Download PDF
Thorac Cardiovasc Surg 2013; 61(01): 007-014
DOI: 10.1055/s-0032-1331038
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Gender and Its Implications for Cardiothoracic Perioperative Care and Anesthesia

Miriam Schopper
1   Department of Anaesthesiology, University of Munich, Munich, Germany
,
Dominik Irnich
1   Department of Anaesthesiology, University of Munich, Munich, Germany
› Author Affiliations
Further Information

Publication History

20 May 2012

14 August 2012

Publication Date:
06 December 2012 (online)

    Permissions and Reprints All articles of this category

Abstract

Differences in gender can influence perioperative outcome, with men and women being differently affected by adverse events in the perioperative period. Differences relating to specific drug effects, comorbidities and outcomes after anesthesia or intensive care have been demonstrated. There is a gender bias in diagnosis and therapy. While knowledge regarding this field is still growing, certain aspects have already been integrated into clinical practice (prevention of postoperative nausea and vomiting, target-controlled infusion, male-only policy with production of blood products). There is a need to study the influence of gender, age, and race on perioperative outcome to optimize treatment and move toward more individualized therapy. This article highlights already identified differences and discusses potential underlying mechanisms.

Keywords

sex - bias - treatment outcome - chronic pain - sex steroid hormones
 

  • References

  • 1 Berkley KJ. Vive la différence!. Trends Neurosci 1992; 15 (9) 331-332
    CrossrefPubMedSearch in Google Scholar
  • 2 Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med 1991; 325 (4) 221-225
    CrossrefPubMedSearch in Google Scholar
  • 3 Boon WC, Chow JD, Simpson ER. The multiple roles of estrogens and the enzyme aromatase. Prog Brain Res 2010; 181: 209-232
    PubMedSearch in Google Scholar
  • 4 Murphy E. Estrogen signaling and cardiovascular disease. Circ Res 2011; 109 (6) 687-696
    CrossrefPubMedSearch in Google Scholar
  • 5 Chung AK, Das SR, Leonard D , et al. Women have higher left ventricular ejection fractions than men independent of differences in left ventricular volume: the Dallas Heart Study. Circulation 2006; 113 (12) 1597-1604
    CrossrefPubMedSearch in Google Scholar
  • 6 Jonsson MK, Vos MA, Duker G, Demolombe S, van Veen TA. Gender disparity in cardiac electrophysiology: implications for cardiac safety pharmacology. Pharmacol Ther 2010; 127 (1) 9-18
    CrossrefPubMedSearch in Google Scholar
  • 7 Kurokawa J, Tamagawa M, Harada N , et al. Acute effects of oestrogen on the guinea pig and human IKr channels and drug-induced prolongation of cardiac repolarization. J Physiol 2008; 586 (Pt 12) 2961-2973
    CrossrefPubMedSearch in Google Scholar
  • 8 Buchanan FF, Myles PS, Cicuttini F. Patient sex and its influence on general anaesthesia. Anaesth Intensive Care 2009; 37 (2) 207-218
    PubMedSearch in Google Scholar
  • 9 Hart EC, Charkoudian N, Miller VM. Sex, hormones and neuroeffector mechanisms. Acta Physiol (Oxf) 2011; 203 (1) 155-165
    CrossrefPubMedSearch in Google Scholar
  • 10 Favre J, Gao J, Henry JP , et al. Endothelial estrogen receptor alpha plays an essential role in the coronary and myocardial protective effects of estradiol in ischemia/reperfusion. Arterioscler Thromb Vasc Biol 2010; 30 (12) 2562-2567
    CrossrefPubMedSearch in Google Scholar
  • 11 Regitz-Zagrosek V, Seeland U. Sex and gender differences in myocardial hypertrophy and heart failure. Wien Med Wochenschr 2011; 161 (5-6) 109-116
    CrossrefPubMedSearch in Google Scholar
  • 12 Pleym H, Spigset O, Kharasch ED, Dale O. Gender differences in drug effects: implications for anesthesiologists. Acta Anaesthesiol Scand 2003; 47 (3) 241-259
    CrossrefPubMedSearch in Google Scholar
