Precision Medicine: an Interesting Role in Anesthesia

Main Article Content

Sudta Parkkamodom


In those days, a doctor took care of patients
indifferently. The treatment on the par-individualized
medicine-was based on statistical data of the population.
However, people characteristics are diversified by means
of genotype which affecting pharmacodynamics and
pharmacokinetics. Thus, this management-the precision
medicine-becomes more specific.
In anesthesia, the quantitative determination of
pseudocholinesterase by dibucaine number, is a good
example for everyone to understand the genetic effects
on anesthetic drug, as succinylcholine.
However, in monitored anesthesia care, the personnel
need more information on pharmacogenomics of
morphine-induced respiratory depression. This is to avoid
over dosage of the pain-killer.
In the near future, knowledge of anesthesia personnel
with different experience will insidiously decline by means
of genetic testing.

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1. Heilmeyer L, Schoen R, de Rudder B. Moderne Probleme
der Humangenetik [Internet]. 1914-93; [cited 2019 March
20]. Available from:
1007/978-3-642-94744-5_2#authorsandaffiliationsVogel F.
Modern problems of human genetics. Ergeb Inn Med
Kinderheild 12. 1959, p 52-125.
2. Vogel F, Buselmaier W, Reichert W, Kellermann G, Berg P.
Human genetic variation in response to medical and
environmental agents [Internet]. International Titisee
Conference; October 13th-15th, 1977; Schwarzwald-Hotel,
Titisee, Black Forest, Federal Republic of Germany. Black
Forest;Springer Verlag; 1978. [cited 2019 March 20].
Available from:
3. Roll-Hansen N. The holist tradition in twentieth century
genetics. Wilhelm Johannsen’s genotype concept. J Physiol
2014; 592(11): 2431-8.
4. Yu X, Schneiderhan-Marra N, Joos TO. Protein Microarrays
for Personalized Medicine. Clinical Chemistry 2010; 56(3):
5. Duarte TT, Spencer CT. Personalized Proteomics: the Future
of Precision Medicine. Proteomes 2016; 4(4): 29; doi:
6. Susztak K, Bottinger E P. Diabetic Nephropathy: a Frontier
for Personalized Medicine. J Am Soc Nephrol 2006; 17: 361-7.
7. Mesko B. The role of artificial intelligence in precision
medicine [Internet]. Expert Review of Precision Medicine and
Drug Development, 2:5, 239-241, DOI: 10.1080/23808993.
2017.1380516. [cited 2019 March 20]. Available from: https://
8. Mesko B. Expert review of precision medicine and drug
development [Internet]. J Expert Review of Precision
Medicine and Drug Development [cited 2018 May 21]; 2 (5).
doi:10.1080/23808993.2017.1380516. [cited 2019 March
20]. Available from:
9. Ray A. Artificial intelligence and block chain for precision
medicine [Internet]. Inner Light Publishers. [cited 2018 May
21]. Available from:
10. Lu YF, Goldstein DB, Angrist M, Cavalleri G. Personalized
medicine and human genetic diversity. Cold Spring Harbor
Perspectives in Medicine 2014; 4 (9): a008581-a008581.
11. Harrod K. Precision Medicine in Anesthesia [Internet].
Genetic Component in Opioid-induced Respiratory
Depression. [cited 2019 March 20]. Available from: https:// last update Posted
June 27, 2018.
12. Kirchheiner J, Seeringer A. Clinical implications of
pharmacogenetics of cytochrome P450 drug metabolizing
enzymes. Biochem Biophys Acta 2007; 1770: 489-94.
13. Tracy TS. Metabolism and Excretion of Drugs. In: Craig CR,
