Newly Published
Editorial Views  |   July 2019
Be Wary of Genes Governing Awareness
Author Notes
  • From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington (P.G.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania (M.B.K.).
  • Accepted for publication June 14, 2019.
    Accepted for publication June 14, 2019.×
  • Correspondence: Address correspondence to Dr. Morgan: pgm4@uw.edu
Article Information
Editorial Views / Patient Safety / Pharmacology
Editorial Views   |   July 2019
Be Wary of Genes Governing Awareness
Anesthesiology Newly Published on July 15, 2019. doi:10.1097/ALN.0000000000002886
Anesthesiology Newly Published on July 15, 2019. doi:10.1097/ALN.0000000000002886
On October 16, 1846 William Morton demonstrated the successful administration of diethyl ether allowing the removal of a neck tumor from a quiescent and pain-free patient. With the advent of muscle relaxants, the significance of immobility as evidence of adequate anesthesia was diminished. However, it was not until 1950 that the first case report of insufficient anesthesia appeared.1  Recently, a great deal of interest has surfaced in improving our ability to eliminate this catastrophic occurrence.2 
Aranake et al.3  demonstrated a fivefold increased risk of awareness with recall in patients with a previous history, but whether this increase reflects a genetic predisposition, or is attributable to environmental factors, remains unknown. The study by Sleigh et al.4  in this issue of Anesthesiology represents a bold first attempt to determine a potential genetic vulnerability. Assuming that there are a small number of important molecular targets for anesthetics, alleles of those targets may exist which cause an individual to be resistant to general anesthesia. Although we limit our discussion to molecular targets, the reader should realize that similar arguments apply to developmental genes controlling neuronal circuits underlying anesthetic effects; changes at the circuit level could also shift anesthetic sensitivity.