Cellular and Molecular Anesthesia: from Bench to Bedside

Cellular and Molecular Anesthesia: from Bench to Bedside
In the current practice of anesthesia, each day, anesthesiologists deal with a great work: they use the cellular mechanisms of drug molecules to induce their desired effects for induction and maintenance of anesthesia to achieve appropriate tolerance of surgery and its pain, modulation of stress response, sedation needed for performing a variety of procedures, emergency anesthesia care, acute and chronic pain management or other everyday jobs of anesthesiologists during perioperative period.
As a matter of fact, molecular anesthesia has been cited for more than 6 decades though in a
very limited scale. In 1956, the molecular mechanisms of morphine and pethidine are described (1). Pauling in 1961 published an article in Science describing a molecular theorey for general anesthesia (2).
In its report “the World in 2025”, Thomson Reuters has predicted clinical medicine would be the most active research front; while molecular biology has the 9th rank (3). But are we still practicing in clinic the same as today?
In fact, the future trend of anesthesia is highly dependent on finding the novel cellular and molecular mechanisms and the possible interactions of the newly discovered molecules and inreraction mechanisms with organ systems. Today, we emphasize on the role of pharmacologists, physiologists, immunologists, anatomists, embryologists, geneticians, cellular medicine specialists, physicists and other basic science specialists; some very interesting examples are published in this volume of the Journal (4-7).
However, changes that have well started now would “revolutionize” our daily practice during the next decade in such a way that it will change the basis of medicine: presumably we will have a new model medicine known as “personalized medicine” or “precision medicine”. In this approach, the content of each patient’s genes accompanied with his/her cellular and molecular analysis is used as the basis for further diagnosis and treatment, tailoring the most appropriate treatment for each individual; some aspects of this novel approach like genetic makeup or genetic profile of an individual’s tumor is nowadays approved by FDA (8-10).
In the approach of personalized medicine, not only clinical and psychological modalities are used for clinical management of patients, genetic, proteomic and pharmacogenomic methods are used as well. Techniques known as “bench techniques” are much more used in clinic, at times even more than the conventional assessment tools and diagnostic methods (11, 12). Personalized medicine has satrted a few years ago and we will be incorporated in every day practice; clinical anesthesia practice is not only excluded, but seems to be among the front line fields due to the nature of anesthesia; especially when looking at the nearly 7 decades history of interactions between cellular and molecular medicine and anesthesia.
Cellular and molecular anesthesia is going to pave its way from bench to bedside. Possibly, in the next years, the remnants of the arbitrary line between clinical and basic medicine is completely removed ; this would not take to many years.
The Thomson Reuters report “the World in 2025” has very well quoted François Voltaire just the line after its title: “It is said that the present is pregnant with the future”.