Anesthetic Implications of Pharmacogenetics

In a recent editorial in Anesthesiology 1 the authors stated that ‘‘education in genomics will be essential for practitioners to translate genomic discoveries into clinical practice.’’ The Refresher Course lecture on which this chapter is based was designed to be part of that effort. First, basic concepts and nomenclature of genetics are reviewed. We will then discuss examples of the influence of genetic information and genetic research strategies upon patient care in anesthesia. Envision that you are reviewing the laboratory results for your next patient and you find that the blood counts and serum chemistries are all within normal limits. However, you notice that your patient has had genetic testing and is carrying the allele A290G (*1b) for the gene CYP3A4, homozygous for butyrylcholinesterase Asp70Gly polymorphism, and has an alarming single nucleotide polymorphism (SNP) analysis of natriuretic peptide receptor C/guanylate cyclase C (atrionatriuretic peptide receptor C), also known as NPR3, and natriuretic peptide precursor A (NPPA) and B (NPPB) genes (Supplemental Digital Content 1, http://links.lww.com/ASA/ A459). As she comes into your office, you see that she has flaming red hair. During the interview she claims that she requires large doses of local anesthetics when she visits the dentist. Would this information alter your anesthetic plan?