Precision Medicine in Anesthesia: Genetic Component in Opioid-induced Respiratory Depression

This would be a prospective study for which patients not prescribed chronic pain medication (defined as not using narcotic medications in 3 months prior to surgery) and presenting for surgery would be recruited. Preop administration of sedating medications (i.e. midazolam) would be avoided. On the day of surgery, once in OR and standard ASA monitors placed, a standardized dose of 2mcg/kg ideal body weight IV fentanyl is administered. The patient is then monitored for respiratory depression for 5 minutes prior to administration of additional induction agents. \[would include respiratory rate, with RR \< 10, or O2 Sat \< 90%\]. Would not provide supplemental oxygen during this time unless patient was already on supplemental oxygen. Patient would then be preoxygenated and general anesthesia induced. Once general anesthesia is induced, a blood sample is collected and stored. \[sample could also be collected in preop upon IV placement\]. Blood will be tested for Single Nucleotide Polymorphisms of genes related to opioid-induced analgesia. \[Potential target genes listed in 7.0-1\] This genomic data will be evaluated for any correlations of the presence of opioid-related SNPs and concomitant opioid-induced respiratory depression.