We use cookies to improve your experience. By continuing to browse this site, you accept our cookie policy.×
Skip main navigation
Open Drawer MenuClose Drawer Menu
Aging Health
Bioelectronics in Medicine
Biomarkers in Medicine
Breast Cancer Management
CNS Oncology
Colorectal Cancer
Concussion
Epigenomics
Future Cardiology
Future Medicine AI
Future Microbiology
Future Neurology
Future Oncology
Future Rare Diseases
Future Virology
Hepatic Oncology
HIV Therapy
Immunotherapy
International Journal of Endocrine Oncology
International Journal of Hematologic Oncology
Journal of 3D Printing in Medicine
Lung Cancer Management
Melanoma Management
Nanomedicine
Neurodegenerative Disease Management
Pain Management
Pediatric Health
Personalized Medicine
Pharmacogenomics
Regenerative Medicine
Research Article

Clinical and pharmacogenetics associated with recovery time from general anesthesia

    Shangchen Xie‡

    Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, Hunan, PR China

    ‡Authors contributed equally

    Search for more papers by this author

    ,
    Wenjuan Ma‡

    Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China

    ‡Authors contributed equally

    Search for more papers by this author

    ,
    Minxue Shen

    Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China

    Search for more papers by this author

    ,
    Qulian Guo

    Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China

    Search for more papers by this author

    ,
    E Wang

    Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China

    Search for more papers by this author

    ,
    Changsheng Huang

    Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China

    Search for more papers by this author

    ,
    Yueling Wang

    Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China

    Search for more papers by this author

    ,
    Xiang Chen

    Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China

    Search for more papers by this author

    ,
    Zhaoqian Liu

    Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, Hunan, PR China

    Search for more papers by this author

    ,
    Wei Zhang

    Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, Hunan, PR China

    Search for more papers by this author

    ,
    Howard L McLeod

    **Author for correspondence:

    E-mail Address: Howard.McLeod@moffitt.org

    Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, Hunan, PR China

    Moffitt Cancer Center, DeBartolo Family Personalized Medicine Institute, Tampa, 33612 FL, USA

    Search for more papers by this author

    &
    Yijing He

    *Author for correspondence: Tel.: +86 158 748 12612;

    E-mail Address: yijing.he@foxmail.com

    Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China

    Moffitt Cancer Center, DeBartolo Family Personalized Medicine Institute, Tampa, 33612 FL, USA

    Search for more papers by this author

    Published Online:23 Aug 2018https://doi.org/10.2217/pgs-2018-0085

    Abstract

    Aim: Delayed recovery from general anesthesia is a well-known complication that requires predictive tools and approaches. This study aimed to determine significant factors associated with postanesthesia recovery and to develop an algorithm for estimating recovery time from general anesthesia. Materials & methods: The genotypes of patients were determined by SNaPshot or ARMS-qPCR. The algorithm was developed via machine-learning and tested by the worm plot. Results: Results showed that OPRM1 rs1799971 (p = 0.006) and ABCG2 rs2231142 (p = 0.041) were significantly associated with recovery time. Ten factors after random forest and stepwise selection were associated with recovery time. Ten factors after random forest and stepwise selection were associated with recovery time. Meanwhile, seven factors were associated with delayed recovery. Conclusion: This study demonstrated that both clinical and pharmacogenetic data are significantly associated with recovery from general anesthesia and provide the basis for pre-emptive prediction tools.

