The influence of GABAAγ2 genetic polymorphism on the emergence agitation induced by sevoflurane

Abstract

Background: Sevoflurane is one of the most popular anesthetics, used in pediatric anesthesia, but emergence agitation is more common with using sevoflurane as compared to that with using the other inhalation anesthetics. Sevoflurane exerts its effect on γ-aminobutyric acid (GABA) ergic transmission. This study aimed to investigate if genetic variations at the GABRγ2 (single nucleotide polymorphism [SNP] 211037 C/T, nucleotide position 3145 in intron A/G) on the 5q33 chromosome were associated with the development of emergence agitation when sevoflurane is used. Methods: One hundred fourteen, pre-school aged patients who were to undergo tonsillectomy and adenoidectomy were included in this study. Anesthesia was induced with 5 mg/kg of thiopental sodium, 0.02 mg/kg of atropine and 0.1 mg/kg of vecuronium, and this was maintained with 3% sevoflurane and 50% N2O in oxygen. The incidence of emergence agitation and the emergence agitation scores were assessed at 0 min, 10 min, 20 min and 30 min after arriving at the post anesthetic care unit (PACU). Genomic DNA from peripheral leukocytes was isolated using the QIAamp Blood Minikits and the GABRγ2 genetic polymorphisms were analyzed by performing polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results: There were no significant differences of the emergence agitation scores among the genotypes in the GABRγ2SNP211037 C/T and GABRγ2-nucleotide position 3145 in intron A/G. There was a trend in which the AA group in the GABRγ2nucleotide position 3145 in intron A/G has a lower incidence of emergence agitation compared with the non-AA group, but this was without statistical significance (P = 0.07). Conclusions: There is a possibility that the GABR2 genetic polymorphism may affect the development of emergence agitation when sevoflurane is used in pediatric anesthesia. (Korean J Anesthesiol 2008; 55: 139∼44)