Biological sex and gender related differences in pharmacological requirements, physiological response and perioperative outcomes: current evidence and clinical implications

Psychosocial factors related to biological sex and gender are recognized as relevant determinants of perioperative outcomes [1]. The literature suggests that sex differences may influence the requirements and response to anesthetic agents, pain perception, and postoperative recovery, highlighting the need for anesthetic practice tailored to patients’ needs. A systematic review of the literature was conducted to examine the influence of gender and sex on anesthetic pharmacology and postoperative outcomes. A search was conducted in PubMed/MEDLINE, EMBASE, Cochrane Library and SCOPUS databases using the terms “gender perspective”, “gender identity”, “sex”, “anesthesia”, and “anesthesia recovery period,” applying Boolean operators. Studies published in Spanish or English in the last 5 years (2019–2024) that evaluated adult patients undergoing surgical procedures or medical interventions with exposure to intravenous or inhaled anesthetic agents and that reported results stratified by sex or gender were included. The outcomes of interest included pharmacokinetics, pharmacodynamics, pharmacological requirements, physiological response, and perioperative outcomes. A total of 1355 articles were obtained, of which 15 met the inclusion criteria. Differences in perioperative outcomes associated with sex were reported. Several studies have reported greater postoperative pain intensity and differences in analgesic requirements in women influenced by factors such as age, presence of chronic pain, and hormonal status [2, 3]. Similarly, sex-related variations in anesthetic agent sensitivity, intraoperative requirements, and recovery profiles have been described. Moreover, female sex has been associated with a higher risk of intraoperative awareness [4], a higher incidence of postoperative nausea and vomiting, and other recovery-related outcomes [5]. Biological sex is a factor that can significantly influence anesthetic pharmacology, physiological response, and perioperative outcomes. These findings support the need to move toward an individualized anesthetic approach that considers specific variables linked to sex to optimize patient safety and clinical outcomes [1–5]. To clarify the underlying mechanisms and guide individualized anesthetic practice tailored to the particular needs determined by sex and gender, studies with greater methodological rigor are needed.