    References

    • 1 Czarnetzki C, Elia N, Frossard JL et al. Erythromycin for gastric emptying in patients undergoing general anesthesia for emergency surgery: a randomized clinical trial. JAMA Surg. 150(8), 730–737 (2015).
      MedlineGoogle Scholar
    • 2 Gulur P, Nishimori M, Ballantyne JC. Regional anaesthesia versus general anaesthesia, morbidity and mortality. Best Pract. Res. Clin. Anaesthesiol. 20(2), 249–263 (2006).
      MedlineGoogle Scholar
    • 3 Tzabazis A, Miller C, Dobrow MF, Zheng K, Brock-Utne JG. Delayed emergence after anesthesia. J. Clin. Anesth. 27(4), 353–360 (2015).
      MedlineGoogle Scholar
    • 4 Buchanan FF, Myles PS, Leslie K, Forbes A, Cicuttini F. Gender and recovery after general anesthesia combined with neuromuscular blocking drugs. Anesth. Analg. 102(1), 291–297 (2006).
      Medline CASGoogle Scholar
    • 5 Chemali JJ, Kenny JD, Olutola O et al. Ageing delays emergence from general anaesthesia in rats by increasing anaesthetic sensitivity in the brain. Br. J. Anaesth. 115(Suppl. 1), i58–i65 (2015).
      MedlineGoogle Scholar
    • 6 Mahajan VA, Ni Chonghaile M, Bokhari SA, Harte BH, Flynn NM, Laffey JG. Recovery of older patients undergoing ambulatory anaesthesia with isoflurane or sevoflurane. Eur. J. Anaesthesiol. 24(6), 505–510 (2007).
      Medline CASGoogle Scholar
    • 7 Tsai HJ, Chen CC, Chang KY. Patients and surgery-related factors that affect time to recovery of consciousness in adult patients undergoing elective cardiac surgery. J. Chin. Med. Assoc. 74(8), 345–349 (2011).
      MedlineGoogle Scholar
    • 8 Frost EA. Differential diagnosis of delayed awakening from general anesthesia: a review. Middle East J. Anaesthesiol. 22(6), 537–548 (2014).
      MedlineGoogle Scholar
    • 9 Cohen M, Sadhasivam S, Vinks AA. Pharmacogenetics in perioperative medicine. Curr. Opin. Anaesthesiol. 25(4), 419–427 (2012).
      Medline CASGoogle Scholar
    • 10 Gong XD, Wang JY, Liu F et al. Gene polymorphisms of OPRM1 A118G and ABCB1 C3435T may influence opioid requirements in Chinese patients with cancer pain. Asian Pac. J. Cancer Prev. 14(5), 2937–2943 (2013).
      MedlineGoogle Scholar
    • 11 Hwang IC, Park JY, Myung SK, Ahn HY, Fukuda K, Liao Q. OPRM1 A118G gene variant and postoperative opioid requirement: a systematic review and meta-analysis. Anesthesiology 121(4), 825–834 (2014).
      MedlineGoogle Scholar
    • 12 Mikstacki A, Skrzypczak-Zielinska M, Tamowicz B, Zakerska-Banaszak O, Szalata M, Slomski R. The impact of genetic factors on response to anaesthetics. Adv. Med. Sci. 58(1), 9–14 (2013).
      Medline CASGoogle Scholar
    • 13 Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49(4), 239–243 (1978).
      Medline CASGoogle Scholar
    • 14 Fritz BA, Rao P, Mashour GA et al. Postoperative recovery with bispectral index versus anesthetic concentration-guided protocols. Anesthesiology 118(5), 1113–1122 (2013).
      MedlineGoogle Scholar
    • 15 Bell GC, Donovan KA, McLeod HL. Clinical implications of opioid pharmacogenomics in patients with cancer. Cancer Control 22(4), 426–432 (2015).
      MedlineGoogle Scholar
    • 16 Dong H, Lu SJ, Zhang R, Liu DD, Zhang YZ, Song CY. Effect of the CYP2D6 gene polymorphism on postoperative analgesia of tramadol in Han nationality nephrectomy patients. Eur. J. Clin. Pharmacol. 71(6), 681–686 (2015).
      Medline CASGoogle Scholar
