Pharmacogenetics and anaesthesia: the value of genetic profiling.

Approximately 50 years ago, pharmacogenetics was described as a new field of medicine that may explain human drug action. Anaesthesia played a key role in the early investigations. An understanding of how a person's DNA influences drug metabolism and effectiveness may allow individually tailored prescriptions, improving outcomes and safety. The ultimate goal of pharmacogenetic research is to offer tailored personalised medicine to improve both the efficacy of medication and patient safety by helping to predict risk of adverse outcomes. In this review, we present a selection of historical landmarks where anaesthesia has been a catalyst for pharmacogenetic development. We examine the level of evidence and cite examples of candidate genes and common polymorphisms known to alter the response to peri-operative medication. Finally, we set forth current views and potential exciting perspectives that may arise from the application of pharmacogenetics to the daily practice of anaesthesia and pain medicine.

Repeated simulation-based training for performing general anesthesia for emergency cesarean delivery: long-term retention and recurring mistakes.

BACKGROUND: The percentage of women undergoing cesarean delivery under general anesthesia has significantly decreased, which limits training opportunities for its safe administration. The purpose of this study was to evaluate how effective simulation-based training was in the learning and long-term retention of skills to perform general anesthesia for an emergent cesarean delivery. METHODS: During an eight-week obstetric anesthesia rotation, 24 residents attended lectures and simulation-based training to perform general anesthesia for emergent cesarean delivery. Performance assessments using a validated weighted scaling system were made during the first (pre-test) and fifth weeks (post-test) of training, and eight months later (post-retention test). Resident's competency level (weighted score) and errors were assessed at each testing session. Six obstetric anesthesia attending physicians, unfamiliar with the simulation scenario, generated a mean attendings' performance score. The results were compared. RESULTS: At one week of training, residents' performance was significantly below mean attendings' performance score (pre-test: 135±22 vs. 159±11, P=0.013). At five weeks, residents' performance was similar to mean attendings' performance score (post-test: 159±21) and remained at that level at eight months (post-retention test: 164±16). Of the important obstetric-specific tasks, left uterine displacement was missed by 46% of residents at eight months. CONCLUSION: Following lectures and simulation-enhanced training, anesthesia residents reached and retained for up to eight months a competency level in a simulator comparable to that of obstetric anesthesia attending physicians. Errors in performance and missed tasks may be used to improve residency training and continuing medical education.