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2026, Número S1

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Rev Mex Anest 2026; 49 (S1)


De la variabilidad a la precisión: el nuevo paradigma anestésico

Díaz-Hernández, E

Idioma: Español
Referencias bibliográficas: 32
Paginas: 454-456
Archivo PDF: 757.63 Kb.


FRAGMENTO

LA COMPLEJIDAD DE
LA VARIABILIDAD

Se entiende como variabilidad, en el contexto anestésico, a aquellas diferencias significativas en la respuesta a los fármacos tanto entre diferentes individuos, es decir, variabilidad interindividual, como en un mismo individuo en diferentes momentos, es decir, variabilidad intraindividual.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Borden BA, Jhun EH, Danahey K, Schierer E, Apfelbaum JL, AnitescuM, et al. Appraisal and development of evidence-based clinicaldecision support to enable perioperative pharmacogenomic application.Pharmacogenomics J [Internet]. 2021;21:691-711. Available in: https://doi.org/10.1038/s41397-021-00248-2

  2. Zhang Y, Wang Z, Wang Y, Jin W, Zhang Z, Jin L, et al. CYP3A4and CYP3A5: the crucial roles in clinical drug metabolism and thesignificant implications of genetic polymorphisms. PeerJ [Internet].2024;12:e18636. Available in: https://doi.org/10.7717/peerj.18636

  3. Kumar S, Kundra P, Ramsamy K, Surendiran A. Pharmacogenetics ofopioids: a narrative review. Anaesthesia [Internet]. 2019;74:1456-1470.Available in: https://doi.org/10.1111/anae.14813

  4. Stone ME, Kelz MB, Proekt A, Wasilczuk AZ. A probabilistic model ofbehavioural emergence from general anaesthesia in mice. Br J Anaesth[Internet]. 2025;135:121-133. Available in: https://doi.org/10.1016/j.bja.2025.02.036

  5. Zhang D, Wei Y. Distinct neural Mechanisms between anesthesiainduction and emergence: A Narrative review. Anesth Analg[Internet]. 2024;141:162-171. Available in: https://doi.org/10.1213/ane.0000000000007114

  6. Lee U. Emergence from general anaesthesia: stochastic or deterministic?Br J Anaesth [Internet]. 2025;135:5-8. Available in: https://doi.org/10.1016/j.bja.2025.04.002

  7. Schnider TW, Minto CF, Luginbühl M, Egan TD. The drug titrationparadox: more drug does not correlate with more effect in individualclinical data. Br J Anaesth [Internet]. 2022;129:861-867. Available in:https://doi.org/10.1016/j.bja.2022.05.036

  8. Thompson A, Fleischmann KE, Smilowitz NR, De Las FuentesL, Mukherjee D, Aggarwal NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperativecardiovascular management for noncardiac surgery. J Am Coll Cardiol[Internet]. 2024;84:1869-1969. Available in: https://doi.org/10.1016/j.jacc.2024.06.013

  9. Aceto P, Incalzi RA, Bettelli G, Carron M, Chiumiento F, CorcioneA, et al. Perioperative management of elderly patients (PriME):recommendations from an Italian intersociety consensus. Aging Clin ExpRes [Internet]. 2020;32:1647-1673. Available in: https://doi.org/10.1007/s40520-020-01624-x

  10. Lamperti M, Romero CS, Guarracino F, Cammarota G, VetrugnoL, Tufegdzic B, et al. Preoperative assessment of adults undergoingelective noncardiac surgery. Eur J Anaesthesiol [Internet]. 2024;42:1-35.Available in: https://doi.org/10.1097/eja.0000000000002069

  11. Rogobete AF, Bedreag OH, Papurica M, Popovici SE, Bratu LM, RataA, et al. Multiparametric monitoring of hypnosis and nociceptionantinociceptionbalance during general anesthesia—a new era in patientsafety standards and healthcare management. Medicina [Internet].2021;57:132. Available in: https://doi.org/10.3390/medicina57020132

  12. Saugel B, Michard F, Scheeren TWL. Goal-directed therapy: hit earlyand personalize! J Clin Monit Comput [Internet]. 2017;32(:375-377.Available in: https://doi.org/10.1007/s10877-017-0043-x

  13. Saugel B, Vincent JL. Protocolised personalised peri-operativehaemodynamic management. Eur J Anaesthesiol [Internet]. 2019;36:551-554. Available in: https://doi.org/10.1097/eja.0000000000001015

  14. Tulbah Y, Aljamaan I. Advances in pharmacokinetic-pharmacodynamicmodeling for anesthesia, 1987–2024: a review. Front Pharmacol[Internet]. 2026;17:1741851. Available in: https://doi.org/10.3389/fphar.2026.1741851

  15. Feng Y, Xu J, Ma H, Wang E, Bian J, Fang X, et al. Chinese clinicalpractice guidelines for total intravenous anaesthesia: a systematicreview and expert consensus-based recommendations. Br J Anaesth[Internet]. 2025;136:876-896. Available in: https://doi.org/10.1016/j.bja.2025.09.038

