Higher incidence of emergence agitation in children with genetic intronic variant GABRγ2 rs2279020 after sevoflurane anesthesia

Abstract

Emergence agitation (EA) is very common in Preschool children who receive Sevoflurane anesthesia. The GABA receptors are the target effect site of Sevoflurane. The aim of this study Is to investigate if GABRγ2 Genetic variant (or Single nucleotide polymorphism SNP) rs211037 and an intronic nucleotide number rs2279020 polymorphism from A to G, is associated with EA after Sevoflurane anesthesia in Preschool children. Patients and Methods This study included 60 pre-school children, ASA I, of both sexes who underwent lower abdominal surgery, anesthetized by Sevoflurane and caudal blockade. At emergence, children were assessed for EA every 5 min, in PACU by Watcha scale1: (0: Asleep, 1: calm, 2: crying, can be consoled, 3: crying, cannot be consoled, or 4: agitated and thrashing). Children were divided into 2 groups. Gr.I: Non-agitated children; scored (0, 1 or 2) Gr.2: Agitated children; scored (3 or 4). GABA receptor gene polymorphisms rs211037 and intronic rs2279020 were genotyped by PCR-RFLP. Results GABRγ2 rs211037 stratified the cases into wild homozygous CC in (65%) and Heterozygous CT in (35%) of children, none of the cases was homozygous mutant (TT). The two groups showed insignificant EA between them. The intronic polymorphism rs2279020, however, was heterozygous AG in 73.3% of the cases; it was associated with EA in 54.50% of children versus 9 % in AA and 0.0% in GG Introns, (P < 0.001). Conclusion There was high incidence of EA in children with genetic intronic variant GABRγ2 (SNP) rs2279020 (A/G) after Sevoflurane anesthesia.