The significance of race-related differences in anaesthesiological setting
More details
Hide details
Department of Anaesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Departament of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Poland
Katarzyna Szymonek   

Rataja19A/28, 10-203 Olsztyn Poland
Submission date: 2022-02-02
Final revision date: 2022-07-05
Acceptance date: 2022-07-05
Online publication date: 2022-09-20
The human species shows a great variability. The differences involve culture, customs, appearance but they also come to include some biological or physiological aspects which have a potential bearing on the course of diseases and the effects of treatment. Over the recent years, the increasing globalisation and improved travel opportunities have resulted in a growing mass mobility. The arrival of people representing other ethnicities may pose a challenge to doctors traditionally offering treatment to individuals within ethnically homogenous societies.

The paper aims to present a comprehensive summary of state-of-the-art knowledge on race-related differences which may be of great importance for patient management in anaesthesiological setting.

Material and methods:
This paper is based on the available literature.

Results and discussion:
A literature review reveals a number of anatomical, pharmacokinetic and pharmacodynamic differences between the races. Moreover, particular ethnic groups show dissimilarities in the prevalence of some diseases requiring modifications in anaesthesiological management.

Prior to the commencement of treatment, patient’s ethnicity and the consequent differences in terms of physiology should be recognised and considered in the treatment to ensure it is conducted appropriately and safely.

