Correlation of MDR1 gene polymorphism with propofol combined with remifentanil anesthesia in pediatric tonsillectomy

Clinical Importance of Potential Genetic Determinants Affecting Propofol Pharmacokinetics and Pharmacodynamics

Interindividual variability in response to drugs used in anesthesia has long been considered the rule, not the exception. It is important to mention that in anesthesiology, the variability in response to drugs is multifactorial, i.e., genetic and environmental factors interact with each other and thus affect the metabolism, efficacy, and side effects of drugs. Propofol (2,6-diisopropylphenol) is the most common intravenous anesthetic used in modern medicine. Individual differences in genetic factors [single nucleotide polymorphisms (SNPs)] in the genes encoding metabolic enzymes, molecular transporters, and molecular binding sites of propofol can be responsible for susceptibility to propofol effects. The objective of this review (through the analysis of published research) was to systematize the influence of gene polymorphisms on the pharmacokinetics and pharmacodynamics of propofol, to explain whether and to what extent the gene profile has an impact on variations observed in the clinical response to propofol, and to estimate the benefit of genotyping in anesthesiology. Despite the fact that there has been a considerable advance in this type of research in recent years, which has been largely limited to one or a group of genes, interindividual differences in propofol pharmacokinetics and pharmacodynamics may be best explained by the contribution of multiple pathways and need to be further investigated.

Effects of genetic polymorphisms of ABCB1 on the efficacy of anesthetic and analgesic agents: a systematic review

Aim: To perform a systematic review to determine the effect of ABCB1 (1236C>T, 2677G>T/A and 3435C>T) variants on the effects of anesthetic and analgesic agents in various surgical procedures. Materials & methods: Literature was obtained from established databases and reference tracking. The main outcome measures were efficacy of anesthetic and analgesic agents intraoperative or within 48 h post surgery of human population. Results: Seventeen studies were included for data extraction from 1127 screened studies. The influences of ABCB1 gene polymorphisms on analgesic effects showed conflicting results. The mutational homozygous TT genotypes of 1236C>T and 3435C>T polymorphisms demonstrated significant association with the anesthetic effects. Conclusion: The mutational homozygous TT genotype in both ABCB1 1236C>T and 3435C>T is associated with weaker anesthetic effect but there are no clearly demonstrated analgesic effects.

The effects of remifentanil combined with propofol on the oxidative damage and the stress and inflammatory responses in cardiac surgery patients

OBJECTIVE

This paper aims to explore the effects of remifentanil combined with propofol on the stress responses, oxidative damage, and inflammatory responses in cardiac surgery patients.

METHODS

One hundred and four patients who underwent cardiac surgery in our hospital from August 2017 to March 2019, were recruited as the study cohort and divided into control and observation groups. The 50 patients in the control group were anesthetized with fentanyl and propofol, and the 54 patients in the observation group were anesthetized with remifentanil and propofol. The general clinical data were observed and compared between the two groups. At different time points, changes in the oxidative stress response indicators (mean artery pressure (MAP) and heart rate (HR)) and in the cardiac function indexes (left ventricular ejection fraction (LVEF), stroke volume (SV), and cardiac output (CO)) were observed. The inflammatory cytokine levels (high-sensitivity C-reactive protein (hs-CRP), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α)) were analyzed using enzyme-linked immunosorbent assays (ELISA). The patients' postoperative recovery (time to spontaneous respiration, time to opening eyes, extubation time) and their Visual Analogue Scale (VAS) scores were observed. Their pain at half an hour and at 24 hours after the operation were observed, as well as their postoperative adverse reactions.

RESULTS

There were no differences in the general data between the two groups (P>0.05). Compared with the patients in the control group, the patients in the observation group had better oxidative stress levels and better cardiac function indexes (P<0.05), better postoperative inflammatory cytokine levels (P<0.05), better postoperative recovery (P<0.05), lower postoperative pain scores (P<0.05), and a lower total incidence of adverse reactions (P<0.05).

CONCLUSION

Remifentanil combined with propofol can effectively reduce oxidative stress and inflammatory responses in cardiac surgery patients.

Influence of Potential Gene Polymorphisms on Propofol Dosage Regimen in Patients Undergoing Abdominal Hysterectomy

Propofol (2,6-diisopropylphenol) is the most common intravenous anesthetic used in modern medicine. It is postulated that individual differences in genetic factors [polymorphism of single nucleotide polymorphisms (SNPs)] in the genes encoding metabolic enzymes, molecular targets and molecular binding sites of propofol can be responsible for susceptibility to propofol effects. The aim of our study was to investigate the influence of the cytochrome P450 2B6 isozyme CYP2B6 (rs3745274), γ-aminobutyric acid type A (GABAA) receptor α1 subunit GABRA1 (rs2279020) and ATP-binding cassette subfamily B member 1 ABCB1 (rs1045642) gene polymorphisms on propofol therapeutic outcomes in the patients undergoing abdominal hysterectomy. Ninety patients aged 29-74 years, with different ethnicities were included in this study. The presence of polymorphisms was analyzed using TaqMan SNP genotype analysis on Stratagene MxPro 3005P real-time polymerase chain reaction (qPCR). The distribution of all three genetic variants was within the Hardy-Weinberg equilibrium. There was no significant difference (p >0.05) in the allelic frequencies of polymorphic variants and genotype distributions between adult and older patients and between patients of different ethnicities. Our study did not detect a statistically significant influence of the CYP2B6 (c.516G>A), GABRA1 (c.1059+15G>A) and ABCB1 (c.3435T>C) variants on the variability of clinical parameters (doses for induction in anesthesia, additional doses, induction time and wake time after anesthesia and side effects of propofol). However, the observed trend on the possible influence of the CYP2B6 (c.516G>A) and GABRA1 (c.1059+15G>A) variants warrant an extension of these studies on a larger number of patients.

Challenges in anesthesia personalization: resolving the pharmacogenomic puzzle

Clinicians are witnessing differences in the doses required for induction and maintenance of anesthesia, as well as prolonged recovery in some patients. Predictable factors like patient characteristics, factors related to the procedure, pharmacological characteristics of anesthetics and adjunctive drugs, might explain some of the observed differences. However, the role of various polymorphisms of genes encoding for drugs’ molecular targets, transporters and metabolic enzymes can have a significant impact on anesthesia outcome, too. In the present paper, we critically discuss pharmacological characteristics of the most common drugs used in anesthesia, with a focus on the possible genetic background of unpredictable diversities in anesthesia outcomes.