FUTURE DIRECTIONS IN PERIOPERATIVE RISK

The impact of genetics on perioperative risk has been well known since the elucidation of the inheritance pattern of malignant hyperthermia. With malignant hyperthermia, there is a clear link between the autosomal dominant disease and an adverse outcome after administration of an anesthetic.^[226] There is increasing interest in evaluating the impact of genetic polymorphism on overall perioperative outcome, even if the link to anesthesia is less well defined. For example, apolipoprotein E4 has been shown to modulate neurologic injury and recovery after a variety of acute ischemic insults, including coronary artery bypass grafting.^[227] Polymorphism of the glycoprotein GPIIIa constituent of the platelet integrin receptor has also been correlated with postoperative cognitive decline.