Important Alert: Anesthetic Risks Linked to ND4 Gene Mutation

The College is sharing this communication for your information.

The Canadian Academy of Dental Anaesthesia (CADA) has circulated an important communication from the American Society of Anesthesiologists (ASA) and the Society for Pediatric Anesthesia (SPA).

Rare Gene Mutation in Some with Venezuelan Ancestry Linked to Severe Neurologic Complications and Death After General Anesthesia

This is in regard to severe neurologic complications—including stroke and death—reported after routine general anesthesia in otherwise healthy patients of Venezuelan maternal ancestry. Approximately 36 cases have been identified globally, including cases in the United States and Europe.

Recent family histories and genetic testing indicate an association with a mitochondrial ND4 gene mutation, inherited exclusively through the maternal line. Several affected individuals also had relatives who experienced adverse outcomes following anesthesia.

While the optimal anesthetic approach for patients with the ND4 mutation is not yet established, ASA and SPA recommend that anesthesia providers:

• Ask patients about maternal Venezuelan heritage, recognizing that absence of a family history does not eliminate risk.
• Communicate with sensitivity when discussing ancestry and potential risk.
• Consult genetics experts when considering testing, and alert laboratories to the specific ND4 mutation.
• Avoid inhalational anesthetics, consider regional techniques, and implement enhanced neurologic monitoring during anesthesia.

Providers are also encouraged to report any suspected cases to institutional patient safety bodies and to the Anesthesia Incident Reporting System of the Anesthesia Quality Institute.