  • 13 Soldin OP, Chung SH, Mattison DR. Sex differences in drug disposition. J Biomed Biotechnol 2011; 2011: 187103
    PubMedSearch in Google Scholar
  • 14 Huttunen KM, Mähönen N, Raunio H, Rautio J. Cytochrome P450-activated prodrugs: targeted drug delivery. Curr Med Chem 2008; 15 (23) 2346-2365
    CrossrefPubMedSearch in Google Scholar
  • 15 Rademaker M. Do women have more adverse drug reactions?. Am J Clin Dermatol 2001; 2 (6) 349-351
    CrossrefPubMedSearch in Google Scholar
  • 16 Capodanno D, Angiolillo DJ. Impact of race and gender on antithrombotic therapy. Thromb Haemost 2010; 104 (3) 471-484
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Herzog AG. Neuroactive properties of reproductive steroids. Headache 2007; 47 (Suppl. 02) S68-S78
    CrossrefPubMedSearch in Google Scholar
  • 18 Finocchi C, Ferrari M. Female reproductive steroids and neuronal excitability. Neurological sciences: official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2011; 32 (Suppl. 01) S31-35
    PubMedSearch in Google Scholar
  • 19 Casulari LA, Maggi R, Dondi D , et al. Effect of oestrus cyclicity on the number of brain opioid mu receptors in the rat. Horm Metab Res 1987; 19 (11) 549-554
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Smith YR, Stohler CS, Nichols TE, Bueller JA, Koeppe RA, Zubieta JK. Pronociceptive and antinociceptive effects of estradiol through endogenous opioid neurotransmission in women. J Neurosci 2006; 26 (21) 5777-5785
    CrossrefPubMedSearch in Google Scholar
  • 21 Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley III JL. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009; 10 (5) 447-485
    PubMedSearch in Google Scholar
  • 22 Camorcia M, Capogna G, Columb MO. Effect of sex and pregnancy on the potency of intrathecal bupivacaine: determination of ED50 for motor block with the up-down sequential allocation method. Eur J Anaesthesiol 2011; 28 (4) 240-244
    PubMedSearch in Google Scholar
  • 23 Racine M, Tousignant-Laflamme Y, Kloda LA, Dion D, Dupuis G, Choinière M. A systematic literature review of 10 years of research on sex/gender and experimental pain perception - part 1: are there really differences between women and men?. Pain 2012; 153 (3) 602-618
    CrossrefPubMedSearch in Google Scholar
  • 24 Cutolo M, Sulli A, Capellino S , et al. Sex hormones influence on the immune system: basic and clinical aspects in autoimmunity. Lupus 2004; 13 (9) 635-638
    CrossrefPubMedSearch in Google Scholar
  • 25 Niesters M, Dahan A, Kest B , et al. Do sex differences exist in opioid analgesia? A systematic review and meta-analysis of human experimental and clinical studies. Pain 2010; 151 (1) 61-68
    CrossrefPubMedSearch in Google Scholar
  • 26 Minto CF, Schnider TW, Egan TD , et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology 1997; 86 (1) 10-23
    CrossrefPubMedSearch in Google Scholar
  • 27 Booij LH. Sex, age, and genetics in anesthesia. Curr Opin Anaesthesiol 2008; 21 (4) 462-466
    CrossrefPubMedSearch in Google Scholar
  • 28 Schnider TW, Minto CF, Gambus PL , et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology 1998; 88 (5) 1170-1182
    CrossrefPubMedSearch in Google Scholar
  • 29 Sigtermans M, Dahan A, Mooren R , et al. S(+)-ketamine effect on experimental pain and cardiac output: a population pharmacokinetic-pharmacodynamic modeling study in healthy volunteers. Anesthesiology 2009; 111 (4) 892-903
    CrossrefPubMedSearch in Google Scholar
  • 30 Vanlinthout LE, van Egmond J, de Boo T, Lerou JG, Wevers RA, Booij LH. Factors affecting magnitude and time course of neuromuscular block produced by suxamethonium. Br J Anaesth 1992; 69 (1) 29-35
    CrossrefPubMedSearch in Google Scholar
  • 31 Mencke T, Schreiber JU, Knoll H, Werth M, Grundmann U, Rensing H. [Influence of gender on the intubation conditions with rocuronium]. Anaesthesist 2005; 54 (9) 884-888
