• Sirkku Ahlström, Paula Bergman, Ritva Jokela, Linda Ottensmann, Ari Ahola-Olli, Matti Pirinen, Klaus T Olkkola, Mari A Kaunisto, and Eija Kalso.
• Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland. Electronic address: Sirkku.tornqvist@helsinki.fi.
• Br J Anaesth. 2021 May 1; 126 (5): 949-957.

BackgroundRocuronium, a common neuromuscular blocking agent, is mainly excreted unchanged in urine (10-25%) and bile (>70%). Age, sex, liver blood flow, smoking, medical conditions, and ethnic background can affect its pharmacological actions. However, reasons for the wide variation in rocuronium requirements are mostly unknown. We hypothesised that pharmacogenetic factors might explain part of the variation.MethodsOne thousand women undergoing surgery for breast cancer were studied. Anaesthesia was maintained with propofol (50-100 μg kg-1 min-1) and remifentanil (0.05-0.25 μg kg-1 min-1). Neuromuscular block was maintained with rocuronium to keep the train-of-four ratio at 0-10%. DNA was extracted from peripheral blood and genotyped with a next-generation genotyping array. The genome-wide association study (GWAS) was conducted using an additive linear regression model with PLINK software. The FINEMAP tool and data from the Genotype-Tissue Expression project v8 were utilised to study the locus further.ResultsThe final patient population comprised 918 individuals. Of the clinical variables tested, age, BMI, ASA physical status, and total dose of propofol correlated significantly (all P<0.001) with the rocuronium dose in a linear regression model. The GWAS highlighted one genome-wide significant locus in chromosome 12. The single-nucleotide polymorphisms (SNPs) with the most significant evidence of association were located in or near SLCO1A2. The two top SNPs, rs7967354 (P=5.3e-11) and rs11045995 (P=1.4e-10), and the clinical variables accounted for 41% of the variability in rocuronium dosage.ConclusionsGenetic variation in the gene SLCO1A2, encoding OATP1A2, an uptake transporter, accounted for 4% of the variability in rocuronium consumption. The underlying mechanism remains unknown.Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

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