Table 4.
Pharmacogenomic Decision-Support Guideline AGREE II Scores & Recommendations for Implementation in the Perioperative Setting.
| Medication | Gene | Variants | Domains* | Overall Quality | Recommended for Implementation | |||
|---|---|---|---|---|---|---|---|---|
| Scope & Purpose | Rigor of Development | Clarity of Presentation | Applicability | |||||
| Analgesia | ||||||||
| Codeine | CYP2D6 | UM/NM/IM/PM | 92.2 | 93.3 | 84.4 | 80.0 | 6.5 | YES |
| Tramadol | CYP2D6 | UM/NM/IM/PM | 96.7 | 92.2 | 85.6 | 86.7 | 6.8 | YES |
| Oxycodone | CYP2D6 | UM/NM/IM/PM | 96.7 | 94.4 | 86.7 | 85.0 | 7.0 | YES |
| Morphine | OPRM1 | A118G | 90.0 | 91.1 | 83.3 | 85.0 | 6.5 | YES |
| Celecoxib Diclofenac Flurbiprofen Ibuprofen Piroxicam |
CYP2C9 | *3 allele | 100.0 | 96.7 | 93.3 | 91.7 | 7.0 | YES |
| Anesthesia | ||||||||
| Mivacurium | BCHE | K-variant A-variant |
93.3 | 90.0 | 87.8 | 88.3 | 6.5 | YES |
| Desflurane Enflurane Halothane Isoflurane Sevoflurane Succinylcholine |
RYR1
CACNA1S |
40 RYR1 mutations, 2 CACNA1S mutations | 93.3 | 90.0 | 90.0 | 90.0 | 6.8 | YES |
| Succinylcholine | BCHE | A-variant | 94.4 | 91.1 | 85.6 | 86.7 | 6.8 | YES |
| Antiepilepsy | ||||||||
| Phenytoin | CYP2C9 | NM/IM/PM | 96.7 | 96.7 | 90.0 | 90.0 | 7.0 | YES |
| Antianxiety | ||||||||
| Diazepam | CYP2C19 | NM/IM/PM | 96.7 | 96.7 | 86.7 | 81.7 | 6.8 | YES |
| Overall mean ± SD | 95.0±2.8 | 93.2±2.8 | 87.3±3.0 | 86.5±3.7 | 6.7±0.2 | |||
*
Scores in this table represent the average of the individual scores from 5 independent expert appraisers. The exception is the overall quality scores, which were calculated as the averages of the individual scores from 4 of the 5 appraisers, as 1 appraiser did not submit Overall Quality scores.
For each of the four Domains, the maximum score=100.0. For Overall Quality, the maximum score=7.0.
UM=Ultrarapid Metabolizer; NM=Normal Metabolizer; IM=Intermediate Metabolizer; PM=Poor Metabolizer
SD=standard deviation