Gender and Recovery After General Anesthesia Combined with Neuromuscular Blocking Drugs

Abstract

Previous studies suggest that women recover faster from general anesthesia than men, but it is unclear whether this is a result of a gender effect or differences in the pattern of drug administration or type of surgery. We performed a subset analysis comparing recovery characteristics from general anesthesia combined with neuromuscular blocking drugs of female and male patients, at risk of awareness, enrolled in a large trial testing the effectiveness of bispectral index (BIS) monitoring. We used multivariate statistical methods to adjust for differences in baseline characteristics, duration and extent of surgery, and anesthetic drug administration in 1079 patients (584 male, 495 female). Female patients had higher BIS values than male patients despite similar amounts of anesthetic drug administration (time-averaged mean [sd] BIS: male 44.6 [7.1] versus female 46.4 [6.6]; P = 0.005). Time to eye opening after anesthesia and time to eligibility to discharge from the postanesthesia care unit were less in women than men (male 13.9 [13.2] min versus female 10.6 [11.6] min; P < 0.001; male 133 [209] min versus female 78 [106] min; P < 0.001, respectively). These differences persisted after multivariate adjustment (both P < or = 0.001). Gender has an independent effect on recovery times in patients undergoing general anesthesia combined with neuromuscular blocking drugs, with women recovering faster than men. Higher BIS values during maintenance of anesthesia in women, despite similar amounts of anesthetic drug administration, suggests that women are less sensitive to the hypnotic effect of anesthetic drugs than men and may help explain faster recovery times in women.

Effects of Combined Epidural Analgesia with Total Intravenous Anesthesia on Risky Patients Underwent Major Abdominal Surgery

“…Buchanan et al [28] proposed that gender has an independent effect on recovery times in patients undergoing general anesthesia. They concluded that women are less sensitive to the hypnotic effect of anaesthetic drugs than men and may help explain faster recovery times in women.…”

“…They suggested that the combination of TIVA and continuous epidural anesthesia would be useful to maintain stable hemodynamic state and to obtain early recovery time, especially in the elderly. [23][24][25]28,30,41] The combination of TIVA and epidural anesthesia does not require the use of intraoperative intravenous opioids and shortens recovery time without increasing the incidence of side effects [41][42][43] and reduce the dose consumption of IV and inhalation anaesthetics. [44][45][46] We used 0.1% bupivacaine combined with 2µg/ mL fentanyl infusion doses in our study, and found that MAP values on 10 th min.…”

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

“…6 In a study of 1079 patients, Buchanan et al demonstrated similar findings and proposed that lower sensitivity to the hypnotic effect of anesthetics in women may account for their faster recovery. 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.…”

Bispectral Index-Guided General Anesthesia in Combination with Thoracic Epidural Analgesia Reduces Recovery Time in Fast-Track Colon Surgery: Retracted

“…Data about improving the recovery process by BIS-titrated anesthetic agents have been inconsistent. The recovery process appears to be dependant on factors such as age, gender, ASA physical status, and duration of anesthesia (6,7). The objective of this study was to assess the effects of BIS-guided general anesthesia in combination with thoracic epidural analgesia on recovery times and early mobilization in patients undergoing elective fast-track colon surgery.…”