Pharmacogenomic Considerations for Medications in the Perioperative Setting

Abstract

Several high-profile examples of adverse outcomes from medications used in the perioperative setting are well known (e.g., malignant hyperthermia, prolonged apnea, respiratory depression, inadequate analgesia), leading to an increased understanding of genetic susceptibilities underlying these risks. Pharmacogenomic information is increasingly being utilized in certain areas of medicine. Despite this, routine preoperative genetic screening to inform medication risk is not yet standard practice. In this review, we assess the current readiness of pharmacogenomic information for clinical consideration for several common perioperative medications, including description of key pharmacogenes, pharmacokinetic implications and potential clinical outcomes. The goal is to highlight medications for which emerging or considerable pharmacogenomic information exists and identify areas for future potential research.

Keywords::

• analgesia
• anesthesia
• genetic markers
• genomics
• genotyping
• perioperative
• pharmacogenetics
• pharmacogenomic
• precision medicine
• surgery

Acknowledgments

We thank E Schierer for her assistance with preparing this manuscript.

Financial & competing interests disclosure

This work was supported by NIH/NHGRI 1R01HG009938-01A1 (PH O’Donnell), by the University of Chicago Clinical Therapeutics Training Grant (NIH/NIGMS T32GM007019; for EH Jhun as a trainee) and by an Innovations Grant from the University of Chicago Medicine Office of Clinical Effectiveness (DM Dickerson and PH O’Donnell). We do want our article to be deposited on the NUHMS/PMC system. MJ Ratain is a coinventor holding patents related to pharmacogenetic diagnostics and receives royalties related to UGT1A1 genotyping. No royalties were received from this work. EH Jhun is an employee and stockholder of Base10 Genetics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

This work was supported by NIH/NHGRI 1R01HG009938-01A1 (PH O’Donnell), by the University of Chicago Clinical Therapeutics Training Grant (NIH/NIGMS T32GM007019; for EH Jhun as a trainee) and by an Innovations Grant from the University of Chicago Medicine Office of Clinical Effectiveness (DM Dickerson and PH O’Donnell). We do want our article to be deposited on the NUHMS/PMC system. MJ Ratain is a coinventor holding patents related to pharmacogenetic diagnostics and receives royalties related to UGT1A1 genotyping. No royalties were received from this work. EH Jhun is an employee and stockholder of Base10 Genetics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.