Patient Sex and its Influence on General Anaesthesia

Abstract

Physiological and pharmacological differences exist between men and women. Women wake faster than men following general anaesthesia. Women also differ from men in their postoperative recovery as reflected by differences in postoperative pain, nausea and vomiting and overall quality of recovery. These gender differences seem to be more pronounced in premenopausal women, suggesting hormonal mechanisms are a major contributing factor.

Patients and surgery-related factors that affect time to recovery of consciousness in adult patients undergoing elective cardiac surgery

“…7 The female sex hormone that affected pharmacokinetics and pharmacodynamics of anesthetics was postulated to play a role in the gender differences in recovery time. 19 Further investigations are needed to elucidate the relationship between sex hormone and recovery from anesthesia.…”

Sex Differences in Drug Disposition

“…Variability in the intestinal expression of transport proteins may result in sex differences in plasma drug concentrations. For example, p-glycoprotein (PGP), a membrane adenosine triphosphatase transporter protein found in high concentrations in the enterocytes of the small intestine, is encoded by the multidrug resistance transporter-1 gene (MDR1) expressed in the human intestine, liver and other tissues [39]. PGP, expressed in higher numbers in men, has been shown to decrease intracellular concentrations of certain drugs at the intestine by transporting them out of the enterocytes and back into the intestinal lumen.…”

Gender aspects in anesthesia

“…Anästhesierelevant ist z. B., dass Progesteron über seine Wirkung am γ-Aminobuttersäure(GABA)-Rezeptor hypnotische, anxiolytische und antikonvulsive Effekte hat [13] …”

“…Der mittlere Blutdruckwert liegt bei prä-menopausalen Frauen niedriger [13]. Dies ist z. T. auf Östrogenwirkungen zurück-zuführen.…”

“…Die Ergebnisse dazu sind aber bisher nicht konsistent, sodass die klinische Relevanz noch nicht feststeht[68]. Erklärbar sind diese Widersprüche damit, dass neben der hepatischen Metabolisierung viele andere Faktoren wie Verteilungsvolumen, Plasmaproteinbindung u. Ä. eine Rolle spielen[13]. Eine aktuelle Metaanalyse kommt zu dem Schluss, dass keine Unterschiede in der oralen Bioverfügbarkeit von Midazolam bestehen[45].…”