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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2012 Marzo;78(3):303-9
Cytochrome P450 polymorphism and postoperative cognitive dysfunction
Steinmetz J. 1, Jespersgaard C. 2, Dalhoff K. 3, Hedley P. 2, Abildstrøm H. 1, Christiansen M. 2, Rasmussen L. S. 1 ✉
1 Department of Anesthesia, Centre of Head and Orthopedics; Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;
2 Department of Clinical Biochemistry and Immunology; Statens Serum Institut, Copenhagen, Denmark; 3 Department of Clinical Pharmacology, Bispebjerg Hospital; Copenhagen University Hospital, Copenhagen, Denmark
BACKGROUND: The etiology of postoperative cognitive dysfunction (POCD) remains unclear but toxicity of anesthetic drugs and their metabolites could be important. We aimed to assess the possible association between POCD after propofol anesthesia and various phenotypes owing to polymorphisms in cytochrome P450 encoding genes.
METHODS: We included patients who underwent non-cardiac surgery under total intravenous anesthesia with propofol. POCD was identified using a neuropsychological test-battery administered preoperatively, one week, and three months after surgery. Genotyping of CYP2C19*2, *3, CYP2D6*3, *4, *5 and *6 was performed using pyrosequencing, and patients were characterized according to their phenotype as ultra, extensive, intermediate, or poor metabolizers.
RESULTS: In total, 337 patients with a median age of 67 years were included. 30 (9.4%) out of the 319 patients who underwent neuropsychological testing at one week had POCD, and 24 out of 307 (7.8%) had POCD at three months. None of the examined CYP2C19, 2D6 alleles, or various phenotypes were significantly associated with POCD.
CONCLUSION: Polymorphisms in CYP2C19, or 2D6 genes do not seem to be related to the occurrence of cognitive dysfunction after non-cardiac surgery in patients anesthetised with propofol.