Why do some people sail through surgery that requires general anesthesia, while others have tremendous difficulty recovering? No doubt some of the difference lies in the specific drug the anesthesiologist or anesthetist uses. In addition, genetic factors may play a role, as they do in fruit flies (Behavior Genetics, Sep. 2011). A reader recently wondered whether genetic testing would help the doctors choose the most appropriate anesthesia.
Trouble With Anesthesia:
Q. I am super sensitive to anesthesia. I can’t tolerate more than 0.25 mg of lorazepam. A colonoscopy can leave me foggy for days. After general anesthesia for sinus surgery, I needed a month to recover from the brain fog.
The last time I had a colonoscopy, I persuaded the anesthetist to use straight propofol with good results.
I am in good health except for my thyroid. Because it has numerous large nodules, my doctor has recommended surgery. Needless to say, I’m extremely apprehensive. Would genetic testing help identify either drugs I should avoid or those that I could tolerate better?
A. We were fascinated by your question and quite surprised to discover so little research appears to have been done in this regard. Two decades ago, an expert in the field of personalized medicine shared his vision that all of us would soon carry a card coded with our genetic susceptibility to drugs. It would make tailored prescribing much easier. His dream has yet to be realized.
Genetic Testing Might Help:
Doctors occasionally use genetic testing to determine whether a person is susceptible to malignant hyperthermia, a potentially life-threatening reaction to anesthesia (Orphanet Journal of Rare Diseases, Aug. 4, 2015). Because this condition is rare, however, they generally reserve the tests for family members of people who have experienced this reaction.
Research has shown that certain genetic profiles are associated with delayed recovery from general anesthesia (Pharmacogenomics, Sep. 1, 2018). The OPRM1 gene appears to govern speed of recovery to some extent. However, clinical factors are also important.
Before your surgery, request a consultation with the anesthesiologist. Your history, as you have outlined it, will be helpful. In addition, the physician may decide to order a pharmacogenomic test to personalize your anesthesia and recovery.