Impact of female sex on anaesthetic awareness, depth, and emergence: a systematic review and meta-analysis

医学 荟萃分析 全身麻醉 置信区间 优势比 入射(几何) 科克伦图书馆 麻醉 梅德林 前瞻性队列研究 队列研究 限制 外科 内科学 政治学 法学 光学 物理 机械工程 工程类
作者
Hannah E. Braithwaite,Thomas Payne,Nicholas Duce,Jessica Lim,Tim McCulloch,John A Loadsman,Kate Leslie,Angela C Webster,Amy Gaskell,Robert D. Sanders
出处
期刊:BJA: British Journal of Anaesthesia [Elsevier BV]
卷期号:131 (3): 510-522 被引量:8
标识
DOI:10.1016/j.bja.2023.06.042
摘要

Abstract

Background

Suggested anaesthetic dose ranges do not differ by sex, likely because of limited studies comparing sexes. Our objective was to systematically synthesise studies with outcomes of unintended anaesthesia awareness under anaesthesia, intraoperative connected consciousness, time to emergence from anaesthesia, and dosing to achieve adequate depth of anaesthesia, and to compare between females and males.

Methods

Studies were identified from MEDLINE, Embase, and the Cochrane library databases until August 2, 2022. Controlled clinical trials (randomised/non-randomised) and prospective cohort studies that reported outcomes by sex were included. Results were synthesised by random effects meta-analysis where possible, or narrative form.

Results

Of the 19 749 studies identified, 64 (98 243 participants; 53 143 females and 45 100 males) were eligible for inclusion, and 44 citations contributed to meta-analysis. Females had a higher incidence of awareness with postoperative recall (33 studies, odds ratio 1.38, 95% confidence interval [CI] 1.09–1.75) and connected consciousness during anaesthesia (three studies, OR 2.09, 95% CI 1.04–4.23) than males. Time to emergence was faster in females, including time to eye-opening (10 studies, mean difference −2.28 min, 95% CI −3.58 to −0.98), and time to response to command (six studies, mean difference −2.84 min, 95% CI −4.07 to −1.62). Data on depth of anaesthesia were heterogenous, limiting synthesis to a qualitative review which did not identify sex differences.

Conclusions

Female sex was associated with a greater incidence of awareness under general anaesthesia, and faster emergence from anaesthesia. These data suggest reappraisal of anaesthetic care, including whether similar drug dosing for females and males represents best care.

Systematic review registration

PROSPERO CRD42022336087.
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