[Anesthesia in the afro-american population]

A significant percentage of the 12 million Afro-Americans may present physiological, pathophysiological and pharmacological changes able to impact the success of anesthesia; Brazilian Afro-American population (40%) is subject to those changes for having the same ethnic and geographic origin. This review aimed at re-evaluating racial differences bias on potential anesthetic drug and adjuvant effect changes during anesthesia.

The analysis of pathophysiological studies inherent to the historical migration of the African gene as compared to Caucasians shows significant racial differences between Afro-American and African populations, suggesting a close interface between genetics and environment able to affect anesthesia. Unfavorable Afro-American socio-economic conditions, as a result of 400 years of slavery, are still influencing the preservation of cultural and physiological differences beyond the color of the skin: organic system dysfunctions are related to CNS, CVS, respiratory and renal systems. However, different effects of anesthetic drugs and adjuvants, such as decreased local analgesic effect of the anesthetic ointment EMLA, increased propofol hypnotic effect and paracetamol toxicity, less anti-hypertensive effects of renin-decreasing drugs (ACEI, beta2 blockers and AT1), decreased beta2-vasodilator effects and less t-PA fibrinolysis, may affect pre and postanesthetic approaches, especially in hypertensive, renal, asthma or stroke Afro-American patients.

Drug response may vary among different populations due to biological (age, gender, disease), genetic, cultural and environmental factors. Race should be taken into account during preanesthetic evaluation to prevent perioperative idiosyncratic reactions and assure the anesthetic-surgical success.