Effect of ADRA2A gene polymorphisms on the anesthetic and analgesic effects of dexmedetomidine in Chinese Han women with cesarean section

Correlation between gene polymorphisms and perioperative analgesia in patients undergoing gynecological surgery

Objectives

This study aims to identify specific single nucleotide polymorphism (SNP) correlated to perioperative analgesia in patients undergoing laparoscopic gynecological surgery.

Methods

A total of 200 females meeting specific criteria underwent gynecological laparoscopic procedures under general anesthesia. Preoperative pain sensitivity was evaluated using Pain Sensitivity Questionnaire and Pain Catastrophizing Scale (PCS). Venous blood samples were collected for SNP analysis of nine genes. The study analyzed the correlation between SNPs and pre-operative pain assessment, analgesics usage, and the occurrence of related adverse effects.

Results

Six out of nine identified loci showed polymorphisms. The PCS scores were higher in the mutation group (GG + GC) for ADRA2A rs1800544 compared to the CC group (P < 0.05). No differences were observed in visual analog scale or Ramsay sedation scores between the mutation and wild-type groups for any of the SNPs (P < 0.05). Patients in the mutant group (AG + GG) for OPRM1 rs1799971 had higher analgesic usage within 24 h compared to the wild-type group (P < 0.05). The consumption of intraoperative remifentanil was higher in the mutation group (GG + GC) of ADRA2A rs1800544 than in the CC group. The Multifactorial Dimensionality Reduction analysis suggests that the optimal interaction model includes OPRM1 rs179971 and CYP450 3A4 * 1G rs2242480 together.

Conclusion

Patients with GG and AG genotypes of OPRM1 rs1799971 gene required more 24-h postoperative analgesics after gynecological surgery compared to those with AA genotype. A SNP-SNP interaction was observed between OPRM1 rs179971 and CYP450 3A4 * 1G rs2242480. Clinical Trial Registration: (www.chictr.org.cn, registration number: ChiCTR2200062425).

Excimer light versus topical methotrexate 1% hydrogel in treatment of scalp psoriasis: clinical and dermoscopic study

One of the most frequently impacted locations by psoriasis is the scalp. It is seen in about 80% of psoriasis cases worldwide, and its treatment is challenging. To compare the efficacy and safety of excimer light versus topical methotrexate (MTX) 1% hydrogel in treatment of scalp psoriasis. This randomized prospective intra-patient comparative study was carried out on 30 patients with scalp psoriasis. Lesions were divided randomly into two areas: Area A and Area B. Area A received biweekly sessions of 308-nm excimer light and Area B received topical MTX 1% hydrogel once daily for 3 consecutive months. Psoriatic Scalp Severity Index (PSSI), itching score, patient satisfaction and dermoscopic red dots and white scales were used for assessment at the baseline, at the end of treatment protocol and 1 month after the last treatment session. Both treatment modalities induced significant improvement in PSSI, itching score and dermoscopic red dots and white scales (p < 0.001 for each). The mean percentage of improvement of PSSI was 75.82 ± 33.72 in Area A and 74.19 ± 31.64 in Area B with non-significant difference between both areas (p = 0.763). Moreover, the mean percentage reduction of itching score was 77.40 ± 24.61 in Area A and 67.67 ± 34.94 in Area B with non-significant difference between both areas (p = 0.430). Additionally, a notable improvement in dermoscopic red dots and white scales was observed in 83.3% of patients in Area A and in 60% in Area B at the end of treatment protocol with non-significant difference between both areas (p = 0.518) (p = 0.436). Marked patient satisfaction was noticed in both areas with non-significant difference between both areas (p = 0.433). 308-nm excimer light and topical MTX 1% hydrogel are equally safe and effective treatment options for scalp psoriasis with minimal side effects.