Adehin A, Bolaji OO, Kennedy MA, Adeagbo BA. Allele frequencies of thiopurine S-methyltransferase (TPMT) variants in the Nigerian population. Pol Ann Med. 2017;24(2):144–147.
Chakravarti A. Perspectives on human variation through the lens of diversity and race. Cold Spring Harb Perspect Biol. 2015;7(9):a023358.
Darwin CR. The Descent of Man, and Selection in Relation to Sex. Vol 2, 1st ed. London: Murray J; 1871.
Goldberg MJ, Spector R, Johnson GF. Racial Background and Lidocaine Pharmacokinetics. J Clin Pharmacol. 1982;22(8–9):391–394.
Robinson MK. Population differences in skin structure and physiology and the susceptibility to irritant and allergic contact dermatitis: Implications for skin safety testing and risk assessment. Contact Dermatitis. 1999;41(2):65–79.
do Vale NB, Delfino J, do Vale LFB. [Could the understanding of racial differences prevent idiosyncratic anesthetic reactions?] [in Portuguese]. Rev Bras Anestesiol. 2003;53(2):258–277.
Rivas E, Cohen B, Adegboye J, et al. Ethnic differences in analgesic efficacy and safety of liposomal bupivacaine among Asian and Caucasian surgical patients: A retrospective matched-cohort analysis. Asian J Anesthesiol. 2020;58(3):99–110.
Lampotang S, Lizdas DE, Derendorf H, Gravenstein N, Lok B, Quarles JP. Race-specific pharmacodynamic model of propofol-induced loss of consciousness. J Clin Pharmacol. 2016;56(9):1141–1150.
Ortolani O, Conti A, Sall-Ka B, et al. The recovery of Senegalese African blacks from intravenous anesthesia with propofol and remifentanil is slower than that of Caucasians. Anesth Analg. 2001;93(5):1222–1226.
Ghoneim MM, Korttila K, Chiang CK, et al. Diazepam effects and kinetics in Caucasians and Orientals. Clin Pharmacol Ther. 1981;29(6):749–756.
Kurnik D, Muszkat M, Sofowora GG, et al. Ethnic and genetic determinants of cardiovascular response to the selective α2-adrenoceptor agonist dexmedetomidine. Hypertension. 2008;51(2):406–411.
Liem EB, Lin CM, Suleman MI, et al. Anesthetic requirement is increased in redheads. Anesthesiology. 2004;101(2):279–283.
Ezri T, Sessler D, Weisenberg M, et al. Association of ethnicity with the minimum alveolar concentration of sevoflurane. Anesthesiology. 2007;107(1):9–14.
Houghton IT, Aun CS, Leung DH. Minimum alveolar concentration of halothane: an ethnic comparison. J R Army Med Corps. 1993;139(3):117–119.
Faucett J, Gordon N, Levine J. Differences in postoperative pain severity among four ethnic groups. J Pain Symptom Manage. 1994;9(6):383–389.
Ortolani O, Conti A, Ngumi ZW, et al. Ethnic differences in propofol and fentanyl response: A comparison among Caucasians, Kenyan Africans and Brazilians. Eur J Anaesthesiol. 2004;21(4):314–319.
Zhang W, Chang YZ, Kan QC, et al. CYP3A4*1G genetic polymorphism influences CYP3A activity and response to fentanyl in Chinese gynecologic patients. Eur J Clin Pharmacol. 2010;66(1):61–66.
Zhou HH, Sheller JR, Nu H, Wood M, Wood AJJ. Ethnic differences in response to morphine. Clin Pharmacol Ther. 1993;54(5):507–513.
Cepeda MS, Farrar JT, Roa JH, et al. Ethnicity influences morphine pharmacokinetics and pharmacodynamics. Clin Pharmacol Ther. 2001;70(4):351–361.
Houghton IT, Aun CST, Wong YC, Chan K, Lau JTF, Oh TE. The respiratory depressant effect of morphine: A comparative study in three ethnic groups. Anaesthesia. 1994;49(3):197–201.
Lawrence A, Cooper JN, Deans KJ, Minneci PC, Wrona SK, Chisolm DJ. Effects of the FDA codeine safety investigation on racial and geographic disparities in opioid prescribing after pediatric tonsillectomy and/or adenoidectomy. Glob Pediatr Health. 2021;8:1–11.
Houghton IT, Aun CST, Gin T, Lau JTF. Inter-ethnic differences in postoperative pethidine requirements. Anaesth Intensive Care. 1992;20(1):52–55.
Critchley JA, Nimmo GR, Gregson CA, Woolhouse NM, Prescott LF. Inter-subject and ethnic differences in paracetamol metabolism. Br J Clin Pharmacol. 1986;22(6):649–657.
Critchley JA, Critchley LA, Anderson PJ, Tomlinson B. Differences in the single-oral-dose pharmacokinetics and urinary excretion of paracetamol and its conjugates between Hong Kong Chinese and Caucasian subjects. J Clin Pharm Ther. 2005;30(2):179–184.
Katz RL, Norman J, Seed RF, Conrad L. A comparison of the effects of suxamethonium and tubocurarine in patients in London and New York. Br J Anaesth. 1969;41(12):1041–1047.
Fiset P, Donati F, Balendran P, Meistelman C, Lira E, Bevan DR. Vecuronium is more potent in montreal than in Paris. Can J Anaesth. 1991;38(6):717–721.
Houghton IT, Aun CST, Oh TE. Vecuronium: an anthropometric comparison. Anaesthesia. 1992;47(9):741–746.
Lee S, Ro YJ, Koh WU, Nishiyama T, Yang HS. The neuromuscular effects of rocuronium under sevoflurane-remifentanil or propofol-remifentanil anesthesia: A randomized clinical comparative study in an Asian population. BMC Anesthesiol. 2016;16(1):65.
Wu X, Oerding H, Liu J, et al. Rocuronium blockade reversal with sugammadex vs. neostigmine: Randomized study in Chinese and Caucasian subjects. BMC Anesthesiol. 2014;14(1):53.
Collins LM, Bevan JC, Bevan DR, et al. The prolonged duration of rocuronium in Chinese patients. Anesth Analg. 2000;91(6):1526–1530.
Dahaba AA, Perelman SI, Moskowitz DM, et al. Geographic regional differences in rocuronium bromide dose-response relation and time course of action: An overlooked factor in determining recommended dosage. Anesthesiology. 2006;104(5):950–953.
Dahaba AA, Suljevic I, Bornemann H, Wu XM, Metzler H. No regional difference in cisatracurium doseresponse and time-course-of-action between patients in China and Bosnia. Br J Anaesth. 2011;106(3):331–335.
Motulsky AG, Morrow A. Atypical cholinesterase gene E1a: Rarity in negroes and most orientals. Science. 1968;159(3811):202–203.
Magbagbeola JA, Adadevoh BL, Durowoju JE. Blood sugar and plasma potassium following thiopentone and suxamethonium: A preliminary study in normal and traumatised Nigerians. Anaesthesia. 1973;28(4):423–429.