We thank Rosenberg et al.  for their interest in our editorial1on the potential role that anesthesiologists may have to play as genetic counselors in light of developments in the direct-to-consumer genetic testing market. We also appreciate these researchers noting the importance of malignant hyperthermia when discussing genetics in anesthesiology. The focus of the editorial was on pain genes; it was not meant to be comprehensive.

It is undeniable that most anesthesiologists have little to no formal training in genetics and genetic counseling; therefore, it would be to the patient's benefit to seek consultation with a genetic counselor for answers concerning his or her genetic predispositions. We agree that all specialists, including anesthesiologists, should develop a working relationship with a medical genetics department to respond appropriately to patients' concerns based on their genetic profile and to provide optimal care to their patients.

Unfortunately, such communication between anesthesiologists and genetic counselors is not the norm. For example, although patients with a suspected malignant hyperthermia crisis or a suspected susceptibility to malignant hyperthermia are advised to undergo in vitro  contracture testing and genetic counseling at a certified malignant hyperthermia center,2it is not uncommon for anesthesiologists to counsel and anesthetize such patients. Often, patients are advised of their possible genetic disposition and a trigger-free general or regional anesthetic technique is used, with safe results.2 

Anesthesiologists are often in the difficult position of meeting a patient for the first time minutes before the start of a procedure and do not have all of the patient's relevant medical information. There is a clear need for assistance when it comes to genetic counseling. We hope that in the days of personalized medicine, anesthesiologists will better educate themselves in genetics as it relates to anesthetic practice, seek the expertise of colleagues in medical genetics departments, and foster a pragmatic relationship for the benefit of patients.

*Johns Hopkins Medical Institutions, Baltimore, Maryland. leefh9@gmail.com

Lee FH, Raja SN: Should anesthesiologists be equipped as genetic counselors? Anesthesiology 2010; 113:507–9
Wappler F: Anesthesia for patients with a history of malignant hyperthermia. Curr Opin Anaesthesiol 2010; 23:417–22