Pharmacogenomics in Anesthesiology: Tailoring Drug Selection and Dosing

Abstract

Pharmacogenomics, the study of how genetic variation shapes drug response, is increasingly relevant to anesthesiology, a specialty in which rapid drug administration and narrow safety margins magnify the consequences of interindividual variability. This narrative review synthesizes evidence on pharmacogenomic determinants of anesthetic drug response, drawing on 27 peer-reviewed publications identified through PubMed, Scopus, and Google Scholar (January 2019–September 2025). Variants in CYP2D6, CYP2B6, UGT1A9, OPRM1, BCHE, and RYR1 influence opioid analgesia, antiemetic efficacy, propofol pharmacokinetics, and susceptibility to malignant hyperthermia and prolonged apnea. Clinical translation is most mature for RYR1-based malignant hyperthermia risk stratification, BCHE deficiency screening, and CYP2D6-guided opioid and antiemetic selection; pragmatic trials confirm reduced opioid consumption without compromised analgesia. Reproducibility of weaker associations, limited population diversity, unresolved variants of uncertain significance, and uncertain cost-effectiveness continue to constrain routine implementation. Future progress depends on rapid genotyping, multi-ethnic validation, pediatric-specific evidence, polygenic risk models, and integration into electronic health record–based decision support. Pharmacogenomics is positioned to evolve from a supplementary tool into a central pillar of individualized perioperative care.