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ANESTHETIC PHARMACOLOGY

The Influence of Gender on Loss of Consciousness with Sevoflurane or Propofol

Department of Anesthesiology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia

Address correspondence and reprint requests to Jay W. Johansen, MD, PhD, Department of Anesthesiology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA 30303. Address e-mail to jay_johansen{at}emoryhealthcare.org.

Studies have suggested that hypnotic requirements for general anesthesia and emergence may be influenced by gender. In this study, we examined the effect of gender on the hypnotic requirement for loss of consciousness (LOC) using either a volatile (sevoflurane) or an IV (propofol) anesthetic. One-hundred-fifteen unpremedicated, ASA physical status I–II patients, aged 18–40 yr old, received either sevoflurane by mask to a predetermined end-tidal concentration (%ET_sevo) or propofol by target-controlled infusion (effect site) while breathing spontaneously. After sufficient time for equilibration, LOC was assessed by lack of response to mild prodding. The up-down method of Dixon was used to determine the hypnotic target concentration at 50% response (LOC₅₀). No statistically significant difference in LOC₅₀ was noted between men and women for sevoflurane (0.83% ± 0.1% and 0.92% ± 0.09% ET, respectively). Men required significantly more propofol than women (2.9 ± 0.2 versus 2.7 ± 0.1 µg/mL, respectively). However, there was no difference in the bispectral index (BIS) at LOC for men or women with either hypnotic anesthetic. This investigation identified a small, statistically significant difference in hypnotic requirement at LOC₅₀ between men and women with propofol but not with sevoflurane. As defined by BIS, men and women had equivalent hypnotic states at LOC₅₀, indicating that gender had no clinically significant effect on hypnotic requirements. However, BIS at a defined clinical end-point (LOC₅₀) was significantly different between the sevoflurane and propofol groups, suggesting that neurophysiological effects of these anesthetics may be different.

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