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Perioperative Considerations in Pharmacology

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Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care

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Abstract

Although anesthesiologists are adept at caring for the perioperative patient and the many physiologic aberrations resulting from surgery and anesthesia, management of perioperative pharmacology presents its own diverse set of challenges. Pharmacologic considerations for the perioperative period include the impact of (1) variable responses based on the patient’s genotype and/or phenotype, (2) preexisting diseases and drug therapies, (3) interactions with herbal supplementation, and (4) the physiologic changes associated with anesthesia. Many surgical patients are on chronic medications for comorbidities unrelated to the diagnosis that brought them to the OR. Anesthesiologists must be aware of both the effects of withdrawing chronic medications and the potential for interactions between “home” medications and the many drugs administered during the perioperative period. In addition to pharmacologic interactions, patient-specific factors like weight and genetic makeup will also impact the anesthetic plan. This chapter will discuss these factors, as well as anesthetic implications of commonly used medications, including herbal supplements. The side effects of nicotine and other aspects of cigarette smoking will also be discussed due to its prevalence and important anesthetic implications. Finally, the impact of anesthesia and surgery on human physiology and subsequent effects on drug metabolism will be reviewed.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA

    Angela Vick MD, Amaresh Vydyanathan MD, MS, Tarang Safi MD & Karina Gritsenko MD

  2. Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA

    Karina Gritsenko MD

Authors
  1. Angela Vick MD
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  2. Amaresh Vydyanathan MD, MS
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  3. Tarang Safi MD
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  4. Karina Gritsenko MD
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Corresponding author

Correspondence to Angela Vick MD .

Editor information

Editors and Affiliations

  1. Departments of Anesthesiology and Pharmacology, LSU Health Sciences Center, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, Stockton, California, USA

    Adam M. Kaye

  3. Center for Perioperative Management and Medical Informatics, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

Chemical Structures

Chemical Structures

Chemical Structure 5.1
figure 1

Propofol

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Chemical Structure 5.2
figure 2

Rocuronium bromide

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Vick, A., Vydyanathan, A., Safi, T., Gritsenko, K. (2015). Perioperative Considerations in Pharmacology. In: Kaye, A., Kaye, A., Urman, R. (eds) Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8948-1_5

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  • DOI: https://doi.org/10.1007/978-1-4614-8948-1_5

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