SPECIAL COMMENTARYGenetics and epigenetics in perioperative medicineBain, Chris R.a; Shaw, Andrew D.bAuthor Information aDepartment of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia bDepartment of Anesthesiology, Duke University Medical Center/Durham VAMC, Durham, North Carolina, USA Correspondence to Chris R. Bain, BSc (Hons), MB, ChB, FANZCA, Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria 3004, Australia. Tel: +61 3 90763176; e-mail: [email protected] Current Opinion in Critical Care: October 2012 - Volume 18 - Issue 5 - p 548-554 doi: 10.1097/MCC.0b013e328357af6d Buy Metrics Abstract Purpose of review To summarize is to review recent progress in ‘genomic’ science and how this may be applied to the perioperative environment. Although investigations that relate genetic variation to perioperative outcomes continue, it is increasingly apparent that epigenetic mechanisms may contribute to much of the observed variation in complex outcomes not otherwise explained by differences in genetic sequence. Recent findings Examples of recent findings relating to the role of epigenetic modifications in complex disease and outcomes are derived from research into type 1 diabetes, pain, and the hypoxic response. These studies provide models for future cohort study design, potential perioperative drug targets, and hypothesis development. Genetic and epigenetic factors combine to alter both gene expression and drug responses at both pharmacokinetic and pharmacodynamic levels. These factors impact on the efficacy and safety of multiple drug classes used in perioperative medicine. Summary Enhancing our understanding of the way in which patients as genomic organisms interact with the perioperative environment requires a more sophisticated appreciation of the factors governing gene expression than has been the case to date. Epigenetic mechanisms are sure to play a pivotal role in what is essentially an acquired phenotype. © 2012 Lippincott Williams & Wilkins, Inc.