Genetic polymorphisms are associated with individual susceptibility to dexmedetomidine

Introduction: Dexmedetomidine (DXM) is widely used as an adjuvant to anesthesia or a sedative medicine, and differences in individual sensitivity to the drug exist. This study aimed to investigate the effect of genetic polymorphisms on these differences. Methods: A total of 112 patients undergoing hand surgery were recruited. DXM 0.5 μg/kg was administered within 10 min and then continuously injected (0.4 μg/kg/h). Narcotrend index, effective dose and onset time of sedation, MAP, and HR were measured. Forty-five single nucleotide polymorphisms (SNPs) were selected for genotype. Results: We observed individual differences in the sedation and hemodynamics induced by DXM. ABCG2 rs2231142, CYP2D6 rs16947, WBP2NL rs5758550, KATP rs141294036, KCNMB1 rs11739136, KCNMA1 rs16934182, ABCC9 rs11046209, ADRA2A rs1800544, and ADRB2 rs1042713 were shown to cause statistically significant (p < 0.05) influence on the individual variation of DXM on sedation and hemodynamics. Moreover, the multiple linear regression analysis indicated sex, BMI, and ADRA2A rs1800544 are statistically related to the effective dose of DXM sedation. Discussion: The evidence suggests that the nine SNPs involved in transport proteins, metabolic enzymes, and target proteins of DXM could explain the individual variability in the sedative and hemodynamic effects of DXM. Therefore, with SNP genotyping, these results could guide personalized medication and promote clinical and surgical management.

Effect of dexmedetomidine on oxytocin-induced uterine contraction during optimal caesarean section anaesthesia

Numerous drugs are used during caesarean sections to provide regional and general anaesthesia. Dexmedetomidine has been used in some recent obstetric trials, but there are concerns about postpartum changes in uterine contractions. This study evaluated the effect of dexmedetomidine on oxytocin-induced uterine contractions in women undergoing caesarean section. Sixty women undergoing caesarean section in Lianyungang Second People's Hospital were randomly assigned to dexmedetomidine (group D, n = 30) or saline (group C, n = 30) groups. Equal volumes of saline or dexmedetomidine were administered intravenously (IV). During the intraoperative delivery of the foetus and placenta, oxytocin was administered to promote contractions. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were compared. The Ramsay scale was used to assess sedation, while the Tsai and Chu methods assessed shivering. Adverse intraoperative events were observed. All variables fluctuated significantly after anaesthesia onset in both groups but were most pronounced in group D. The VAS, Ramsay and shivering scores were significantly lower in group D compared to group C. During rapid IV infusion of oxytocin after foetal delivery, the incidence of nausea, vomiting, chest tightness and hypotension was significantly lower in group D than in group C.

A pilot study of ADRA2A genotype association with doses of dexmedetomidine for sedation in pediatric patients

STUDY OBJECTIVE

Dexmedetomidine is titrated to achieve sedation in the pediatric and cardiovascular intensive care units (PICU and CVICU). In adults, dexmedetomidine response has been associated with an ADRA2A polymorphism (rs1800544); CC genotype is associated with an increased sedative response compared with GC and GG. To date, this has not been studied in children.

DESIGN

We conducted a pilot study to determine whether ADRA2A genotype is associated with dexmedetomidine dose in children.

MEASUREMENTS AND MAIN RESULTS

Forty intubated PICU or CVICU patients who received dexmedetomidine as a continuous infusion for at least 2 days were genotyped for ADRA2A with a custom-designed TaqMan® Assay. Ten (25%) subjects were wildtype (GG), 15 (37.5%) were heterozygous (GC), and 15 (37.5%) were homozygous (CC) variant. The maximum dexmedetomidine doses (mCg/kg/h) were not different between genotype groups CC (1, 0.3-1.2), GC (1, 0.3-1.3), and GG (0.8, 0.3-1.2), (p = 0.37); neither were mean dexmedetomidine doses for these respective genotype groups 0.68 (0.24-1.07), 0.72 (0.22-0.98), 0.58 (0.3-0.94), (p = 0.67).

CONCLUSIONS

These findings did not confirm the results from adult studies where ADRA2A polymorphisms correlate with dexmedetomidine response, therefore highlighting the need for pediatric studies to validate PGx findings in adults prior to implementation in pediatrics.