Gender-Specific Differences in Sedation-Associated Outcomes During Complex Electrophysiological Procedures

Background: Interventional electrophysiology is a rapidly advancing field, with sedation essential for patient comfort and immobility during complex electrophysiological procedures (EPS). However, sedatives and analgesics can cause respiratory depression and hypotension. Gender-specific differences (GDs) are often overlooked in medical research, as protocols and dosages are typically based on male subjects, potentially compromising treatment safety and efficacy for women. This study examines GDs in CO₂ levels, respiratory rate, arterial blood pressure (ABP), and anesthetic requirements during deep sedation for EPS. Methods: This prospective study at Ulm University Heart Center included 702 patients (405 men and 297 women) treated under deep sedation between August 2019 and October 2023. Standard monitoring included an electrocardiogram (ECG) with heart rate, non-invasive ABP, oxygen saturation (SpO₂), and a frequent venous blood gas analysis (vBGA). The primary composite endpoint was GDs in SpO₂ dips below 90% and pathological vBGA changes. Results: The primary composite endpoint was reached by 177 women (59.6%) and 213 men (52.6%), showing no significant difference (p = 0.102). Women had a 1,6-fold higher risk of experiencing SpO₂ dips below 90% (p = 0.001). Additionally, women had 1.7 times higher hypoxia rates (p < 0.001) and were 1.5 times more likely to have a mean ABP below 65 mmHg (p < 0.001). On average, they received 65.3 mg less total propofol than men (p = 0.005) and a higher midazolam dose per kilogram of body weight (p < 0.001). Conclusions: Although the primary composite endpoint showed no significant GDs, secondary outcomes highlight the need to consider gender-specific sedation adjustments, particularly for women. This study underscores the need for personalized sedation management and patient monitoring regarding GDs.