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Anesthesia Alert

Adult and pediatric patients of Venezuelan ancestry may carry a mitochondrial gene mutation that correlates with hypersensitivity to volatile anesthetic agents, which can result in severe neurological injuries and death.

January 27, 2026 – The American Society of Anesthesiologists (ASA) and the Society for Pediatric Anesthesia (SPA) released a joint communication to inform the anesthesia community that their respective organizations and South American anesthesia societies have identified cases in which patients of Venezuelan ancestry, who were otherwise healthy, experienced severe neurological injuries after receiving routine anesthetics. In some instances, these events resulted in patient deaths. Any patient with direct maternal Venezuelan lineage should be considered at risk even if no family history of anesthesia-related complications is reported. Though emerging clinical and scientific data is presently incomplete, the ASA and SPA have offered broad recommendations to manage at-risk patients until critical knowledge gaps are addressed.

ASA and SPA encourage anesthesia professionals to: (1) screen patients by inquiring about potential maternal Venezuelan ancestry; (2) if indicated and with their consent, refer at-risk patients for genetic testing and alert the lab to identify the presence or absence of the pertinent mitochondrial DNA sequencing mutation (mtND4 m.11232T>C); (3) if the nature or urgency of an at-risk patient’s procedure requires proceeding with anesthesia absent genetic testing, anesthesia professionals are encouraged to avoid sevoflurane and other volatile anesthetic agents (use of midazolam, dexmedetomidine, ketamine, and short-acting opioids have not been implicated), consider regional anesthesia if it’s a reasonable option for the procedure, use anesthetic depth monitoring with processed EEG to avoid burst suppression, and monitor patients for return to neurocognitive baseline after general anesthesia. Furthermore, the Joint Statement indicates that while it hasn’t been confirmed whether prolonged propofol infusions are a safe option for this patient population, there are reports of affected patients having uneventful propofol anesthetics prior to experiencing sevoflurane-induced complications.

In addition to the above, Preferred Physicians Medical (PPM) strongly recommends anesthesia professionals have a comprehensive informed consent discussion with at-risk patients and surrogate decision-makers to ensure they are meaningfully informed of the risks, benefits, and alternatives of the anesthesia plan before proceeding with the case. The informed consent discussion should also be documented in the anesthesia record. Since there is a heightened risk of intraoperative awareness when volatile agents are not utilized to maintain general anesthesia, PPM suggests anesthesia professionals use depth of anesthesia monitoring if available and watch for hemodynamic changes associated with intraoperative awareness, such as tachycardia or elevated blood pressure.

Within recent months, PPM has received several reports of sentinel events involving patients of South American origin who unexpectedly experienced significant neurological complications after routine anesthetics. Each of these patients received sevoflurane during their procedure. PPM encourages our insureds to report these events as promptly as possible.

For more information see:
https://www.asahq.org/-/media/sites/asahq/files/public/advocating-for-you/asa_spa_communication_012726.pdf

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