Genetic Variation and Sex-Based Differences: Current Considerations for Anesthetic Management

Biomedical sciences have made immense progress and numerous discoveries aimed at improving quality of life and life expectancy in modern times. Anesthesiology is typically tailored to individual patients as its clinical effects depend on multiple factors, including a patient’s physiological and pathological states, age, environmental exposures and genetic variations. Sex differences are also paramount for a complete understanding of the effects of specific anesthetic medications on men and women. However, women-specific research and the inclusion of women in clinical trials, specifically during child-bearing years, remain disproportionately low compared to the general population at large. This review describes and summarizes genetic variations, including sex differences, that affect responses to common anesthetic medications such as volatile anesthetics, induction agents, neuromuscular blocking drugs, opioids and local anesthetics. It also discusses the influence of genetic variations on anesthesia outcomes such as post-operative nausea and vomiting, allergic reactions, pain, depth of anesthesia, awareness under anesthesia and recall, and post-operative delirium.