Emerging anaesthetic safety concern in patients with Venezuelan maternal ancestry

APAGBI is aware of recent evidence and international concern regarding severe neurological complications, including basal ganglia injury and death, reported after general anaesthesia in some previously healthy adults and children with Venezuelan maternal ancestry.

The reported concern relates to a possible mitochondrial pharmacogenetic susceptibility, particularly the homoplasmic mitochondrial DNA variant m.11232T>C in the MT-ND4 gene. The available evidence remains limited and is evolving. The existing ASA/SPA and European statements provide important background and interim expert recommendations, including consideration of maternal Venezuelan ancestry during pre-anaesthetic assessment, genetic testing where feasible, avoidance of volatile anaesthetic agents in potentially at-risk patients, and enhanced perioperative monitoring. (SPA) (ESAIC)
APAGBI is currently reviewing this issue and is developing a UK-facing position statement for paediatric anaesthetists. This will provide practical recommendations, including advice on potential risk identification and peri-operative management. We are also reviewing the appropriate recommendations for genetic testing, as the available pathways are likely to vary by region and across the devolved nations of the UK.

In the meantime, members are encouraged to read the existing international guidance:
ASA/SPA joint communication
https://pedsanesthesia.org/updated-joint-communication-from-the-asa-and-spa/

ESAIC/ESPA  joint statement
https://esaic.org/joint-statement-on-anaesthesia-related-mitochondrial-pharmacogenetic-risk-in-individuals-with-venezuelan-maternal-ancestry/

APAGBI will provide further updates as the UK position statement develops.

Johnny, Catalina, Laurence, Simon, Sumit, Karen,