Drugs and sex differences: a review of drugs relating to anaesthesia

Ciccone, G.; Holdcroft, Anita

doi:10.1093/bja/82.2.255

Cited by 86 publications

(56 citation statements)

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“…Circadian rhythms have been documented for steroid hormone levels [26,105], autonomic nervous system activity [27], and drug absorption [36]. These rhythms may be altered by menstrual cycle rhythms in women.…”

Section: Testing Across the Menstrual Cycle And Reproductive Stages: mentioning

confidence: 99%

“…Finally, it is important to record dysmenorrheal status, as dysmenorrheic women may differ from those without dysmenorrhea in their responses to (non-menstrual) pain stimuli, especially during the perimenstrual period (e.g., [15,75]). Circadian rhythms have been documented for steroid hormone levels [26,105], autonomic nervous system activity [27], and drug absorption [36]. These rhythms may be altered by menstrual cycle rhythms in women.…”

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confidence: 99%

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Studying sex and gender differences in pain and analgesia: A consensus report

Greenspan

Craft

LeResche

et al. 2007

Pain

838

623

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In September 2006, members of the Sex, Gender and Pain Special Interest Group of the International Association for the Study of Pain met to discuss the following: (1) what is known about sex and gender differences in pain and analgesia; (2) what are the "best practice" guidelines for pain research with respect to sex and gender; and (3) what are the crucial questions to address in the near future? The resulting consensus presented herein includes input from basic science, clinical and psychosocial pain researchers, as well as from recognized experts in sexual differentiation and reproductive endocrinology. We intend this document to serve as a utilitarian and thought-provoking guide for future research on sex and gender differences in pain and analgesia, both for those currently working in this field as well as those still wondering, "Do I really need to study females?" Keywords Sex differences; Gonadal hormones; Estrogens The case for studying sex and gender differences in pain and analgesiaThe pain field has moved from debating whether sex differences in pain exist to recognizing the importance of these differences. Attention is now directed toward understanding (1) what conditions lead to the expression of sex and gender differences in pain experience and reactivity, (2) what mechanisms underlie these differences, and (3) how these differences can inform clinical management of pain.As noted in a recent review, at least 79% of animal studies published in Pain over the preceding 10 years included male subjects only, with a mere 8% of studies on females only, and another 4% explicitly designed to test for sex differences (the rest did not specify) [142]. Given the substantially greater prevalence of many clinical pain conditions in women vs. men [20,199], and growing evidence for sex differences in sensitivity to experimental pain and to analgesics [21,41,213], we recommend that all pain researchers consider testing their hypotheses in both sexes, or if restricted by practical considerations, only in females. It is invalid to assume that data obtained in male subjects will generalize to females, and the best non-human model of the modal human pain sufferer -a woman -is a female animal. If only males are examined in a given study, it is important that a rationale for exclusion of females be provided and that the potential limitation in generalizability of the findings be addressed in the discussion, particularly when examining a pain phenomenon that occurs with greater prevalence or severity in females. In both preclinical and clinical studies, a comparison of both sexes will further our understanding of individual differences in sensitivity to pain and analgesia, thus improving our ability to treat and prevent pain in all people. General considerationsTwo issues of terminology are important. First, the term "sex" refers to biologically based differences, while the term "gender" refers to socially based phenomena. Although biological sex exerts a major influence on one's gender identity, sex and gender a...

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Section: Testing Across the Menstrual Cycle And Reproductive Stages: mentioning

confidence: 99%

mentioning

confidence: 99%

Studying sex and gender differences in pain and analgesia: A consensus report

Greenspan

Craft

LeResche

et al. 2007

Pain

838

623

View full text Add to dashboard Cite

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“…Although a gender effect in opioid analgesic responsivenss remains controversial, it would be of interest to perform a similar dose response study in male patients. 27,28 Second, our results are available for ASA I and II patients only, aged 18 to 70 yr. Hemodynamic tolerance in ASA III or IV patients may be different, particularly those suffering from serious heart disease. A further limitation of the study is that the sample size calculation was not based on the primary objective of the study, i.e., the estimation of ED 95 , limiting the precision of the ED 95 estimate.…”

Section: Discussionmentioning

confidence: 99%

Dose optimale de rémifentanil pour l’insertion d’un masque laryngé lors de la co-administration d’une dose standard unique de propofol

Bouvet

Da-Col

Rimmelé

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This dose-response study aimed to determine the optimal dose of remifentanil combined with propofol 2.5 mgÁkg -1 iv in order to achieve excellent conditions for laryngeal mask airway (LMA TM ) insertion in 95% of adult female patients. Methods Sixty-eight adult premedicated female patients, American Society of Anesthesiologists (ASA) physical status I and II requiring anesthesia for ambulatory surgery, were randomly allocated to one of four remifentanil dose groups (0.25, 0.5, 1, or 2 lgÁkg -1 ). Induction of anesthesia was achieved with one of the four blinded doses of remifentanil infused over 60 sec and simultaneously co-administered with propofol 2.5 mgÁkg -1 iv infused over 45 sec. Insertion of the LMA was attempted 150 sec after the beginning of the induction sequence. Insertion conditions were assessed using a six-category score according to resistance to mouth opening and insertion, swallowing, coughing and gagging, movement, and laryngospasm. A probit analysis was performed to calculate the effective dose for insertion of the LMA in 95% of patients (efficient dose [ED] 95 ). The changes in heart rate (HR) and mean arterial blood pressure (MAP) in response to LMA insertion were recorded and compared as secondary outcome variables. Results The ED 95 of remifentanil was 1.32 (95% confidence interval [CI] 0.99-2.46) lgÁkg -1 . Changes in heart rate and mean arterial pressure were modest and similar over time across groups, with maximum decreases in heart rate and mean arterial pressure \ 30% each during induction of anesthesia. Conclusions The required dose of remifentanil is 1.32 (95% CI 0.99-2.46) lgÁkg -1 to achieve excellent LMA insertion conditions in 95% of patients when co-administered with propofol 2.5 mgÁkg -1 in healthy premedicated female patients undergoing elective ambulatory surgery. RésuméObjectif L'objectif de cette e´tude de dose-re´ponse e´tait de de´terminer la dose optimale de re´mifentanil lors de l'administration conjointe de propofol 2,5 mgÁkg -1 iv afin d'obtenir des conditions excellentes pour l'insertion d'un masque larynge´(LMAÒ) chez 95 % de patientes adultes. Méthode Soixante-huit patientes adultes ASA I et II pre´me´dique´es et ne´cessitant une anesthe´sie pour une chirurgie ambulatoire ont e´te´randomise´es en quatre groupes selon la dose de re´mifentanil (0,25, 0,5, 1 ou 2 lgÁkg -1 ). L'induction de l'anesthe´sie a e´te´re´alise´e avec l'une des quatre doses de re´mifentanil en aveugle perfuse´e sur 60 secondes, administre´e simultane´ment a`du propofol 2,5 mgÁkg -1 iv perfuse´sur 45 secondes. L'insertion du Support was provided solely by institutional sources.

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“…The mechanism for gender differences is still elusive [52]. There is some evidence that genetics plays a part in influencing interindividual variation in clinical and experimental pain responses [57]. It can also be attributed to a different socialization processes for men and women that influence bodily experience and the willingness to communicate distress [46].…”

Section: Discussionmentioning

confidence: 99%