Sex differences in speed of emergence and quality of recovery after anaesthesia: cohort study

Myles, Paul S.; McLeod, Andrew; Hunt, Jennifer O.; Fletcher, Helen A.

doi:10.1136/bmj.322.7288.710

Cited by 88 publications

(66 citation statements)

References 5 publications

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“…Thus, there is a considerable potential for drug interactions to occur, some of which may be potentially harmful to the patients. This may be accompanied by cardiovascular and respiratory depression and a delay in recovery for hours or even days [2,3] . Sleep may be prolonged in patients with increased central nervous system responses to depressant drugs, e.g., patients who are hypothermic; or factors affecting redistribution and metabolism of drugs, e.g., patients who have hepatic or renal dysfunction [1] .…”

Section: Introductionmentioning

confidence: 99%

“…Sleep may be prolonged in patients with increased central nervous system responses to depressant drugs, e.g., patients who are hypothermic; or factors affecting redistribution and metabolism of drugs, e.g., patients who have hepatic or renal dysfunction [1] . Patient's gender, age, weight and drug interaction may be important factors influencing recovery from general anesthesia [2][3][4] . Nowadays, medications having minimal side effects and with short recovery period are mostly used to induce anesthesia [5] .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, many patients should take a number of drugs related to their surgical condition or for other medical situations [1][2][3] . Unexpected events may occur when the drugs are administered simultaneously.…”

Section: Introductionmentioning

confidence: 99%

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Interaction Between Phenylbutazone and Thiopental Sodium in Female Stray Dogs: The Effect on the Recovery from Anesthesia

Raeeszadeh¹,

Rajaian²,

Fattahian³

et al. 2013

Kafkas Univ Vet Fak Derg

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Anesthesia often involves administration of several drugs from different classes. Drug-drug interactions may affect the duration of action of anesthetic agents. The purpose of this research was to investigate interaction between phenylbutazone and thiopental sodium in dogs. Twenty-six female stray dogs were randomly divided into two groups. Each group subdivided into two subgroups <18kg and ≥18kg. Equivalent doses of thiopental sodium were intravenously administered following the injection of 0.9% normal saline in control group and phenylbutazone via the same route in experimental group. After anesthesia, time intervals needed for the return of palpebral reflex, opening of eyes, tongue movement, stretching of limbs, head and neck movements, sitting position, trying to stand, imbalanced walking and normal walking were recorded. Results showed the average time periods in the experimental group were generally more than those in the control group. It was shown the duration of the above chronological parameters were significantly higher in heavier dogs compared to the lighter. Females generally have a larger proportion of body fat content than males. This may cause a higher volume of distribution and a longer elimination half-life for thiopental in female dogs. This interaction with phenylbutazone may be due to an increase in the unbound form of thiopental sodium and its quicker distribution into the brain and a longer duration of anesthesia. Keywords: Drug interaction, Thiopental sodium, Phenylbutazone, Anesthesia, Dog Kısırlaştırılmış Dişi Köpeklerde Fenilbutazon ve Thiopental Sodyum Etkileşimi: Anesteziden Çıkışa Etkisi ÖzetAneztezi çoğu zaman birden fazla değişik sınıftan ilaçların uygulanmasını içerir. İlaçlar arası etkileşim anestezik maddenin etki süresini etkileyebilir. Bu çalışmanın amacı köpeklerde fenilbutazon ve thiopental sodyumun etkileşimini araştırmaktır. Yirmi altı kısırlaştırılmış dişi kopek rastgele iki gruba ayrıldı. Her bir grup <18kg ve ≥18kg olmak üzere iki altgruba ayrıldı. Eşit dozlarda olmak üzere thiopental sodyum control grubundakilere intravenöz %0.9 tuzlu su verilmesinin ardından, çalışma grubundakilere ise aynı yolla fenilbutazon verilmesini takiben intravenöz olarak uygulandı. Anesteziyi takiben göz kapağı refleksi, gözünü açma, dilini hareket ettirme, ayaklarını uzatma, kafa ve boyunu hareket ettirme oturma pozisyonunu sağlama, kalkmaya çalışma, dengesiz yürüme ve norma yürüme için geçen süreler kaydedildi. Sonuçlar çalışma grubundaki hayvanlarda kaydedilen ortalama sürelerin genel olarak control grubundaki hayvanlardan daha uzun olduğu gösterdi. Yukarıda belirtilen parametrelerde sürelerin daha ağır köpeklerde hafif olanlara oranla önemli derecede daha uzun olduğu gözlemlendi. Dişiler genellikle erkeklere oranla daha fazla vücut yağına sahiptir. Bu durum, dişilerde daha fazla miktarda yayılmaya ve thiopentalin yarılanma ömrü için daha uzun zamana ihtiyaç doğurabilir. Fenilbutazon ile etkileşim, thiopental sodyumun bağsız formundaki artışa ve onun daha hızlı olarak beyine yayılmasına ...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Interaction Between Phenylbutazone and Thiopental Sodium in Female Stray Dogs: The Effect on the Recovery from Anesthesia

Raeeszadeh¹,

Rajaian²,

Fattahian³

et al. 2013

Kafkas Univ Vet Fak Derg

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“…However, the reason of these differences remains unknown. Some authors explain this as hormonal difference or their fluctuation (16,17), while others claim it depends on women tendency to elaborate their complaints (17). This could be the explanation for the significant difference we found between globus pharyngeus before operation in male and female groups (p = 0.049).…”

