[Could the understanding of racial differences prevent idiosyncratic anesthetic reactions?]

There are several unanswered questions about the interethnic variability in anesthetic and adjuvant drugs responses. Current pharmacogenetic developments are taking us to the verge of being able to identify inherited racial differences which could predict individual patients anesthetic response.

The understanding of interethnic factors affecting drug response will allow anesthesiologists to prevent idiosyncratic reactions: (1) Caucasian: increased dopamine diuretic effect; prolonged apnea following succinylcholine or mivacurium; cardiac arrhythmias after halothane and catecholamines in Riley-Day syndrome; acute porphyria episodes after thiopental. (2) Afro-American: different therapeutic approaches, essential arterial hypertension caused by the poorert response to ACEI anti-hypertensives, AT1 blockers, beta-blockers and clonidine, contrasted with the best anti-hypertensive response of diuretics, calcium channel blockers, claverdilol; attenuated isoproterenol-mediated vasodilatation (beta2) and a better vasodilating response to sublingual nitroglycerine; lower t-PA-induced thrombolytic effect; slower recovery from intravenous anesthesia with propofol and remifentanil; less glycuronide conjugation of paracetamol and less pain relief by codeine in weak metabolizers (CYP2D6); melanin slows onset of epidermal analgesia with EMLA anesthetic cream; less epinephrine-induced mydriasis; major metacholine-induced bronchocospasm in asthmatic children; G-6-PD deficit in erythrocytes increases the risk for hemolysis to oxidative drugs in 10% of the Afro-American population. (3) Asians: toxic kinetic changes of meperidine and codeine; longer diazepam-induced anxiolysis; postpartum intravenous ergonovine-induced coronary artery spasm; inter-relationships of GABA receptor, dehydrogenases and Japanese drinking behavior contribute to their higher sensitivity to alcohol. Cytochrome P450 isoenzymes show genetic polymorphisms in neuropsychotropic drugs metabolism and the slow acetylation of N-acetyltransferase in equatorial populations (95%) increases isoniazid and hydrazine toxicity.

This review aimed at answering specific questions in the area of anesthetic idiosyncrasy related to the effect of ethnicity on drugs pharmacokinetics and pharmacodynamics, in addition to surgical patients safety by optimizing a more individualized neuropsychopharmacotherapy.