Genetic Methylation Disorders and Anesthetic Implications

Abstract

Nitrous oxide (N2O) is a commonly available inhalational agent in anesthesia utilized by many anesthesia providers which is considered to be a safe and effective agent for anesthesia purposes. However, it has been implicated in rare, but severe, adverse effects in patients with genetic methylation defects (Baum, 2007). While a general guideline by Huemer et al. (2017) pertaining to the diagnosis and treatment of methylation disorders does exist, no comprehensive guidelines addressing the use of N2O in anesthesia practice and these genetic disorders currently exists. Aims of the quality improvement project were: 1.) recruit members of a local anesthesia practice to evaluate an existing clinical practice guideline by Huemer et al. (2017) aimed at enhancing and improving the diagnosis and treatment of patients with genetic methylation defects; and 2.) based on the review of the guidelines, have local anesthesia providers make practice recommendations that could enhance anesthesia care for patients with methylation defects. Participants for this DNP Project were selected via purposive sampling of anesthesia providers. Data collection for aim 1 was conducted using the AGREE II tool scoring framework and data collection for aim 2 was conducted via descriptive analytics focusing on common themes generated from direct quotes made by the participants during the focus group. For aim one, all domains scored above the 70% quality threshold that was set except for two domains, that being domain 2, “Stakeholder Involvement” that scored 61% and domain 5, “Applicability” which scored the lowest score of 38%. All participants gave the CPG an overall score of 5 out of 7 and stated they would recommend the CPG for use with modifications. For aim two, common themes per the participants’ responses were that the issue of genetic methylation defects is significant but that it might not ultimately change their anesthesia practice as the participants in this study do not use N2O for long durations of time as part of their practice.