Genetic Susceptibility To Postoperative Nausea And Vomiting Undergoing Breast Surgery With General Anesthesia In Chinese Population

Objective: To investigate the influence of gene polymorphisms onPONV of patient undergoing breast surgery with general anesthesiaand to provide foundation and theoretical evidence forindividualization of medication in antiemetic treatment.Methods:246female patients, on American Society ofAnesthesiologists (ASA) physical status of I or II, undergoing breastsurgery with general anesthesia were enrolled. Age, height, weight,history of motion sickness and PONV, duration of anesthesia,incidence of nausea or vomiting and time to first nausea or vomitingwithin24hours after surgery were recorded.7single nucleotidepolymorphisms (SNPs) in5candidate genes related to nausea orvomiting (OPRM1, HTR3D, HTR3C, HTR3B, DRD2) were analyzed for theassociation with PONV. IMLDR was used for Genotyping and logisticregression model, Kaplan-Meier plot and Cox regression model wereused for statistical analysis.Results: All the patients were successfully completed surgery andfollow-up.240cases got successful genotyping. Five cases wereexcluded because of prophylactic antiemetic medication and one casewas excluded because of failed genotyping. Patients carrying CCgenotype of rs6443930in HTR3D had a higher risk of nausea andvomiting than those carrying GG genotype in early period (during thefirst6hours after surgery), respectively(P=0.019，OR=3.310，95%CI:1.221-8.975and P=0.033，OR=3.403，95%CI:1.106-10.469) andpatients carrying CC genotype had a higher risk of nausea than thosecarrying GG genotype during24h after surgery (P=0.047，HR=1.998， 95%CI：1.009-3.956).With AA genotype being the reference, patientscarrying GG genotype of rs6807670in HTR3C had a lower risk of nauseaand patients carrying GA genotype had a lower risk of vomiting during24h after surgery (P=0.022，HR=0.077，95%CI：0.008-0.693and P=0.047，HR=0.482，95%CI：0.235-0.990). With AA genotype being the reference,Patients carrying GA genotype of rs1672717in HTR3B had a higher riskof vomiting in later period (during6h and24h aftersurgery)(P=0.046，OR=4.146，95%CI:1.026-16.754).Conclusion: SNPs rs6443930in HTR3D, rs6807670in HTR3C andrs1672717in HTR3B were associated with PONV of patient undergoingbreast surgery with general anesthesia.These may play an importantrole in mediating susceptibility to developing PONV.