    • 17 Duysen EG, Lockridge O. Prolonged toxic effects after cocaine challenge in butyrylcholinesterase/plasma carboxylesterase double knockout mice: a model for butyrylcholinesterase-deficient humans. Drug Metab. Dispos. 39(8), 1321–1323 (2011).
      Medline CASGoogle Scholar
    • 18 Mei Y, Wang SY, Li Y et al. Role of SLCO1B1, ABCB1, and CHRNA1 gene polymorphisms on the efficacy of rocuronium in Chinese patients. J. Clin. Pharmacol. 55(3), 261–268 (2015).
      Medline CASGoogle Scholar
    • 19 Rosenberg H, Pollock N, Schiemann A, Bulger T, Stowell K. Malignant hyperthermia: a review. Orphanet J. Rare Dis. 10, 93 (2015).
      MedlineGoogle Scholar
    • 20 Tsuji D, Yokoi M, Suzuki K et al. Influence of ABCB1 and ABCG2 polymorphisms on the antiemetic efficacy in patients with cancer receiving cisplatin-based chemotherapy: a TRIPLE pharmacogenomics study. Pharmacogenomics J. 17(5), 435–440 (2016).
      MedlineGoogle Scholar
    • 21 Zhang F, Tong J, Hu J et al. COMT gene haplotypes are closely associated with postoperative fentanyl dose in patients. Anesth. Analg. 120(4), 933–940 (2015).
      MedlineGoogle Scholar
    • 22 Genuer R, Poggi JM, Tuleau-Malot C. VSURF: an R package for variable selection using random forests. R. J. 7(2), 19–33 (2015).
      Google Scholar
    • 23 Stasinopoulos DM, Rigby RA. Generalized additive models for location scale and shape (GAMLSS) in R. J. Stat. Softw. 23(7), 1–46 (2007).
      Google Scholar
    • 24 Kuhn M, Leeuw JD, Zeileis A. Building predictive models in R using the Caret package. J. Stat. Softw. 28(5), 1–26 (2008).
      MedlineGoogle Scholar
    • 25 Rivera R, Antognini JF. Perioperative drug therapy in elderly patients. Anesthesiology 110(5), 1176–1181 (2009).
      MedlineGoogle Scholar
    • 26 Smith ML, Booze RM. Cholinergic and GABAergic neurons in the nucleus basalis region of young and aged rats. Neuroscience 67(3), 679–688 (1995).
      Medline CASGoogle Scholar
    • 27 Taylor NE, Van Dort CJ, Kenny JD et al. Optogenetic activation of dopamine neurons in the ventral tegmental area induces reanimation from general anesthesia. Proc. Natl Acad. Sci. USA 113(45), 12826–12831 (2016).
      Medline CASGoogle Scholar
    • 28 Lai HC, Chan SM, Lu CH, Wong CS, Cherng CH, Wu ZF. Planning for operating room efficiency and faster anesthesia wake-up time in open major upper abdominal surgery. Medicine 96(7), e6148 (2017).
      Medline CASGoogle Scholar
    • 29 McKay RE, Malhotra A, Cakmakkaya OS, Hall KT, McKay WR, Apfel CC. Effect of increased body mass index and anaesthetic duration on recovery of protective airway reflexes after sevoflurane vs desflurane. Br. J. Anaesth. 104(2), 175–182 (2010).
      Medline CASGoogle Scholar
    • 30 Misal US, Joshi SA, Shaikh MM. Delayed recovery from anesthesia: a postgraduate educational review. Anesth. Essays Res. 10(2), 164–172 (2016).
      MedlineGoogle Scholar
    • 31 Kozasa Y, Takaseya H, Koga Y et al. A case of delayed emergence from anesthesia caused by postoperative brain edema associated with unexpected cerebral venous sinus thrombosis. J. Anesth. 27(5), 764–767 (2013).
      MedlineGoogle Scholar
    • 32 Pan H, Li T, Huang Z et al. Laparoscopic versus opengastric surgery for the treatment of pathological T1N0M0 gastric cancer in elderly patients: a matched study. Sci. Rep. 7(1), 1919 (2017).
      MedlineGoogle Scholar
    • 33 Ye L, Wu X, Wu T et al. Meta-analysis of laparoscopic vs. open resection of gastric gastrointestinal stromal tumors. PLoS ONE 12(5), e0177193 (2017).