Stitzel RE. Editors. Modern Pharmacology with Clinical
Applications. 6th edition. [Internet]. Philadelphia: Lippincott
Williams & Wilkins; 2004. p 34-47. [cited 2019 March 20].
Available from:
14. Zanger UM, Schwab M. Cytochrome P450 enzymes in drug
metabolism [Internet]. Regulation of gene expression,
enzyme activities, and impact of genetic variation.
Pharmacology & Therapeutics 2013; 138: 103-41. [cited
2019 March 20]. Available from: https://www.sciencedirect.
15. Cascorbi I. Pharmacogenetics of cytochrome P4502D6:
genetic background and clinical implication. Eur J Clin Invest
2003; 33: 17-22.
16. Sistonena J, Sajantilaa A, Laoc O, Coranderb J, Barbujanid
G, Fusellia S. CYP2D6 worldwide genetic variation shows
high frequency of altered activity variants and no continental
structure. Pharmacogenetics and Genomics 2007; 17: 93-101.
17. Weinshilboum RD. Pharmacogenomics: Catechol
O-methyltransferase to Thiopurine S-methyltransferase. Cell
Mol Neurobiol 2006; 26: 539-61.
18. Song DK, Zhao J, Zhang LR. TPMT genotype and its clinical
implication in renal transplant recipients with azathioprine
treatment. J Clin Pharm Ther 2006; 31: 627- 35.
19. Ansari A, Aslam Z, De Sica A, et al. Influence of xanthine
oxidase on thiopurine metabolism in Crohn’s disease.
Aliment Pharmacol Ther 2008; 28: 749-57.
20. Rassekh SR, Ross CJD. Cancer Pharmacogenomics in
Children. In: Dellaire G, Berman J, Arceci R, Editors. Cancer
Genomics From Bench to Personalized Medicine.
Massachusetts: Academic Press; 2014. p 79-81.
21. Gibson GG, Skett P. En Introduction to Drug Metabolism
[Internet]. 3rd ed. Cheltenham: Nelson Thornes Publishers;
2001. p 73-84. [cited 2016 March 21]. Available from: https://
dq=Gibson+GG, +Skett+P.+En+Introduction+to+Drug+
22. Kraft JC, Kim J, Schwinn DA, Landau R. A History of
Pharmacogenomics Related to Anesthesiology. In: Eger II
EI, Saidman LJ, Westhorpe RN. Editors. The Wondrous
Story of Anesthesia. 2nd ed. London: Springer Science &
Business Media; 2014. p 585-96.
23. Formea CM, Nicholson WT. Pharmacogenomic Considerations
in Anesthesia and Pain Management [Internet]. In: Dasgupta
A, Langman LJ. Editors. Pharmacogenonmics in Clinical
Therapeutics. 1st ed. Oxford: WILEY-BLACKWELL; 2012.
[cited 2016 March 21] Available from: T82&dq= pseudoch
24. Bryson EO, Kellner CH. Eletroconculsive Therapy [Internet].
In: Reed AP, Yudkowitz FS. Editors. Clinical Cases in
Anesthesia. 4th ed. Philadelphia: ELSEVIER; 2014. p 82-85.
[cited 2016 March 21]. Available from: acquired+
25. Trescot AM. Genetics and implications in perioperative
analgesia [internet]. Best Practice and Research Clinical
Anaesthesiology 2014; 28: 153-166. [cited 2016 March 21].
Avaliable from:
263810526_genetics_and_anesthesia 26. Ashraf MW,
Peltoniemi MA, Olkkola KT, Neuvonen PJ, Saari TI.
Semimechanistic Population Pharmacokinetic Model to
Predict the Drug-Drug Interaction Between S- ketamine and
Ticlopidine in Healthy Human Volunteers. Citation: CPT
Pharmacometrics Syst. Pharmacol 2018; 7: 687-97; doi:
27. Peltoniemi MA, Hagelberg NM, Olkkola KT, Saari TI.
Ketamine: A Review of Clinical Pharmacokinetics and
Pharmacodynamics in Anesthesia and Pain Therapy. [internet].
Clin Pharmacokinet 2016; 55(9): 1059-77. [cited 2019
March 20]. doi: 10.1007/s40262-016-0383-6.
28. UCLA Anesthesiology & Perioperative Medicine [Internet].
Precision Medicine; [cited 2019 March 20]. Available from: