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Copyright of Anaesthesiology & Rescue Medicine / Anestezjologia i Ratownictwo is the property of Akademia Medycyny Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Pain has a significant negative impact on the quality of life of cancer patients and implies numerous clinical consequences. Moderate to severe pain is common in patients receiving palliative care. A major issue is the individual variability resulting in different degrees of response to the analgesic effects of opioids, including morphine, and to the occurrence of their adverse effects. According to one of the theories of pharmacogenomics, single nucleotide polymorphisms (SNPs) are associated with opioid metabolism. Material and methods: A literature review of the PubMed database identified 18 scientific articles concerning SNPs that affect the analgesic effects and adverse effects of morphine or other opioids, per morphine equivalent, from which additional 22 scientific articles were retrieved. Results: The review identified SNPs in the genes OPRM1 A118G, COMT rs4680, ABCB1 C3435T, IL-6, IL-8, TNF-a, TAOK3, HTR3B, UGT1A1/UGT1A8 and OPRM1 Arg181Cys, which were found to affect both the occurrence of potential adverse effects and the different demand in palliative care patients for a dose of morphine that will effectively relieve pain. SNPs were found to significantly affect morphine metabolism; the determination of this effect is individual-based. Most studies were conducted in small groups of individuals from ethnically diverse populations, which, if mutations are present, may significantly affect the efficacy of opioid-related SNP assays and the response of patients to the analgesic treatment administered. Conclusions: Findings raise the prospect of the use of SNPs in clinical practice as part of personalised medicine in the future. [ABSTRACT FROM AUTHOR]

Hospice patients experience a variety of symptoms in the last hours and days of life, which cause mental and physical suffering. One form of management is the use of controlled sedation. It aims to relieve symptoms that are resistant to treatment and cannot be controlled by other methods. A new group of drugs that are helpful in reducing agitation and controlled sedation of the patient, and are applicable in shallow procedural sedation of patients in end-stage life-threatening diseases, are those acting on alpha-2-adrenergic receptors in the CNS: dexmedetomidine and clonidine. This review presents the actions and possible benefits of dexmedetomidine in palliative medicine, including the following: easier control of sedation compared to widely used benzodiazepines, clinically significant improvement in the treatment of pain with opioid drugs and reduction of the need for opioids, improvement of sleep quality, better control of shortness of breath, vomiting, and cough, and the neuroprotective effect of the drug. Dexmedetomidine exhibits clinical effects by various routes of administration – intravenous, subcutaneous, or intranasal – and it is also possible to use it in combination with other drugs widely used in palliative medicine. For situations in which all treatments are exhausted, palliative sedation is considered helpful and highly effective, and dexmedetomidine provides an interesting alternative to benzodiazepines. [ABSTRACT FROM AUTHOR]

Copyright of Palliative Medicine / Medycyna Paliatywna is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)