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β2-Adrenoceptor Genotype Affects Vasopressor Requirements during Spinal Anesthesia for Cesarean Delivery
Journal article

β2-Adrenoceptor Genotype Affects Vasopressor Requirements during Spinal Anesthesia for Cesarean Delivery

  • Smiley, Richard M. Professor of Clinical Anesthesiology, Department of Anesthesiology, Columbia University.
  • Blouin, Jean-Louis Senior Biologist, Division of Medical Genetics and Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland.
  • Negron, Maria Research Coordinator, Department of Anesthesiology, Columbia University. Current position: Resident in Anesthesiology, University of Medicine and Dentistry, New Brunswick, New Jersey.
  • Landau, Ruth Chef de Clinique Scientifique, Department of Anesthesia, University Hospital of Geneva, Geneva, Switzerland. Visiting Assistant Professor, Department of Anesthesiology, Columbia University.
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Published in:
  • Anesthesiology. - Ovid Technologies (Wolters Kluwer Health). - 2006, vol. 104, no. 4, p. 644-650
Anesthesiology and Pain Medicine
English
Background
Maternal hypotension is common after spinal anesthesia for cesarean delivery. There is wide variability in the incidence and severity of hypotension and in the response to treatment. The beta2 adrenoceptor (beta2AR) possesses several polymorphic sites. Codons 16 (Arg16Gly) and 27 (Glu27Gln) have been shown to affect desensitization of the receptor. The goal of this study was to determine whether genetic variants of the beta2AR alter incidence of hypotension or the amount of vasopressor treatment required during spinal anesthesia for cesarean delivery.


Methods
One hundred seventy healthy women undergoing elective cesarean delivery were studied. Spinal anesthesia was performed with 12 mg hyperbaric bupivacaine, 25 microg fentanyl, and 200 microg morphine. Hypotension was treated with ephedrine and/or phenylephrine intravenously, and beta2AR genotype at codons 16 and 27 was determined. Analysis of variance was used to compare variables between genotypes, with data expressed as mean +/- SD.


Results
Ephedrine or phenylephrine was used in more than 90% of patients, with no difference in the incidence of hypotension between beta2AR genotypes. However, there was a significant effect of genotype on the amount of vasopressor required. Gly16 homozygotes received significantly less ephedrine (18 +/- 14 mg) than Arg16 homozygotes (28 +/- 13 mg) and Arg16Gly heterozygotes (30 +/- 20 mg; P = 0.0005). Glu27 homozygotes required significantly less ephedrine than Gln 27 homozygotes (14 +/- 13 vs. 30 +/- 19 mg; P = 0.002). Gln27Glu heterozygotes received less ephedrine than Gln27 homozygotes (23 +/- 16 vs. 30 +/- 19 mg; P = 0.03).


Conclusions
Glycine at position 16 and/or glutamate at position 27 of the beta2AR leads to lower vasopressor use for treatment of hypotension during spinal anesthesia.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.rero.ch/global/documents/23263
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