Section: Discussionmentioning

confidence: 54%

Laryngopharyngeal complaints following short-term endotracheal intubation: peculiarities of males and females

Paulauskienė¹,

Lesinskas²

2012

AML

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Background. Laryngopharyngeal complaints are classified as minor post-intubation complications. They cause great discomfort, have some influence on the quality of life and can limit patient's casual activity. The extent of complaints ranges from 12 to 65%. Undesirable complications can be avoided by ascertaining factors that are able to provoke or decrease laryngopharyngeal symptoms after endotracheal intubation. In this study, we assessed predominant laryngopharyngeal symptoms following a short-term endotracheal intubation and their peculiarities subject to gender, and we estimated the most important influencing factors.Materials and methods. 218 patients were examined before endotracheal anesthesia, 1-2 and 24 hours after extubation. The following laryngopharyngeal complaints were recorded: hoarseness, vocal fatigue, globus pharyngeus, throat pain and throat clearing. These factors were also assessed in relation to endotracheal intubation parameters: endotracheal tube size, cuff volume and pressure, number of intubation attempts, length of anesthesia, experience of anesthesiologist and additional parameters: smoking, allergy, GERD symptoms, laryngitis and singing skills subject to gender.Results. All laryngopharyngeal symptoms increased significantly in 2 hours after extubation and remained increased after 24 hours in both male and female groups. In 1-2 hours after extubation, females complained of throat pain more than males (61.3 vs. 42.9%; p = 0,014). The following significant relations were found 1-2 hours after extubation: between throat pain and length of anesthesia, globus pharyngeus and tube size and cuff volume in the male group; between globus pharyngeus, vocal fatigue and smoking, throat clearing and cuff volume in the female group. After 24 hours, the relation was noticed between vocal fatigue and cuff volume and number of intubation attempts, globus pharyngeus and length of anesthesia, between hoarseness and number of intubation attempts and between throat pain and singing skills in the male group. Some relation between throat clearing and cuff volume remained for 24 hours after extubation, smoking had influence on hoarseness and vocal fatigue in the female group.Conclusions. Laryngopharyngeal symptoms remain an important cause of discomfort for 24 hours after extubation. Females complain of laryngeal and pharyngeal symptoms more than males and throat pain following extubation is also more frequent in females. The most important parameters of short-term endotracheal intubation that influence laryngopharyngeal complaints are as follows: cuff volume, length of anesthesia and number of intubation attempts that affect males more than females. Smoking affects females more, though singing skills are more significant in the male group.

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“…Other studies in adults have demonstrated that women recover more quickly than men following sedation with propofol. 9,10 In a study of 20 adult laparoscopic cholecystectomy patients, time to response to verbal stimuli from the time propofol infusion was stopped was shorter in females than in males, with no differences in plasma concentrations. 11 A study of propofol pharmacokinetics in elderly patients found that blood concentrations of propofol were approximately 10% lower in females than in males during infusions running at the same milligram per kilogram rate.…”

Section: Dosementioning

confidence: 99%

Retrospective Review of Propofol Dosing for Procedural Sedation in Pediatric Patients

Milius

Papademetrious

Heitlinger

2012

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES The purpose of this study was to determine the total propofol dose (mg/kg) for non-emergent pediatric procedural sedation and evaluate dosing differences with regard to a patient's sex, age, and body mass index. Adverse events were recorded and evaluated to determine whether certain patient groups were at a higher risk than others. METHODS This study was a retrospective observational pilot study including patients 0 to 18 years of age admitted between January 2008 and November 2009 for non-emergent gastrointestinal endoscopic procedures or radiologic imaging, who received propofol for procedural sedation. Data gathered included sex, age, height, weight, chronic medical conditions and medication use, concomitant anesthetic gas, preprocedure midazolam, procedure length, propofol dose in mg/kg, other medications administered during procedure, and adverse events that occurred. Comparisons between adverse event groups and categories of baseline characteristics were made using the Wilcoxon signed-rank, Kruskal-Wallis nonparametric and Pearson's chisquare tests, as appropriate. RESULTS A total of 101 patients met inclusion criteria and were included in the analysis. The mean dose of propofol required for female patients was 3.7 mg/kg versus 3.4 mg/kg for males (p=0.3). The mean dose of propofol for patients ≤9 years, 10 to 12 years, and >12 years was 3.2, 3.9, and 3.9 mg/kg, respectively (p=0.25). The mean dose of propofol for underweight, healthy weight, overweight, and obese patients was 4.2, 3.9, 3.6, and 2.6 mg/kg, respectively (p=0.38). Hypotension occurred in 42.6% of patients, and bradycardia occurred in 13.9% of patients. CONCLUSIONS There were no differences in dose requirements based on sex or age. The difference in dosing between different body weight categories was not statistically significant. The dose of propofol was higher in patients that experienced bradycardia and hypotension, but there was no statistical significance. Given the above, future studies with larger sample sizes should be conducted to establish if statistical significance exists.

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Sex differences in speed of emergence and quality of recovery after anaesthesia: cohort study

Cited by 88 publications

References 5 publications

Interaction Between Phenylbutazone and Thiopental Sodium in Female Stray Dogs: The Effect on the Recovery from Anesthesia

Interaction Between Phenylbutazone and Thiopental Sodium in Female Stray Dogs: The Effect on the Recovery from Anesthesia

Laryngopharyngeal complaints following short-term endotracheal intubation: peculiarities of males and females

Retrospective Review of Propofol Dosing for Procedural Sedation in Pediatric Patients

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