The effect of beta‐2 adrenergic receptor haplotype variations on the haemodynamic response following spinal anaesthesia for caesarean delivery*

Abstract

SummaryWe investigated whether genetic variations of the beta-2 adrenergic receptor (ADRB2) modulate the haemodynamic response following spinal anaesthesia for caesarean delivery. We focused on the effects of haplotypes formed by combinations of the Arg16Gly and Gln27Glu polymorphisms. Clinical data from 143 healthy parturients were collected. Only the ArgGln haplotype appeared to influence the risk of hypotension, most probably through a recessive mode of inheritance (p = 0.027). Therefore, patients were grouped according to ArgGln homozygosity in two groups: presence of one or no copies of the haplotype (n = 120) or two copies of the haplotype (n = 23). Both groups presented similar baseline characteristics. Comparatively, patients homozygous for the ArgGln haplotype presented consistently higher blood pressure levels throughout the evaluation period (p = 0.001 for systolic arterial pressure variation from baseline). In conclusion, our results demonstrate that haplotype variations of the the ADRB2 modulate the haemodynamic response following spinal anaesthesia for caesarean delivery. The description of genetic markers that could identify parturients more susceptible to develop hypotension would have a therapeutic interest, and a more individualised approach could then be undertaken. Moreover, this information may improve our knowledge of the genetic mechanisms involved with haemodynamic regulation, contributing to investigations in different clinical scenarios, such as septic shock.

Ephedrine requirements during spinal anesthesia for cesarean delivery in Jordanian parturients: association with β2-adrenoceptor gene variants

“… 8 In a Chinese cohort, Landau et al found that the maternal β2AR genotype did not affect ephedrine requirements during elective cesarean delivery. 10 Results obtained by Daher et al in Brazil, 11 supported their previous study 9 in which patients homozygous for the Arg16 genotype were protected against arterial hypotension after induction of spinal anaesthesia for cesarean delivery. In a more recent study that was performed in adult patients of Caucasian ethnicity undergoing major abdominal surgery, the results coincided with ours, as they found that after sympathetic block by thoracic epidural anesthesia, Gly16 and Glu27 allele carriers in the β2AR gene had greater vasopressor requirements to sustain arterial normotension compared to homozygous Arg16 and Gln27 carriers.…”

Prediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies

“…11,14,18 We speculate that these parameters are not direct determinants of blood pressure, restricting their predictive efficacy. Although polymorphisms within the ADRB2 gene were associated with increased risk, 15 genotype screening is not a routine procedure. Some studies addressed the predictive value of parameters measured after spinal anesthesia, for example, sensory block level, 25,38 decrease in ScO 2 after spinal anesthesia, 29 and PI or PVI changes after spinal anesthesia.…”

“…Patients in most studies received a 500-1000 mL crystalloid preload 11,12 or 500-2000 mL crystalloid coload. [13][14][15] Other studies used 500-mL colloid preload 10,16 or coload 17 as fluid infusion strategy. Vasopressors used to treat spinal anesthesia-induced hypotension were bolus doses of ephedrine 5-15 mg and/or phenylephrine 25-100 µg in most studies.…”

“…Daher et al 15 reported the relationship between beta-2 adrenergic receptor (ADRB2) genetic polymorphism and blood pressure during spinal anesthesia-induced hypotension. Two copies of the ArgGln haplotype were associated with a lower risk for hypotension (52.2% vs 75.0%; OR 0.36, 95% confidence interval 0.15 to 0.91; P=0.042).…”