    CrossrefPubMedSearch in Google Scholar
  • 32 Li Y, Zhou Y, Chen H, Feng Z. The effect of sex on the minimum local analgesic concentration of ropivacaine for caudal anesthesia in anorectal surgery. Anesth Analg 2010; 110 (5) 1490-1493
    CrossrefPubMedSearch in Google Scholar
  • 33 Leuzzi C, Sangiorgi GM, Modena MG. Gender-specific aspects in the clinical presentation of cardiovascular disease. Fundam Clin Pharmacol 2010; 24 (6) 711-717
    CrossrefPubMedSearch in Google Scholar
  • 34 Gopalakrishnan P, Ragland MM, Tak T. Gender differences in coronary artery disease: review of diagnostic challenges and current treatment. Postgrad Med 2009; 121 (2) 60-68
    CrossrefPubMedSearch in Google Scholar
  • 35 Reis SE, Holubkov R, Conrad Smith AJ , et al; WISE Investigators. Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study. Am Heart J 2001; 141 (5) 735-741
    CrossrefPubMedSearch in Google Scholar
  • 36 Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006; 355 (3) 251-259
    CrossrefPubMedSearch in Google Scholar
  • 37 Pugh ME, Hemnes AR. Pulmonary hypertension in women. Expert Rev Cardiovasc Ther 2010; 8 (11) 1549-1558
    CrossrefPubMedSearch in Google Scholar
  • 38 Townsend EA, Miller VM, Prakash YS. Sex differences and sex steroids in lung health and disease. Endocr Rev 2012; 33 (1) 1-47
    CrossrefPubMedSearch in Google Scholar
  • 39 Jacobson DL, Gange SJ, Rose NR, Graham NM. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin Immunol Immunopathol 1997; 84 (3) 223-243
    Search in Google Scholar
  • 40 Matyal R. Newly appreciated pathophysiology of ischemic heart disease in women mandates changes in perioperative management: a core review. Anesth Analg 2008; 107 (1) 37-50
    CrossrefPubMedSearch in Google Scholar
  • 41 Blumenthal JA, Lett HS, Babyak MA , et al; NORG Investigators. Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet 2003; 362 (9384) 604-609
    CrossrefPubMedSearch in Google Scholar
  • 42 Scott KM. Sex differences in the disability associated with mental disorders. Curr Opin Psychiatry 2011; 24 (4) 331-335
    CrossrefPubMedSearch in Google Scholar
  • 43 Greenspan JD, Craft RM, LeResche L , et al; Consensus Working Group of the Sex, Gender, and Pain SIG of the IASP. Studying sex and gender differences in pain and analgesia: a consensus report. Pain 2007; 132 (Suppl. 01) S26-S45
    CrossrefPubMedSearch in Google Scholar
  • 44 Linton SJ. A population-based study of the relationship between sexual abuse and back pain: establishing a link. Pain 1997; 73 (1) 47-53
    CrossrefPubMedSearch in Google Scholar
  • 45 Finkelhor D, Hotaling G, Lewis IA, Smith C. Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors. Child Abuse Negl 1990; 14 (1) 19-28
    CrossrefPubMedSearch in Google Scholar
  • 46 Han MK, Postma D, Mannino DM , et al. Gender and chronic obstructive pulmonary disease: why it matters. Am J Respir Crit Care Med 2007; 176 (12) 1179-1184
    CrossrefPubMedSearch in Google Scholar
  • 47 Alvarez PA, Pahissa J. QT alterations in psychopharmacology: proven candidates and suspects. Curr Drug Saf 2010; 5 (1) 97-104
    CrossrefPubMedSearch in Google Scholar
  • 48 Ghoneim MM, Block RI, Haffarnan M, Mathews MJ. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg 2009; 108 (2) 527-535
    CrossrefPubMedSearch in Google Scholar
  • 49 Buchanan FF, Myles PS, Cicuttini F. Patient sex and its influence on general anaesthesia. Anaesth Intensive Care 2009; 37 (2) 207-218
    PubMedSearch in Google Scholar
  • 50 Stonell CA, Leslie K, He C, Lee L. No sex differences in memory formation during general anesthesia. Anesthesiology 2006; 105 (5) 920-926
    CrossrefPubMedSearch in Google Scholar
  • 51 Gan TJ, Meyer T, Apfel CC , et al; Department of Anesthesiology, Duke University Medical Center. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003; 97 (1) 62-71 table of contents
