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Review
. 2023 Aug 30;11(10):357.
doi: 10.21037/atm-22-3547. Epub 2023 Apr 20.

Translational research updates in female health anesthesiology: a narrative review

Andrea J Ibarra  1 , Kenny Roman  1 , Eileen Nguyen  2 , Megan E Yates  2 , Alexandra Nicholas  1 , Grace Lim  1   3
Affiliations
Review

Translational research updates in female health anesthesiology: a narrative review

Andrea J Ibarra et al. Ann Transl Med. .

Abstract

Background and objective: Females represent 49.6% of the global population and constitute a significant proportion of surgical patients and hospital admissions. Little is known about the bi-directional effects of sex and anesthetics or the impact of anesthetic interventions on long-term female health outcomes. Sex differences in pain pathways can influence pain experience and treatment effectiveness. The impact of anesthetic management on the recurrence of breast cancer is poorly understood, as are the long-term consequences of cardiovascular disease and safe and effective treatments in pregnancy. This review aims to outline recent advances in translational science in female health anesthesiology research and highlight critical research opportunities in pain, cancer outcomes, and cardiovascular disorders.

Methods: We searched PubMed and summarized relevant articles published in English between December 2021 and June 2022.

Key content and findings: Studies reveal sex differences in pain pathways and highlight the importance of sex as a biological variable in experimental designs and translational medicine. Sex differences have also been observed in side effects attributed to opioid analgesics. We summarize some of the neural circuits that might underlie these differences. In the perioperative setting, specific anesthetics are implicated in metastatic seeding potential and acute and chronic pain outcomes, suggesting the importance of anesthetic selection in comprehensive care during oncologic surgery. In the peridelivery setting, preeclampsia, a cardiovascular disorder of pregnancy, affects maternal outcomes; however, biomarkers can risk-stratify females at risk for preeclampsia and hold promise for identifying the risk of adverse neurological and other health outcomes.

Conclusions: Research that builds diagnostic and predictive tools in pain and cardiovascular disease will help anesthesiologists minimize sex-related risks and side effects associated with anesthetics and peri-hospital treatments. Sex-specific anesthesia care will improve outcomes, as will the provision of practical information to patients and clinicians about the effectiveness of therapies and behavioral interventions. However, more research studies and specific analytic plans are needed to continue addressing sex-based outcomes in anesthesiology.

Keywords: Sex differences; breast cancer; cardiovascular; opioids; review.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-3547/coif). The series “Highlights in Anesthesia and Critical Care Medicine” was commissioned by the editorial office without any funding or sponsorship. AJI is supported by Bristol Myers Squibb Foundation Diversity in Clinical Trials Career Development Program. KR is supported by NIH (No. 5K01DK114395-05). EN is supported by NIH (No. F31NS113371 and T32GM008208). MEY is supported by NIH (No. F30CA250167). GL is supported by NIH (No. K12HD043441), receives grants from Heron Therapeutics, book royalties from Cambridge University Press, consulting fees from Octapharma, lecture payments from Brigham & Women’s, Boston University, Emory University, Cedars Sinai, Colorado University, Beth Israel Deaconess, University of Arkansas, and servers as an Board of Directors Member of Society for Obstetric Anesthesiology and Perinatology. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Schematic depicting interlinked factors that affect anesthesia in females. Sex-related differences influencing female anesthesia and analgesics can be caused by genetic factors, cancers, hypertension, chemical exposures, age, or hormonal changes during and after pregnancy.
Figure 2
Figure 2
Mechanisms underlying opioid side effects. These are the common side effects of opioids administered neuraxially. The cells, molecules, and circuits involved in mediating these side effects have recently been delineated. Pruritus is thought to originate at the spinal level, respiratory depression is thought to originate in the brainstem, and the hypokinetic effects of opioids are thought to originate through primary afferent neurons.
Figure 3
Figure 3
Benefits of non-inhalation propofol anesthetic in breast cancer patients. In patients undergoing breast cancer procedures, a literature review shows a reduction in inflammatory markers, locoregional breast malignancy recurrences, and angiogenesis in patients anesthetized by paravertebral propofol blocks rather than sevoflurane inhalation anesthetic. Chronic pain is reduced in patients who receive intravenous propofol.
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