  16. Vandemoortele O, Hannivoort LN, Vanhoorebeeck F, Struys MMRF,Vereecke HEM. General purpose pharmacokinetic-pharmacodynamicmodels for target-controlled infusion of anaesthetic drugs: a narrativereview. J Clin Med [Internet]. 2022;11:2487. Available in: https://doi.org/10.3390/jcm11092487

  17. Borden BA, Jhun EH, Danahey K, Schierer E, Apfelbaum JL, AnitescuM, et al. Appraisal and development of evidence-based clinicaldecision support to enable perioperative pharmacogenomic application.Pharmacogenomics J [Internet]. 2021;21:691-711. Available in: https://doi.org/10.1038/s41397-021-00248-2

  18. Zhang Y, Wang Z, Wang Y, Jin W, Zhang Z, Jin L, et al. CYP3A4and CYP3A5: the crucial roles in clinical drug metabolism and thesignificant implications of genetic polymorphisms. PeerJ [Internet].2024;12:e18636. Available in: https://doi.org/10.7717/peerj.18636

  19. Kumar S, Kundra P, Ramsamy K, Surendiran A. Pharmacogenetics ofopioids: a narrative review. Anaesthesia [Internet]. 2019;74:1456-1470.Available in: https://doi.org/10.1111/anae.14813

  20. Stone ME, Kelz MB, Proekt A, Wasilczuk AZ. A probabilistic model ofbehavioural emergence from general anaesthesia in mice. Br J Anaesth[Internet]. 2025;135:121-133. Available in: https://doi.org/10.1016/j.bja.2025.02.036

  21. Zhang D, Wei Y. Distinct neural Mechanisms between anesthesiainduction and emergence: A Narrative review. Anesth Analg[Internet]. 2024;141:162-171. Available in: https://doi.org/10.1213/ane.0000000000007114

  22. Lee U. Emergence from general anaesthesia: stochastic or deterministic?Br J Anaesth [Internet]. 2025;135:5-8. Available in: https://doi.org/10.1016/j.bja.2025.04.002

  23. Schnider TW, Minto CF, Luginbühl M, Egan TD. The drug titrationparadox: more drug does not correlate with more effect in individualclinical data. Br J Anaesth [Internet]. 2022;129:861-867. Available in:https://doi.org/10.1016/j.bja.2022.05.036

  24. Thompson A, Fleischmann KE, Smilowitz NR, De Las FuentesL, Mukherjee D, Aggarwal NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperativecardiovascular management for noncardiac surgery. J Am Coll Cardiol[Internet]. 2024;84:1869-1969. Available in: https://doi.org/10.1016/j.jacc.2024.06.013

  25. Aceto P, Incalzi RA, Bettelli G, Carron M, Chiumiento F, CorcioneA, et al. Perioperative management of elderly patients (PriME):recommendations from an Italian intersociety consensus. Aging Clin ExpRes [Internet]. 2020;32:1647-1673. Available in: https://doi.org/10.1007/s40520-020-01624-x

  26. Lamperti M, Romero CS, Guarracino F, Cammarota G, VetrugnoL, Tufegdzic B, et al. Preoperative assessment of adults undergoingelective noncardiac surgery. Eur J Anaesthesiol [Internet]. 2024;42:1-35.Available in: https://doi.org/10.1097/eja.0000000000002069

  27. Rogobete AF, Bedreag OH, Papurica M, Popovici SE, Bratu LM, RataA, et al. Multiparametric monitoring of hypnosis and nociceptionantinociceptionbalance during general anesthesia—a new era in patientsafety standards and healthcare management. Medicina [Internet].2021;57:132. Available in: https://doi.org/10.3390/medicina57020132

  28. Saugel B, Michard F, Scheeren TWL. Goal-directed therapy: hit earlyand personalize! J Clin Monit Comput [Internet]. 2017;32(:375-377.Available in: https://doi.org/10.1007/s10877-017-0043-x

  29. Saugel B, Vincent JL. Protocolised personalised peri-operativehaemodynamic management. Eur J Anaesthesiol [Internet]. 2019;36:551-554. Available in: https://doi.org/10.1097/eja.0000000000001015

  30. Tulbah Y, Aljamaan I. Advances in pharmacokinetic-pharmacodynamicmodeling for anesthesia, 1987–2024: a review. Front Pharmacol[Internet]. 2026;17:1741851. Available in: https://doi.org/10.3389/fphar.2026.1741851

  31. Feng Y, Xu J, Ma H, Wang E, Bian J, Fang X, et al. Chinese clinicalpractice guidelines for total intravenous anaesthesia: a systematicreview and expert consensus-based recommendations. Br J Anaesth[Internet]. 2025;136:876-896. Available in: https://doi.org/10.1016/j.bja.2025.09.038

  32. Vandemoortele O, Hannivoort LN, Vanhoorebeeck F, Struys MMRF,Vereecke HEM. General purpose pharmacokinetic-pharmacodynamicmodels for target-controlled infusion of anaesthetic drugs: a narrativereview. J Clin Med [Internet]. 2022;11:2487. Available in: https://doi.org/10.3390/jcm11092487




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