Does the phase of the menstrual cycle really matter to anaesthesia?

Kurdi, Madhuri S; Ramaswamy, Ashwini H

doi:10.4103/ija.ija_139_18

Cited by 13 publications

(6 citation statements)

References 57 publications

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“…37 EST reaches the highest level during the proliferative phase, and PRO peak occurs in the secretory and luteal phases, while the levels of both hormones are low in the menstrual phase. 38 This study showed that there was no significant difference between the pain levels of female patients in the follicular and luteal phases. However, although their PRO levels increased numerically, the increase was not statistically different.…”

Section: Discussionmentioning

confidence: 66%

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The Effects of Sex Hormones on Postoperative Pain in Patients with Laparoscopic Cholecystectomy

Koraş Sözen,

Bolat,

Güntürk

2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Objective: There are many factors that affect postoperative pain. This study determines the effect of preoperative sex hormone levels on postoperative pain levels in patients undergoing laparoscopic cholecystectomy. Patients and Methods: This study included a total of 89 patients who met the study inclusion criteria. The patients were divided into 3 groups based on their sex and pre and postmenopausal periods: male patients (n = 28), postmenopausal female patients (n = 31), and female patients with normal cycles (n = 30). Normal-cycle women were also regrouped based on their follicular and luteal phases. Data were collected using a descriptive characteristics form, a patient follow-up form, and the Visual Analog Scale. Results: Venous blood samples taken from the patients before surgery were used to measure their levels of estradiol (EST), testosterone (TES), and progesterone levels. Male patients had lower pain levels than female patients. The male patients’ Visual Analog Scale scores were inversely related and correlated strongly with their TES levels (P < 0.05). However, subgroup analyses suggested that their EST level played a primary role in males and that the EST/TES ratio was determinant in the late postoperative period. In female patients, the EST/progesterone ratio was the most determining factor for the level of pain felt in the postmenopausal period, whereas there was no change in the premenopausal period at different stages of the menstrual cycle. Conclusions: Sex hormones were found to be effective in predicting postoperative pain severity.

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Section: Discussionmentioning

confidence: 66%

“…The perception of pain caused by different stimuli varies during the menstrual cycle due to fluctuations in EST and PRO levels 37 . EST reaches the highest level during the proliferative phase, and PRO peak occurs in the secretory and luteal phases, while the levels of both hormones are low in the menstrual phase 38 …”

Section: Discussionmentioning

confidence: 99%

The Effects of Sex Hormones on Postoperative Pain in Patients with Laparoscopic Cholecystectomy

Koraş Sözen,

Bolat,

Güntürk

2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Our review suggests that, at least some, females have a relative insensitivity to anaesthetic agents. Some recent research has suggested that variation in sex hormones may have a modulatory role, 96,98 with studies reporting higher end-tidal volatile requirements 13 and higher propofol effect-site concentration requirements 16 in pre-menopausal females during the follicular phase of their menstrual cycle. Oestrogen and progesterone have central nervous system effects, 14 including allosteric modulation of the gamma-aminobutyric acid receptors, a major molecular target of anaesthetic action.…”

Section: Discussionmentioning

confidence: 99%

The impact of female sex on anaesthetic awareness, depth and emergence: A systematic review and meta-analysis

Braithwaite

Payne

Duce

et al. 2023

Preprint

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Background: Accumulating evidence supports sex differences in pharmacodynamic and pharmacokinetic drug profiles. However, recommended anaesthetic drug doses are not sex-adjusted, likely due to limited studies comparing sexes. Our objective was to systematically synthesise studies of anaesthetic key performance indicators (anaesthesia awareness), and markers of relatively lighter anaesthesia, time to emergence and dosing to achieve adequate depth of anaesthesia, for females and males. Methods: MEDLINE, Embase, and the Cochrane library databases. Studies were identified from inception of database to August 2nd, 2022. Controlled clinical trials (randomised and non-randomised) and prospective cohort studies that reported outcomes by sex for awareness with post-operative recall, connected consciousness during anaesthesia, depth of anaesthesia, and emergence from anaesthesia. Two authors undertook search, review, selection, and data abstraction. Risk of bias was assessed using the Newcastle Ottawa Scale. Results were synthesized by random effects meta-analysis where possible, or narrative form. Results were expressed as odds ratios (ORs) and mean differences (MDs) with corresponding 95% confidence intervals (CIs). Results: Of the 19,749 studies identified from literature search, 66 citations of 64 studies (98,243 participants; 53,143 females and 45,100 males) were eligible for inclusion, of which 44 contributed to meta-analysis. Females had a higher incidence of awareness with post-operative recall (33 studies, OR 1.37, 95%CI 1.09 to 1.75) and connected consciousness during anaesthesia (3 studies, OR 2.09, 95% CI 1.04 to 4.23) than males. Time to emergence was faster in females than in males, including time to eye-opening (10 studies, MD -2.28 min, 95% CI -3.58 to -0.98), and time to response to command (6 studies, MD -2.84 min, 95% CI -4.07 to -1.62). Data on depth of anaesthesia were heterogenous limiting synthesis to a qualitative review which did not identify differences by sex. Conclusion: Female sex was associated with a greater incidence of anaesthetic awareness, as well as faster emergence from anaesthesia. These data suggest reappraisal of anaesthetic care, including whether similar drug dosing for females and males represents best care. Equitable outcomes for females undergoing general anaesthesia warrants strategic focus in future research.

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“…During luteal phase, the heart rate and systolic blood pressure were elevated with a lower diastolic blood pressure as a result of higher sympathetic activity and estrogen induced nitric oxide production. [ 26 ] The physiological as well as the psychological stress response to hemodynamic stimuli was also heightened. [ 27 ] Rosano et al [ 28 ] noted a higher incidence of arrhythmias particularly paroxysmal supraventricular tachycardia in the menstrual phase than during the follicular phase.…”

Section: Discussionmentioning

confidence: 99%

Is menstruation a valid reason to postpone cardiac surgery?

et al. 2022

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Background: Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss. Aims: The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation. Settings and Design: A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS. Patients and Methods: The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss. Results: The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10). Conclusion: Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.

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Does the phase of the menstrual cycle really matter to anaesthesia?

Cited by 13 publications

References 57 publications

The Effects of Sex Hormones on Postoperative Pain in Patients with Laparoscopic Cholecystectomy

The Effects of Sex Hormones on Postoperative Pain in Patients with Laparoscopic Cholecystectomy

The impact of female sex on anaesthetic awareness, depth and emergence: A systematic review and meta-analysis

Is menstruation a valid reason to postpone cardiac surgery?

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