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Postoperative Issues/Does gender influence recovery?

QUESTION:

Does anyone know of any studies examining whether gender influences recovery
after ambulatory surgery under general anesthesia?

-- From Danilo Soto, Puerto Ordaz, Venezuela

REPLY:

I am not aware of any studies which have directly examined the influence of gender on recovery from general anesthesia in ambulatory surgery patients. One study of inpatients has shown that women emerge faster than men from general anesthesia with inhalational anesthetic agents (Myles PS et al, BMJ 2001;322:710-1). Another, which did not indicate the inpatient/outpatient status of their subjects, showed that women also emerge faster after general anesthesia with propofol/alfentanil/nitrous oxide (Gan TJ et al, Anesthesiology 1999;90:1283-7). The authors of these studies suggested that these findings may be due to women being less sensitive to the sedating effects of propofol, more rapid clearance of propofol in women than men, and/or hormonally-regulated functional changes in the γ -aminobutyric acid receptor (which is the site of action of most intravenous anesthetic agents).

Despite these differences in speed of emergence, gender has not been demonstrated to influence discharge time. Although I know of no studies which have specifically involved outpatients, two studies of inpatients and one study in which the inpatient/outpatient status of the subjects was not indicated, all demonstrated similar PACU discharge times for women and men (Myles PS et al, BMJ 2001;322:710-1; Waddle JP et al, Anesth Analg 1998;87:628-33; Taenzer AH et al, Anesthesiology 2000;93:670-5). These findings may be attributable to a higher rate of complications in women, which delay discharge from the PACU. For example, nausea and/or vomiting in the PACU are well known to occur more frequently in women than men, and hypertension in the PACU has also been demonstrated to occur more frequently in women (Rose DK et al, Anesthesiology 1996;84:772-81). Failure to find an effect of gender on PACU discharge may also reflect the predominance of other factors effecting time of discharge, particularly institutional system factors.

-- From D. Daley, M.D., Houston, TX

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