Pharmacogenomic Considerations in Anesthesia and Pain Management

Today's anesthesiology practitioner often is faced with numerous pharmacologic challenges due to the criticality and comorbidities of patients. Adverse drug reactions in anesthesiology may be further complicated by pharmacodynamic or pharmacokinetic alterations caused by genetics. Anesthesiology was one of the first areas of medicine to demonstrate variability in drug response due to underlying genetic variations in enzymatic activity and contribute to the emergence of pharmacogenetics, the melding of pharmacology and genetics. Early genetic examples in this field include pseudocholinesterase deficiency and malignant hyperthermia. The goal of considering pharmacogenomics in clinical practice is to improve therapeutic outcomes and reduce adverse drug reactions. As new pharmacogenomic information becomes available, the clinician should incorporate emerging pharmacogenomics considerations with established pharmacokinetic and pharmacodynamic information in order to evaluate their total contribution to efficacy and adverse drug reactions.