Did gender affect opioids for analgesia and anesthesia?
Letter to the Editor

Did gender affect opioids for analgesia and anesthesia?

Nanjin Chen1, Yongpo Jiang2

1Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China; 2Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China

Correspondence to: Yongpo Jiang. Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, No. 150, Ximen Street, Taizhou 317000, China. Email: jyongpo8@163.com.

Response to: Wang L, Wu Q, Wang M, et al. Gender differences in the effective dose of alfentanil in painless bronchoscopy. J Thorac Dis 2023;15:216-8.

Submitted Nov 02, 2022. Accepted for publication Nov 21, 2022. Published online Dec 12 2022.

doi: 10.21037/jtd-2022-23

We appreciate the valuable comments from Wang et al. Some previous studies found that males required more opioids for analgesia and anesthesia than females did (1,2). Males require higher doses to alleviate similar pain because females are more sensitive than males to opioid receptor agonists (3). Multiple mechanisms are possible reasons for sex differences in opioid analgesia, including pharmacokinetics and pharmacodynamics, gonadal hormonal effects, the balance of analgesic/anti-analgesic processes, genetic influences, and psychological factors (4). However, the pharmacokinetics and pharmacokinetics of remifentanil were affected by age and Body Mass Index, and there was no influence of sex on any pharmacokinetic or pharmacodynamic parameter (5). Other Previous research established a pharmacokinetic model of sufentanil that was not based on sex (6). In our study, we showed no apparent differences between men and women in the effective dose of alfentanil in painless bronchoscopy (7). Previous research also has shown that alfentanil analgesia is an absence of sex differences (8). We humbly agree that there is an important bias in our study. Future studies are needed to investigate the analgesic effects of alfentanil at different anesthetic protocols and in different genders. In short, clinicians need to be aware of whether there are gender differences when administering opioids in different situations.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Thoracic Disease. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2022-23/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Pleym H, Spigset O, Kharasch ED, et al. Gender differences in drug effects: implications for anesthesiologists. Acta Anaesthesiol Scand 2003;47:241-59. [Crossref] [PubMed]
  2. Kang XH, Bao FP, Zhang HG, et al. Gender Affects the Median Effective Dose and 95% Effective Dose of Oxycodone for Blunting the Hemodynamic Response to Tracheal Intubation in Narcotic-Naïve Adult Patients. Chin Med J (Engl) 2018;131:1958-63. [Crossref] [PubMed]
  3. Pisanu C, Franconi F, Gessa GL, et al. Sex differences in the response to opioids for pain relief: A systematic review and meta-analysis. Pharmacol Res 2019;148:104447. [Crossref] [PubMed]
  4. Fillingim RB, Gear RW. Sex differences in opioid analgesia: clinical and experimental findings. Eur J Pain 2004;8:413-25. [Crossref] [PubMed]
  5. Minto CF, Schnider TW, Egan TD, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology 1997;86:10-23. [Crossref] [PubMed]
  6. Gepts E, Shafer SL, Camu F, et al. Linearity of pharmacokinetics and model estimation of sufentanil. Anesthesiology 1995;83:1194-204. [Crossref] [PubMed]
  7. Chen N, Wang X, Chen L, et al. Estimation of the median effective dose and the 95% effective dose of alfentanil required to inhibit the bronchoscopy reaction during painless bronchoscopy with i-gel supraglottic airway device: an Up-and-Down Sequential Allocation Trial. J Thorac Dis 2022;14:1537-43. [Crossref] [PubMed]
  8. Olofsen E, Romberg R, Bijl H, et al. Alfentanil and placebo analgesia: no sex differences detected in models of experimental pain. Anesthesiology 2005;103:130-9. [Crossref] [PubMed]
Cite this article as: Chen N, Jiang Y. Did gender affect opioids for analgesia and anesthesia? J Thorac Dis 2023;15(1):214-215. doi: 10.21037/jtd-2022-23

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