Monitored anesthesia care (MAC) sedation: clinical utility of fospropofol

Fospropofol, a phosphorylated prodrug version of the popular induction agent propofol, is hydrolyzed in vivo to release active propofol, formaldehyde, and phosphate. Pharmacodynamic studies show fospropofol provides clinically useful sedation and EEG/bispectral index suppression while causing significantly less respiratory depression than propofol. Pain at the injection site, a common complaint with propofol, was not reported with fospropofol; the major patient complaint was transitory perianal itching during the drug’s administration. Although many clinicians believe fospropofol can safely be given by a registered nurse, the FDA mandated that fospropofol, like propofol, must be used only in the presence of a trained anesthesia provider

Anti-emetic drugs in oncology: pharmacology and individualization by pharmacogenetics

Objective Nausea and vomiting are the most distressful side effects of cytotoxic drugs in cancer patients. Antiemetics are commonly used to reduce these side effects. However, the current antiemetic efficacy is about 70–80% in patients treated with highly-emetogenic cytotoxic drugs. One of the potential factors explaining this suboptimal response is variability in genes encoding enzymes and proteins which play a role in metabolism, transport and receptors related to antiemetic drugs. Aim of this review was to describe the pharmacology and pharmacogenetic concepts of of antiemetics in oncology. Method Pharmacogenetic and pharmacology studies of antiemetics in oncology published between January 1997 and February 2010 were searched in PubMed. Furthermore, related textbooks were also used for exploring the pharmacology of antiemetic drugs. The antiemetic drugs which were searched were the 5-hydroxytryptamine 3 receptor antagonists (5-HT3RAs), dopamine antagonists, corticosteroids, benzodiazepines, cannabinoids, antihistamines and neurokinin-1 antagonists. Result The 5-HT3RAs are widely used in highly emetogenic chemotherapy in combination with dexamethasone and a neurokinin-1 antagonist, especially in acute phase. However, the dopamine antagonists and benzodiazepines were found more appropriate for use in breakthrough and anticipatory symptoms or in preventing the delayed phase of chemotherapy induced nausea and vomiting. The use of cannabinoids and antihistamines need further investigation. Only six articles on pharmacogenetics of the 5-HT3RAs in highly emetogenic chemotherapy are published. Specifically, these studies investigated the association of the efficacy of 5-HT3RAs and variants in the multi drug resistance 1 (MDR1) gene, 5-HT3A,B and C receptor genes and CYP2D6 gene. The pharmacogenetic studies of the other antiemetics were not found in this review. Conclusion It is concluded that pharmacogenetic studies with antiemetics are sparse. It is too early to implement results of pharmacogenetic association studies of antiemetic drugs in clinical practice: confirmation of early findings is required

Combinatoriality in the vocal systems of nonhuman animals

A key challenge in the field of human language evolution is the identification of the selective conditions that gave rise to language's generative nature. Comparative data on nonhuman animals provides a powerful tool to investigate similarities and differences among nonhuman and human communication systems and to reveal convergent evolutionary mechanisms. In this article, we provide an overview of the current evidence for combinatorial structures found in the vocal system of diverse species. We show that considerable structural diversity exits across and within species in the forms of combinatorial structures used. Based on this we suggest that a fine‐grained classification and differentiation of combinatoriality is a useful approach permitting systematic comparisons across animals. Specifically, this will help to identify factors that might promote the emergence of combinatoriality and, crucially, whether differences in combinatorial mechanisms might be driven by variations in social and ecological conditions or cognitive capacities

Anesthesia in the Radiation Oncology Suite

Cancer continues to be a leading cause of mortality worldwide and ranks second among the pediatric population. Radiation therapy (XRT) is a potent tool used by oncologists to manage this disease. Although treatment is typically painless, the need for immobilization has resulted in anesthesiologists frequently being consulted to provide service to these patients during their treatment. In addition to the challenges of providing anesthesia in a non–operating room environment, the provider must tailor an appropriate anesthetic for the simulation or XRT treatment sessions. Complications are rare but may be exacerbated by the distance between the patient and the anesthesia provider. Finally, the anesthesiologist must be prepared to discuss issues related to multiple anesthetic exposures with the patient and caregivers