Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000300013
Brazilian Journal of Anesthesiology
Miscellaneous

Anestesia na população negra

Anesthesia in the afro-american population

Nilton Bezerra do Vale; José Delfino

Downloads: 0
Views: 1131

Resumo

JUSTIFICATIVA E OBJETIVOS: Percentual significativo dos 12 milhões de negros americanos pode apresentar modificações fisiológicas, fisiopatológicas e farmacológicas capazes de modificar o bom desenvolvimento do ato anestésico; a população brasileira que se considera afro-descendente (40%) pode também apresentá-las por causa da mesma origem étnica e geográfica. O objetivo desta revisão é reavaliar o viés da diferença racial em eventuais mudanças no efeito das drogas anestésicas e adjuvantes no ato anestésico. CONTEÚDO: A análise dos estudos fisiopatológicos inerentes à histórica migração do gene africano em relação aos caucasianos mostra significativas diferenças raciais entre o negro americano ou africano, sugerindo uma estreita interface entre a genética e o ambiente, capaz de modificar o procedimento anestésico. As condições sócio-econômicas desfavoráveis da população negra das Américas como resultado de 400 anos de história de escravidão continuam sempre a influenciar na preservação de diferenças culturais e fisiológicas, além da cor da pele: disfunções de sistemas orgânicos estão relacionados com o SNC, SCV, respiratório e renal. No entanto, modificações de efeito de drogas anestésicas e seus adjuvantes, como diminuição do efeito analgésico local do creme anestésico EMLA, aumento do efeito hipnótico do propofol e da toxicidade do paracetamol, menor efeito anti-hipertensivo das drogas que reduzem renina (IECA, bloqueadores beta2 e de AT1), menor ação dos vasodilatadores beta2 e menor fibrinólise do t-PA podem afetar a conduta pré e pós-anestésica, sobretudo em pacientes negros hipertensos, renais, asmáticos ou com acidente vascular cerebral. CONCLUSÕES: Resposta a drogas pode variar entre diferentes populações devido a fatores biológicos (idade, sexo, doença), genéticos, culturais e ambientais. O fator demográfico raça deve ser valorizado na visita ou consulta pré-anestésica para assegurar a profilaxia de reações idiossincrásicas peri-operatórias e salvaguardar o êxito do ato anestésico-cirúrgico.

Palavras-chave

FARMACOLOGIA, RAÇA

Abstract

BACKGROUND AND OBJECTIVES: A significant percentage of the 12 million Afro-Americans may present physiological, pathophysiological and pharmacological changes able to impact the success of anesthesia; Brazilian Afro-American population (40%) is subject to those changes for having the same ethnic and geographic origin. This review aimed at re-evaluating racial differences bias on potential anesthetic drug and adjuvant effect changes during anesthesia. CONTENTS: The analysis of pathophysiological studies inherent to the historical migration of the African gene as compared to Caucasians shows significant racial differences between Afro-American and African populations, suggesting a close interface between genetics and environment able to affect anesthesia. Unfavorable Afro-American socio-economic conditions, as a result of 400 years of slavery, are still influencing the preservation of cultural and physiological differences beyond the color of the skin: organic system dysfunctions are related to CNS, CVS, respiratory and renal systems. However, different effects of anesthetic drugs and adjuvants, such as decreased local analgesic effect of the anesthetic ointment EMLA, increased propofol hypnotic effect and paracetamol toxicity, less anti-hypertensive effects of renin-decreasing drugs (ACEI, beta2 blockers and AT1), decreased beta2-vasodilator effects and less t-PA fibrinolysis, may affect pre and postanesthetic approaches, especially in hypertensive, renal, asthma or stroke Afro-American patients. CONCLUSIONS: Drug response may vary among different populations due to biological (age, gender, disease), genetic, cultural and environmental factors. Race should be taken into account during preanesthetic evaluation to prevent perioperative idiosyncratic reactions and assure the anesthetic-surgical success.

Keywords

PHARMACOLOGY, RACE

References

Freyre G. Casa Grande & Senzala. 2001.

Amabis JM, Martho GR. Biologia das Populações. 1996.

Wood AJJ. Racial differences in the response to drugs: Pointers to genetic differences. N Eng J Med. 2001;344:1393-1396.

