title: Epigenetics in the perioperative period.
abstract: The perioperative period is characterized by profound changes in the body's homoeostatic processes. This review seeks to address whether epigenetic mechanisms may influence an individual's reaction to surgery and anaesthesia. Evidence from animal and human studies suggests that epigenetic mechanisms can explain many facets of susceptibility to acute and chronic pain, making them potential therapeutic targets. Modern pain management is still based upon opiates, and both the developmental expression of opioid receptors and opioid-induced hyperalgesia have been linked to epigenetic mechanisms. In general, opiates seem to increase global DNA methylation levels. This is in contrast to local anaesthetics, which have been ascribed a global demethylating effect. Even though no direct investigations have been carried out, the potential influence of epigenetics on the inflammatory response that follows surgery seems a promising area for research. There is a considerable body of evidence that supports the involvement of epigenetics in the complex process of wound healing. Epigenetics is an important emerging research topic in perioperative medicine, with a huge potential to positively influence patient outcome.
authors: Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: P
authors: P
authors: Lirk
authors: Department of Gynaecology and Obstetrics, Innsbruck Medical University, Innsbruck, Austria.
authors: H
authors: H
authors: Fiegl
authors: Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: N C
authors: NC
authors: Weber
authors: Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: M W
authors: MW
authors: Hollmann
mesh_terms: D000701:Analgesics, Opioid / Q000494:pharmacology; D000762:Anesthesia Recovery Period; D000779:Anesthetics, Local / Q000494:pharmacology; D019175:DNA Methylation; D044127:Epigenesis, Genetic / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D006930:Hyperalgesia / Q000235:genetics; D007249:Inflammation / Q000235:genetics*; D010149:Postoperative Pain / Q000188:drug therapy / Q000235:genetics*; D059035:Perioperative Period; D013312:Stress, Physiological / Q000235:genetics*; D014945:Wound Healing / Q000235:genetics*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local