoderma faded. The patient was eventually discharged from the intensive care unit three days following the event. Severe complications such as cardiac arrest could happen during PCNL. Close monitoring the vital signs is essential for early finding and quick response to rescue