Gender Affects the Median Effective Dose and 95% Effective Dose of Oxycodone for Blunting the Hemodynamic Response to Tracheal Intubation in Narcotic-Naïve Adult Patients

Abstract

Background:Intravenous (IV) oxycodone has been used at induction to prevent an intubation reaction. The aims of the current study were to calculate the median effective dose (ED50) and the 95% effective dose (ED95) of an IV bolus of oxycodone that blunts the hemodynamic response to tracheal intubation with propofol according to gender and to observe the adverse events of induction-dose oxycodone.Methods:Adult patients who required general anesthesia and tracheal intubation were enrolled. Tracheal intubation was performed using unified TD-C-IV video laryngoscopy and an ordinary common endotracheal tube. Dixon's up-and-down method was used to obtain ED50 data for women and men separately. The initial dose of oxycodone was 0.2 mg/kg for women and 0.3 mg/kg for men (step size was 0.01 mg/kg). Next, a dose-response curve from the probit analysis was generated to determine the ED50 and ED95 to blunt the intubation reaction in female and male patients. Adverse events following oxycodone injection were observed for 5 min before propofol injection.Results:Sixty-three patients were analyzed, including 29 females and 34 males. According to the probit analysis, the ED50 and ED95 of oxycodone required to blunt the intubation reaction in women were 0.254 mg/kg (95% confidence interval [CI], 0.220–0.328 mg/kg) and 0.357 mg/kg (95% CI, 0.297–2.563 mg/kg), respectively. In men, the ED50 and ED95 were 0.324 mg/kg (95% CI, 0.274–0.381 mg/kg) and 0.454 mg/kg (95% CI, 0.384–2.862 mg/kg), respectively. Men required 28% more oxycodone than women for induction (P < 0.01). The most common adverse events were dizziness (87.3%), vertigo (66.7%), sedation (74.6%), and respiratory depression (66.7%).Conclusions:Oxycodone can be used for induction to prevent intubation reactions. Gender affected the ED50 and ED95 of oxycodone for blunting the tracheal intubation reaction.

Population pharmacokinetic‐pharmacodynamic modelling of liquid and controlled‐release formulations of oxycodone in healthy volunteers

“…In contrast, human males have been found to require 30%‐40% more morphine to obtain similar analgesic effects compared to females . Similarly, a recent patient study also found that men required 28% more oxycodone than females to blunt the intubation reaction . Our model found that oxycodone is more potent in males compared to females.…”

“…34 Similarly, a recent patient study also found that men required 28% more oxycodone than females to blunt the intubation reaction. 37 Our model found that oxycodone is more potent in males compared to females. Our finding suggests that the dose-effect difference between males and females is not due to pharmacokinetics, as no gender differences were found in the PK model.…”

“…Contradictory results regarding a correlation between opioid potency and gender exist . In most animal studies, morphine and oxycodone had a higher potency in males compared to females .…”

“…23 Contradictory results regarding a correlation between opioid potency and gender exist. [34][35][36][37][38][39] In most animal studies, morphine and oxycodone had a higher potency in males compared to females. 36,38 Kim et al found higher pain relief in men compared to females after equivalent oxycodone dosages.…”

Preemptive Anti–Stress Response Effects of Oxycodone Versus Sufentanil for Patients Undergoing Cardiac Valve Replacement—A Randomized Controlled Trial

“…The progress of OAA/S assessment was performed by a well‐trained, blinded researcher . Respiratory depression was defined as respiratory rate decreased to <10 beats/min …”