|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 292-293
Anesthetic drug repurposing: Laurels to anesthetic pharmacology
Jasvinder Kaur Kohli, Rohan Magoon, Iti Shri, Ramesh Chand Kashav
Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi 110001, India
|Date of Submission||02-Jul-2021|
|Date of Decision||09-Aug-2021|
|Date of Acceptance||25-Aug-2021|
|Date of Web Publication||24-Nov-2021|
Dr. Iti Shri
Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi 110001.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kohli JK, Magoon R, Shri I, Kashav RC. Anesthetic drug repurposing: Laurels to anesthetic pharmacology. Bali J Anaesthesiol 2021;5:292-3
The COVID-19 pandemic has relentlessly exposed the vulnerability and loopholes in the existing social, economic, and political structure of the world with the healthcare sector bearing the biggest brunt of the unprecedented challenge.
In this strife against COVID-19, the anesthesiologist and critical care physician have played a major role in a realignment in this crisis responsiveness. Among various strategies, research, and innovations that were either devised or ameliorated during the pandemic, repurposing of drugs and equipment has been one of the crucial strategies, and our major anesthetic drugs too have emerging roles as repurposed drugs.
Drug repurposing is developing new uses for a drug beyond its original use or initially approved indication. This helps to mitigate a long duration of drug development, risks of failure, and financial liabilities as well, thus aiding in crisis management.
So, apart from being an antiemetic, analgesic, and preventing laryngeal edema, dexamethasone with its broad effects on innate and adaptive immunity has been shown to improve patient survival during dysregulated immune response due to COVID-19 infection.
Similarly, propofol via enhanced angiotensin-converting enzyme 2 expression, incrementing lipid rafts, and by dissociating cholesterol-sensitive proteins from ganglioside-1 lipid rafts in vitro inhibiting sigma 1 receptors might have significant favorable vascular endothelium and antiviral effects. Its anti-inflammatory, antithrombotic, and fewer immunosuppressive effects may facilitate recovery from lung injury in COVID-19 infection.
Ketamine, which finds a place as a sedative, analgesic, relief of bronchospasm, has immunomodulatory roles as well. Its N-methyl-D-aspartate receptor antagonism and downregulation of inflammatory cytokine levels, including interleukin-6 (IL‐6), wins a place in the treatment of resistant depression, suicidal ideation, and anxiety disorders that have a high prevalence in COVID-19 patients.
Lidocaine is not just repurposed as an anticancer agent but by the virtue of suppressing NETosis in the perioperative period also has the potential to be used in the treatment for pneumonia-induced adult respiratory distress syndrome (ARDS), thrombosis, and cytokine storm in the COVID-19 pandemic.
By increasing parasympathetic tone and decreasing sympathetic tone, dexmedetomidine appears to confer protective effects on immune function by effects on T cells and suppress excessive immune responses. Apart from beneficial sedative effects, dexmedetomidine helps prevent the onset or progression of multi-organ dysfunction in COVID-19 and ICU delirium.
The volatile agents especially sevoflurane have been found to improve arterial oxygen partial pressure to fraction of inspired oxygen ratio (PaO2/FiO2 ratio) and to reduce IL-6 and tissue necrosis factor-α levels. They have been shown to decrease viral loads and exhibit antibacterial properties in various in-vitro models. With the acute shortage of sedative drugs and ventilators and emergency repurposing of anesthesia machines as ICU ventilators, it is worth investigating volatile agents not just as sedative but also probable therapeutics on systemic inflammation, sepsis, and ARDS in mechanically ventilated COVID-19 patients.
Although every anesthetic agent has its clinical limitations, with the advent and application of physiological and laboratory data through electronic medical records, complex machine learning algorithms, and artificial intelligence-based systems, and the emergence of precision medicine as a new paradigm in medicine, repurposing of anesthetic drugs can be an effective strategy in combating crisis as well as opening up new avenues for research and for improved patient management with a rapid and cost-effective drug development process.
| Financial support and sponsorship|| |
The support was provided solely from institutional and/or departmental sources.
| Conflicts of interest|| |
There are no conflicts of interest.
| References|| |
Zhao H, Davies R, Ma D. Potential therapeutic value of dexmedetomidine in COVID-19 patients admitted to ICU. Br J Anaesth 2021;126:e33-5.
Wei P, Zheng Q, Ye H, Lyu W, Li J, Yang JJ. Putative antiviral effects of propofol in COVID-19. Br J Anaesth2021;126:e188-91.
Akinosoglou K, Gogos A, Papageorgiou C, Angelopoulos E, Gogos C. Ketamine in COVID-19 patients: Thinking out of the box. J Med Virol 2021;93:4069-70.
Finnerty DT, Buggy DJ. A novel role for lidocaine in COVID-19 patients? Br J Anaesth 2020;125:e391-4.
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