Sex-based differences in anesthesia approaches and outcomes: A narrative review

Area of Science:

• Anesthesiology
• Pharmacology
• Perioperative Medicine

Background:

• Biological sex is a critical factor in perioperative risk assessment and anesthetic management, yet it is often overlooked in clinical practice.
• Existing preoperative risk scores seldom account for sex, despite substantial evidence of sex-based variations in patient responses throughout the perioperative period.

Purpose of the Study:

• To review and synthesize current scientific literature on sex-related differences in anesthesia.
• To identify and highlight significant knowledge gaps in understanding these sex-based variations in perioperative care.

Main Methods:

• This study is a narrative review of existing research.
• The review focuses on evidence concerning sex influences on anesthetic pharmacokinetics, pharmacodynamics, and postoperative outcomes.

Main Results:

• Women show altered sensitivity to anesthetic agents like propofol and increased sensitivity to opioids and neuromuscular blockers (e.g., rocuronium).
• Postoperative outcomes differ by sex, with women reporting more severe chronic pain but lower mortality rates.
• Surgical complications also exhibit sex-specific patterns.

Conclusions:

• Emerging evidence confirms significant sex-based differences in anesthesia and perioperative management.
• Further research is essential to understand the mechanisms driving these variations and to develop sex-specific, personalized patient care strategies.