Pharmacogenetics in perioperative care: Understanding the impact of genetic variants on patient management

Despite advances in perioperative medicine, variability in patient responses to commonly administered anesthetic and analgesic agents remains a clinical challenge. Genetic factors are increasingly proposed contributors to these interindividual differences, yet much of the supporting evidence remains preliminary, heterogeneous or insufficiently validated. Pharmacogenetics has emerged as a promising field to improve therapeutic precision. However, its clinical application in perioperative care remains limited. This narrative review critically appraises pharmacokinetic and pharmacodynamic drug-gene interactions that influence responses to routinely administered agents. Genetic variations affect multiple aspects of perioperative care, including drug metabolism and receptor sensitivity, pain processing, autonomic function, and susceptibility to complications such as postoperative nausea and vomiting and opioid-induced respiratory depression. A better understanding of drug-gene interactions may help anesthesiologists identify patients with atypical sensitivity or resistance to commonly used agents, as well as those at increased risk for perioperative complications. Integration of pharmacogenetic data into perioperative decision-making may facilitate individualized care, but broader implementation will require replication in diverse cohorts, prospective clinical validation and development of evidence-based guidelines.