      MedlineGoogle Scholar
    • 34 Patel SS, Spencer CM. Remifentanil. Drugs 52(3), 417–427; discussion 428 (1996).
      Medline CASGoogle Scholar
    • 35 Mori T, Shibasaki Y, Matsumoto K et al. Mechanisms that underlie mu-opioid receptor agonist-induced constipation: differential involvement of mu-opioid receptor sites and responsible regions. J. Pharmacol. Exp. Ther. 347(1), 91–99 (2013).
      Medline CASGoogle Scholar
    • 36 Al-Mustafa MM, Al Oweidi AS, Al-Zaben KR et al. Remifentanil consumption in septoplasty surgery under general anesthesia. Association with humane mu-opioid receptor gene variants. Saudi. Med. J. 38(2), 170–175 (2017).
      MedlineGoogle Scholar
    • 37 Chou WY, Wang CH, Liu PH, Liu CC, Tseng CC, Jawan B. Human opioid receptor A118G polymorphism affects intravenous patient-controlled analgesia morphine consumption after total abdominal hysterectomy. Anesthesiology 105(2), 334–337 (2006).
      Medline CASGoogle Scholar
    • 38 Mao Q, Unadkat JD. Role of the breast cancer resistance protein (BCRP/ABCG2) in drug transport–an update. AAPS J. 17(1), 65–82 (2015).
      Medline CASGoogle Scholar
    • 39 Brzozowska N, Li KM, Wang XS et al. ABC transporters P-gp and Bcrp do not limit the brain uptake of the novel antipsychotic and anticonvulsant drug cannabidiol in mice. PeerJ 4, e2081 (2016).
      MedlineGoogle Scholar
    • 40 Hunter JM. Rocuronium: the newest aminosteroid neuromuscular blocking drug. Br. J. Anaesth. 76(4), 481–483 (1996).
      Medline CASGoogle Scholar
    • 41 Lobaz S, Sammut M, Damodaran A. Sugammadex rescue following prolonged rocuronium neuromuscular blockade with ‘recurarisation’ in a patient with severe renal failure. BMJ Case Rep. 2013, pii:bcr2012007603 (2013).
      MedlineGoogle Scholar
    • 42 Le Guen M, Liu N, Tounou F et al. Dexmedetomidine reduces propofol and remifentanil requirements during bispectral index-guided closed-loop anesthesia: a double-blind, placebo-controlled trial. Anesth. Analg. 118(5), 946–955 (2014).
      Medline CASGoogle Scholar
    • 43 Zhang C, Hu J, Liu X, Yan J. Effects of intravenous dexmedetomidine on emergence agitation in children under sevoflurane anesthesia: a meta-analysis of randomized controlled trials. PLoS ONE 9(6), e99718 (2014).
      MedlineGoogle Scholar
    • 44 Wang YX, Mao XF, Li TF, Gong N, Zhang MZ. Dezocine exhibits antihypersensitivity activities in neuropathy through spinal mu-opioid receptor activation and norepinephrine reuptake inhibition. Sci. Rep. 7, 43137 (2017).
      Medline CASGoogle Scholar
    • 45 Weingarten TN, Hawkins NM, Beam WB et al. Factors associated with prolonged anesthesia recovery following laparoscopic bariatric surgery: a retrospective analysis. Obes. Surg. 25(6), 1024–1030 (2015).
      MedlineGoogle Scholar
    • 46 Servin F. Remifentanil: when and how to use it. Eur. J. Anaesthesiol. Suppl. 15, 41–44 (1997).
      Medline CASGoogle Scholar
    • 47 Jun NH, Lee JW, Song JW, Koh JC, Park WS, Shim YH. Optimal effect-site concentration of remifentanil for preventing cough during emergence from sevoflurane–remifentanil anaesthesia. Anaesthesia 65(9), 930–935 (2010).
      Medline CASGoogle Scholar
    • 48 Costello GT, Moorthy SS, Vane DW, Dierdorf SF. Hypoglycemia following bilateral adrenalectomy for pheochromocytoma. Crit. Care Med. 16(5), 562–563 (1988).
      Medline CASGoogle Scholar