Pharmacogenomics and end-organ susceptibility to injury in the perioperative period

Abstract

Genomic medicine has provided new mechanistic understanding for many complex diseases over the last 5-10 years. More recently genomic approaches have been applied to the perioperative paradigm, facilitating identification of patients at high risk for adverse events, as well as those who will respond better/worse to specific pharmacologic therapies. The consistent biological theme emerging is that while inflammation is important in healing from surgical trauma, patients who are too robustly proinflammatory appear to be at higher risk for adverse perioperative events. Precise predictors of each adverse event are being elucidated so that corrective therapeutics can be instituted to improve outcomes in high-risk patients. While the field of perioperative genomics could be considered in its infancy, such approaches are the wave of the future.

Genomics relevant to the neuroanaesthesiologist

“…[50][51][52] Genetic risk factors have also been described for post-operative arrhythmias (IL-6 174G/C). [53] Readers are referred to an excellent review on perioperative genomics by Schwinn and Podgoreanu [54] for further elaboration.…”

Pharmacogenetics and anaesthesia: the value of genetic profiling

“…Numerous clinical trials and reviews have surfaced in recent years describing genetic associations with clinical outcomes in the field of anaesthesia, peri‐operative outcomes and pain medicine [15–29]. Nonetheless, many clinicians remain sceptical and often wonder about the relevance of genetic research, as it is often considered that titration of drugs to the desired effect works well.…”

Pharmacogenetics and Obstetric Anesthesia and Analgesia

“…Numerous clinical trials and reviews have surfaced in recent years describing genetic associations with clinical outcomes in the field of anesthesia, peri-operative outcomes and pain medicine [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] . An overview of all the drugs utilized in the peri-operative and peripartum period is beyond the scope of this review.…”