Epstein AM, Ayanian JZ. Racial disparities in medical care. N Eng J Med. 2001;344:1471-1473.

Bhopal R. Racism in medicine: the spectre must be exorcised. Br Med J. 2001;322:1503-1504.

Vale NB. Iatrofarmacogenia na Anestesia Local. Controvérsias em Anestesiologia. 1990:107.

Eichelbaum M, Evert B. Influence of pharmacogenetics on drug disposition and response. Clinical & Experimental Pharmacology & Physiology. 1996;23:983-985.

Kalow W, Bertilsson L. Interethnic factors affecting drug response. Adv Drug Res. 1994;25:1-59.

Kalow W. Pharmacogenetics, pharmacogenomics and pharmacobiology. Clin Pharmacol & Ther. 2001;7:1-4.

Marshall E. DNA studies challenge the meaning of race. Science. 1998;282:654-655.

Moskowitz DW. Hypertension, thermotolerance and the “African gen”: an hypothesis. Clin Exp Hypertesion. 1996;1:1-9.

Sheifer SE, Escarce JJ, Schulman KA. Race and sex differences in the management of coronary artery disease. American Heart Journal. 2000;139:848-857.

Canto JG, Allison JJ, Kiefe CI. Relation of race and sex to the use of reperfusion therapy in medicare beneficiaries with acute myocardial infarction. N Engl J Med. 2000;342:1094-1100.

Oates JA, Brown NJ. Antihypertensive Agents and the Drug Therapy of Hypertension. Goodman and Gilman´s The Pharmacological Basis of Therapeutics. 2001:871.

Davis RC, Hobbs FDR, Lip GYH. History and epidemiology: ABC of heart failure. Br Med J. 2000;320:39-42.

Fontana P, Mooser V, Bovet P. Dose-dependent inverse relationship between alcohol consumption and serum Lp(a) levels in black African males. Arteriosclerosis Thrombosis & Vascular Biology. 1999;19:1075-1082.

Foster Jr HW. The enigma of low birth weight and race. N Engl J Med. 1997;337:1232-1233.

Rauh, VA, Andrews HF, Garfinkel RS. The contribution of maternal age to racial disparities in birthweight: a multilevel perspective. Am J Public Health. 2001;91:1815-1824.

David RJ, Coollins JW. Differing birth weight among infants of US-born blacks, African-born blacks, and US-born Whites. N Engl J Med. 1997;337:1209-1214.

Mehta NJ, Mehta RN, Khan IA. Peripartum cardiomiopathy: clinical and therapeutic aspects. Angiology. 2001;52:759-762.

Savitz DA, Dole N, Terry Jr JW. Smoking and pregnancy outcome among African-American and white women in Central North Carolina. Epidemiology. 2001;12:636-642.

Kotchen AH, Grim CE, Kaldunski M. Predictors of target organ damage in hypertensive black. Hypertension. 2001;38:761-766.

Robinson MK. Population differences in skin structure and physiology and the susceptibility to irritant and allergic contact dermatitis: implications for skin safety testing and skin assessment. Contact Dermatitis. 1999;41:65-79.

Brown RH, Schauble JF, Hamilton RH. Prevalence of latex allergy among anesthesiologists: identification of sensitized but asymptomatic individuals. Anesthesiology. 1998;89:292-299.

Chen KK, Poth EJ. Racial differences as illustrated by the mydriatic action of epinephrine, euphthalmine and ephedrine. J Pharmacol Exp Their. 1929;36:429-431.

Scott TG. The eye of the west African black. Br J Ophthalmol. 1945;29:12.

Deborah J. Racial groups respond differently to glaucoma treatment. Br Med J. 1998;317:164.

Dustan HP. Does keloid pathogenesis hold the key to understanding black/white differences in hypertension severity?. Hypertension. 1995;26:858-862.

Corbo RM, Scacchi R, Cossu G. Genetic studies on the Senegal population II polymorphims of the plasma proteins F13A, F13B, ORM1, AHSG, C6, C7 and APOC2. Hum Biol. 1994;66:885-903.

Ama PF, Simoneau JA, Boulay MR. Skeletal muscle characteristics in sedentary black and Caucasian males. J Appl Physiol. 1986;61:1758-1761.

