Translational research updates in female health anesthesiology: a narrative review.
Translational research updates in female health anesthesiology: a narrative review.
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DOI：
10.21037/atm-22-3547
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发表时间：
2023-08-30
影响因子：
--
通讯作者：
Lim, Grace
中科院分区：
文献类型：
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作者：
Ibarra, Andrea J;Roman, Kenny;Nguyen, Eileen;Yates, Megan E;Nicholas, Alexandra;Lim, Grace
女性占全球人口的49.6%，在手术患者和住院患者中占很大比例。关于性和麻醉剂的双向作用或麻醉干预对女性长期健康结果的影响，人们知之甚少。疼痛通路的性别差异会影响疼痛体验和治疗效果。麻醉管理对乳腺癌复发的影响知之甚少，心血管疾病的长期后果以及妊娠期安全有效的治疗也知之甚少。本文旨在概述女性健康麻醉学研究中转化科学的最新进展，并强调疼痛，癌症结局和心血管疾病的关键研究机会。我们检索了PubMed，并总结了2021年12月至2022年6月期间以英文发表的相关文章。研究揭示了疼痛通路的性别差异，并强调了性别作为实验设计和转化医学中生物变量的重要性。在阿片类镇痛药的副作用方面也观察到了性别差异。我们总结了一些可能导致这些差异的神经回路。在围手术期环境中，特定的麻醉剂与转移性种植潜力以及急性和慢性疼痛结局有关，这表明在肿瘤手术期间麻醉剂选择在综合护理中的重要性。在围产期环境中，先兆子痫，一种妊娠期心血管疾病，会影响孕产妇的结局;然而，生物标志物可以对先兆子痫风险的女性进行风险分层，并有望识别不良神经系统和其他健康结局的风险。建立疼痛和心血管疾病诊断和预测工具的研究将帮助麻醉师最大限度地减少与麻醉剂和围院治疗相关的性相关风险和副作用。性别特异性麻醉护理将改善结果，为患者和临床医生提供有关治疗和行为干预有效性的实用信息。然而，需要更多的研究和具体的分析计划，以继续解决麻醉学中基于性别的结果。
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. We searched PubMed and summarized relevant articles published in English between December 2021 and June 2022. 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. 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.