    PubMedSearch in Google Scholar
  • 52 Beattie WS, Lindblad T, Buckley DN, Forrest JB. The incidence of postoperative nausea and vomiting in women undergoing laparoscopy is influenced by the day of menstrual cycle. Can J Anaesth 1991; 38 (3) 298-302
    PubMedSearch in Google Scholar
  • 53 Eberhart LH, Morin AM, Georgieff M. [The menstruation cycle in the postoperative phase. Its effect of the incidence of nausea and vomiting]. Anaesthesist 2000; 49 (6) 532-535
    CrossrefPubMedSearch in Google Scholar
  • 54 Alexander KP, Chen AY, Newby LK , et al; CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) Investigators. Sex differences in major bleeding with glycoprotein IIb/IIIa inhibitors: results from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) initiative. Circulation 2006; 114 (13) 1380-1387
    CrossrefPubMedSearch in Google Scholar
  • 55 Hutchens MP, Dunlap J, Hurn PD, Jarnberg PO. Renal ischemia: does sex matter?. Anesth Analg 2008; 107 (1) 239-249
    CrossrefPubMedSearch in Google Scholar
  • 56 Kim C, Redberg RF, Pavlic T, Eagle KA. A systematic review of gender differences in mortality after coronary artery bypass graft surgery and percutaneous coronary interventions. Clin Cardiol 2007; 30 (10) 491-495
    CrossrefPubMedSearch in Google Scholar
  • 57 Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 2009; 111 (3) 657-677
    CrossrefPubMedSearch in Google Scholar
  • 58 Schnabel A, Poepping DM, Gerss J, Zahn PK, Pogatzki-Zahn EM. Sex-related differences of patient-controlled epidural analgesia for postoperative pain. Pain 2012; 153 (1) 238-244
    CrossrefPubMedSearch in Google Scholar
  • 59 Schnabel A, Pogatzki-Zahn E. [Predictors of chronic pain following surgery. What do we know?]. Schmerz 2010; 24 (5) 517-531 , quiz 532–533
    CrossrefPubMedSearch in Google Scholar
  • 60 Raju R, Chaudry IH. Sex steroids/receptor antagonist: their use as adjuncts after trauma-hemorrhage for improving immune/cardiovascular responses and for decreasing mortality from subsequent sepsis. Anesth Analg 2008; 107 (1) 159-166
    CrossrefPubMedSearch in Google Scholar
  • 61 Yu HP, Chaudry IH. The role of estrogen and receptor agonists in maintaining organ function after trauma-hemorrhage. Shock 2009; 31 (3) 227-237
    CrossrefPubMedSearch in Google Scholar
  • 62 Deitch EA, Livingston DH, Lavery RF, Monaghan SF, Bongu A, Machiedo GW. Hormonally active women tolerate shock-trauma better than do men: a prospective study of over 4000 trauma patients. Ann Surg 2007; 246 (3) 447-453 , discussion 453–455
    CrossrefPubMedSearch in Google Scholar
  • 63 Gajic O, Yilmaz M, Iscimen R , et al. Transfusion from male-only versus female donors in critically ill recipients of high plasma volume components. Crit Care Med 2007; 35 (7) 1645-1648
    CrossrefPubMedSearch in Google Scholar
  • 64 Nakazawa H, Ohnishi H, Okazaki H , et al. Impact of fresh-frozen plasma from male-only donors versus mixed-sex donors on postoperative respiratory function in surgical patients: a prospective case-controlled study. Transfusion 2009; 49 (11) 2434-2441
    CrossrefPubMedSearch in Google Scholar
  • 65 Chapman CE, Stainsby D, Jones H , et al; Serious Hazards of Transfusion Steering Group. Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma. Transfusion 2009; 49 (3) 440-452
    CrossrefPubMedSearch in Google Scholar
  • 66 Hvelplund A, Galatius S, Madsen M , et al. Women with acute coronary syndrome are less invasively examined and subsequently less treated than men. Eur Heart J 2010; 31 (6) 684-690
    CrossrefPubMedSearch in Google Scholar
  • 67 Raine R, Goldfrad C, Rowan K, Black N. Influence of patient gender on admission to intensive care. J Epidemiol Community Health 2002; 56 (6) 418-423
    CrossrefPubMedSearch in Google Scholar