Remifentanil consumption in septoplasty surgery under general anesthesia. Association with humane mu-opioid receptor gene variants

Abstract

To evaluate the influence of the ORM1 variants in codon 118 on the intra-operative remifentanil consumption under general anesthesia. Methods: A prospective gene association study, performed at the Jordan University Jordan, Amman, Jordan from September 2013 to August 2014. It includes patients who underwent septoplasty surgery under general anesthesia. All patients received standard intravenous anesthesia. Anesthesia maintained with fixed dose of Sevoflurane and variable dose of Remifentanil to keep the systolic blood pressure between 90-100 mm Hg. The Remifentanil dose was calculated and correlated with ORM1 genotype variance. Results: Genotype and clinical data were available for 123 cases. The A118A genotype was seen in 96 patients (78%), the A118G genotype was seen in 25 patients (20.3%), and only 2 patients had genotype G118G (1.6%). The G118G variant was removed from the statistical analysis due to small sample size. There was a significant effect of ORM1 genotype variant and the amount of remifentanil consumed. The A118A genotype received 0.173 ± 0.063 µg kg-1 min-1 and the A118G genotype received 0.316 ± 0.100 µg kg-1 min-1 (p less than 0.0001). Conclusion: The ORM1 gene has a role in intra-operative remifentanil consumption in patients who underwent septoplasty surgery under general anesthesia. The A118G gene required higher dose of remifentanil compared with the A118A genotype.

Figure 1

Representative polymerase chain reaction (PCR) products for A118G genotype. Lane1 is a 100 bp ladder, lane 2 shows non-template controls, while lanes 3 to 6 represent the PCR products (293 bp).

Figure 2

Heart rate (HR) variation over 70 minutes (m) after induction of general anesthesia for the codon 118 genotype.

Figure 3

Systolic blood pressure (SBP) variation over 70 minutes after induction of general anesthesia for the codon 118 genotype.