Deurenberg PA, Deurenbeg-Yap MB. Differences in body composition assumptions across ethnic groups: practical consequences. Curr Opin Crit Nutrit & Metab Care. 2001;4:377-383.

Ama PF, Poehlmam ET, Simoneau JA. Fat distribution and adipose tissue metabolism in non-obese male black African e Caucasian subjects. Int J Obes. 1986;10:502-510.

Cruickshank JK, Mbanya JC, Wilks R. Sick gens, sick individuals or sick populations with chronic disease?: The emergence of diabetes and high blood pressure in African-origin populations. Int J Epidemiology. 2001:111-117.

Hong Y, Weisnagel SJ, Rice TA. Familial resemblance for glucose and insulin metabolism indices derived from an intravenous glucose tolerance test in blacks and whites of the heritage family study. Clinical Genetics. 2001;60:22-30.

Bovet P, Paccaud F. Race responsiveness to drugs for heart failure. N Eng J Med. 2001;345:766-768.

Becker LB, Han BH, Meyer PM. Racial differences in the incidence of cardiac arrest and subsequent survival. N Eng J Med. 1993;329:600-606.

Timberlake DS, O’Connor DT, Parmer RJ. Molecular genetics of essential hypertension: recent results and emerging strategies. Current Opinion in Nephrology & Hypertension. 2001;10:71-79.

Kiowski W, Bühler FR, Fadayomi MO. Age, race, blood pressure, and renin: predictors for antihypertensive treatment with calcium antagonists. Am J Cardiol. 1985;56:81H-85H.

Bassett Jr DR, Duey WJ, Walker AJ. Racial differences in maximal vasodilatory capacity of forearm resistance vessels in normotensive young adults. Am J Hypertens. 1992;5:781-786.

Lang CC, Stein CML, Brown R. Attenuation of isoproterenol-mediated vasodilatation in blacks. N Eng J Med. 1995;333:155-160.

Liggett SB, Wagoner LE, Craft LL. The Ile164 beta2-adrenergic receptor polymorphism adversely affects the outcome of congestive heart failure. J Clin Invest. 1998;102:1534-1539.

Wagoner LE, Craft LL, Singh B. Polymorphisms of the beta(2)-adrenergic receptor determine exercise capacity in patients with heart failure. Circ Res. 2000;86:834-840.

Lang CC, Stein CM, He HB. Blunted blood pressure response to central sympathoinhibition in normotensive blacks: increased importance of nonsympathetic factors in blood pressure maintenance in blacks. Hypertension. 1997;30:157-162.

Cardillo C, Kilcoyne CM, Cannon RO III. Attenuation of cyclic nucleotide-mediated smooth muscle relaxation in blacks as a cause of racial differences in vasodilator function. Circulation. 1999;99:90-95.

Cardillo C, Kilcoyne CM, Cannon RO III. Racial differences in nitric oxide-mediated vasodilator response to mental stress in the forearm circulation. Hypertension. 1998;31:1235-1239.

Carlsson I, Sollevi A, Wennmalm A. The role of myogenic relaxation, adenosine and prostaglandins in human forearm reactive hyperaemia. J Physiol. 1987;389:147-161.

Gibbs CR, Lip GYH, Beevers DG. Angioedema due to ACE inhibitors: increased risk in patients of African origin. Br J Clin Pharmacol. 1999;48:861-865.

Andersson B, Blange I, Sylven C. Angiotensin-II type 1 receptor gene polymorphism and long-term survival in patients with idiopathic congestive heart failure. Eur J Heart Fail. 1999;1:363-369.

Vancura V, Hubacek J, Malek I. Does angiotensin-converting enzyme polymorphism influence the clinical manifestation and progression of heart failure in patients with dilated cardiomiopathy?. Am J Cardiol. 1999;83:461-462.

Exner DV, Dries DL, Domanski MJ. Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction. N Engl J Med. 2001;344:1351-1357.

Turner ST, Schwartz GL, Chapman AB. C825T Polymorphism of the G protein [beta]3-subunit and antihypertensive response to a thiazide diuretic. Hypertension. 2001;37:739-743.

Gainer JV, Nadeau JH, Ryder D. Increased sensitivity to bradykinin among African Americans. J Allergy & Clinical Immunology. 1996;98:283-287.

