Frawley Geoff, Huque Md Hamidul
Department of Paediatric Anaesthesia and Pain Management, Royal Childrens Hospital, Melbourne, VIC, Australia.
Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
Paediatr Anaesth. 2017 Oct;27(10):1037-1042. doi: 10.1111/pan.13219. Epub 2017 Aug 17.
Gender differences in absorption, distribution, and metabolism of a number of anesthetic agents have been identified in adults. Clinically, adult studies suggest women demonstrate slower onset of opioid analgesic effects, lower spinal and epidural dose requirements, and greater sensitivity to neuromuscular blocking agents. Sex-related differences in the pharmacokinetics and pharmacodynamics of local anesthetics in neonates and infants, however, have not been well documented. As a result, it is not known whether modification of the dose of local anesthetic for awake spinal anesthesia in infants is required.
Our aim was to determine whether the ED50 and ED95 of local anesthetics used for infant spinal anesthesia are different between sexes.
This was a retrospective analysis of data previously collected during dose-response studies of levobupivacaine and ropivacaine spinal anesthetics. The doses were reanalyzed using generalized linear regression analysis to determine whether there is a discernible difference in dose requirements between male and female infants.
One hundred and twenty infant spinal anesthetics were reviewed. For levobupivacaine, the ED50 (95% CI) was 0.69 (0.49-0.88) mg vs 0.49 (0.33-0.65), whereas the ED95(95% CI) was 1.07 (0.73-1.41) vs 0.93 (0.64-1.22) for girls and boys, respectively. For ropivacaine spinal anesthesia, the ED50 (95% CI) was 0.64 (0.35-0.92) mg vs 0.30 (-0.32-0.92), whereas the ED95 (95% CI) was 1.30 (0.73-1.87) vs 1.66 (0.55-2.76) for girls and boys, respectively.
There is no evidence that sex differences occur at the ED50 dose range or at the clinically relevant ED95 dose. Modification of spinal anesthetic dose is not required for infant girls.
已在成人中发现多种麻醉剂在吸收、分布和代谢方面存在性别差异。临床上，针对成人的研究表明，女性阿片类镇痛药起效较慢，脊髓和硬膜外剂量需求较低，且对神经肌肉阻滞剂更为敏感。然而，关于新生儿和婴儿局部麻醉药的药代动力学和药效学方面的性别差异，尚未有充分的文献记载。因此，尚不清楚婴儿清醒脊髓麻醉时是否需要调整局部麻醉药的剂量。
我们的目的是确定用于婴儿脊髓麻醉的局部麻醉药的半数有效剂量（ED50）和95%有效剂量（ED95）在性别之间是否存在差异。
这是一项对先前在左旋布比卡因和罗哌卡因脊髓麻醉剂量反应研究中收集的数据进行的回顾性分析。使用广义线性回归分析重新分析这些剂量，以确定男婴和女婴在剂量需求上是否存在明显差异。
回顾了120例婴儿脊髓麻醉病例。对于左旋布比卡因，女孩的ED50（95%可信区间）为0.69（0.49 - 0.88）mg，男孩为0.49（0.33 - 0.65）mg；ED95（95%可信区间）分别为1.07（0.73 - 1.41）mg和0.93（0.64 - 1.22）mg。对于罗哌卡因脊髓麻醉，女孩的ED50（95%可信区间）为0.64（0.35 - 0.92）mg，男孩为0.30（-0.32 - 0.92）mg；ED95（95%可信区间）分别为1.30（0.73 - 1.87）mg和1.66（0.55 - 2.76）mg。
没有证据表明在ED50剂量范围或临床相关的ED95剂量下存在性别差异。女婴不需要调整脊髓麻醉剂量。
