Potential effects of genetic polymorphism on anesthesia use for COVID-19 infected patients at intensive care unit

Abstract

Background: New coronavirus disease is considered one of the most widely spreading viral infections all over the world. Increased numbers of severe COVID-19 cases are growing up. Severe cases require ICU mechanical ventilation and hence anesthesia requirement. Aim: Reviewing of different genetic polymorphisms which might affect patient clinical response, safety and tolerability to different types of anesthesia used in severe COVID-19 patients requiring mechanical ventilation. Main body of the abstract: Severity of COVID-19 infection resulted from cytokine storm that leads to Acute Respiratory Distress Syndrome (ARDS) contribute in ICUs mechanical ventilation and anesthesia. Genetic polymorphisms showed to contribute in wide variation in anesthetic responses. Different polymorphic genes of RYR1, CACNA1S, MTHFR, OPRM1, ABCB1, CYP2B6 and others, play a main role in such variations. Different types of anesthesia as sevoflurane, midazolam, suxamethonium, nitrous oxide, fentanyl, and propofol showed altered pharmacokinetics and/or dynamics leading to a lack of anesthetic effect and incidence of life-threatening adverse effects as malignant hyperthermia, myocardial infarction, dyspnea, and others. Short conclusion: Genetic screening is a serious step to take into consideration to identify genetic polymorphic types that may alter the anesthetic effect in ICUs ventilation. Besides, it will avoid possible adverse effects and different sedation response variations. Sevoflurane, Fentanyl, and propofol can be taken into consideration as a safe choice for use in ICUs taking into consideration genetic polymorphic variants.