Yancy CW, Fowler MB, Colucci WS. Race and the response to adrenergic blockade with carvedilol in patients with chronic heart. N Eng J Med. 2001;344:1358-1365.

Zhou HH, Wood AJ. Stereoselective disposition of carvedilol is determined by CYP2D6. Clin Pharmacol Ther. 1995;57:518-524.

Ortolani O, Conti A, Sall/Ka B. The recovery of Senegalese African blacks form intravenous anesthesia with propofol and remifentanil is slower than that of Caucasians. Anesth Analg. 2001;93:1222-1226.

Faucett J, Gordon N, Levine J. Differences on postoperative pain severity among four ethnic groups. J Pain Sympton Manage. 1994;9:383-389.

McCracken L, Mattheus AK, Tang TS. A comparison of blacks and whites seeking treatment for chronic. Pain Clin J Pain. 2001;17:149-245.

Perez-Stable EJ, Herrera BMS, Jacob P III. Nicotine metabolism and intake in black and white smokers. JAMA. 1998;280:152-156.

Sharpley MS, Hutchinson G, Murray RM. Understanding the excess of psychosis among the African-Caribbean population in England. Br J Psychiat. 2001;178:V60-V68.

Gillum RF. Risk factors for strokes in blacks: a critical review. Am J Epidemiol. 1999;150:1266-1274.

Warnock DG. Low renin hypertension in the next millenium. Semin Nephrol. 2000;20:40-46.

Young CJ, Gaston RS. Medical progress: renal transplantation in black Americans. New Eng J Med. 2000;343:1545-1552.

Powers DR, David JD. End-stage renal disease in specific ethnic and racial groups: risk factors and benefits of antihypertensive therapy. Arch Int Medic. 1998;158:793-800.

Joseph CLM, Havstad SL, Ownby DR. Racial differences in emergency department use persist despite allergist visits and prescriptions filled for anti-inflammatory medications. J Allergy & Clin Immunology. 1998;101:484-490.

Platts-Mills T, Carter MC. Asthma and indoor exposure to allergens. N Eng J Med. 1997;336:1382-1384.

Bach PB, Cramer LD, Warren JL. Racial differences in the treatment of early-stage lung cancer. N Eng J Med. 1999;341:1198-1205.

Roses AD. Pharmacogenetics and the practice of medicine. Nature. 2000;405:857-865.

Xie HG, Kim RB, Wood AJ. Molecular basis of ethnic differences in drug disposition and response. Annu Rev Pharmacol Toxicol. 2001;41:815-850.

Iron A, Groppi A, Fleury B. Polymorphism of class I alcohol-desidrogenase in French, Vietnamese and Niger populations: genotyping by PCR amplification and RFLP analysis of dried blood spot. Ann Gen. 1992;35:152-156.

Critchley JA, Nimmo GR, Gregson CA. Inter-subject and ethnic differences in paracetamol metabolism. Br J Clin Pathology. 1986;22:649-657.

Tanaka E. Clinical importance of non-genetic and genetic cytochrome P450 function tests in liver disease. J Clin Pharm Ther. 1998;23:161-170.

Chang GWM, Kam PCA. The physiological and pharmacological roles of cytochrome P450 isoenzymes. Anaesthesia. 1999;54:42-50.

Bertilsson L. Geographical/interracial differences in polymorphic drug oxidation: current state of knowledge of cytochromes P450 (CYP) 2D6 and 2C19. Clin Pharmacokinet. 1995;29:192-209.

Daly AK, Brockmoller J, Broly F. Nomenclature for human CYP2D6 alleles. Pharmacogenetics. 1996;6:193-201.

Marez D, Legrand M, Sabbagh N. Polymorphism of the cytochrome P450 CYP2D6 gene in a European population: characterization of 48 mutations and 53 alleles, their frequencies and evolution. Pharmacogenetics. 1997;7:193-202.

Conney AH. Pharmacological implications of microsomal enzyme induction. Pharmacol Rev. 1967;19:317-366.

Kalow W. Ethnic differences in drug metabolism. Clin Pharmacokinet. 1982;7:373-400.

5ddd39a80e8825b5131da3e9 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections