• Hannah E Braithwaite, Thomas Payne, Nicholas Duce, Jessica Lim, Tim McCulloch, John Loadsman, Kate Leslie, Angela C Webster, Amy Gaskell, and Robert D Sanders.
• Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia. Electronic address: hannah.e.braithwaite@gmail.com.
• Br J Anaesth. 2023 Sep 1; 131 (3): 510522510-522.

BackgroundSuggested anaesthetic dose ranges do not differ by sex, likely because of limited studies comparing sexes. Our objective was to systematically synthesise studies with outcomes of unintended anaesthesia awareness under anaesthesia, intraoperative connected consciousness, time to emergence from anaesthesia, and dosing to achieve adequate depth of anaesthesia, and to compare between females and males.MethodsStudies were identified from MEDLINE, Embase, and the Cochrane library databases until August 2, 2022. Controlled clinical trials (randomised/non-randomised) and prospective cohort studies that reported outcomes by sex were included. Results were synthesised by random effects meta-analysis where possible, or narrative form.ResultsOf the 19 749 studies identified, 64 (98 243 participants; 53 143 females and 45 100 males) were eligible for inclusion, and 44 citations contributed to meta-analysis. Females had a higher incidence of awareness with postoperative recall (33 studies, odds ratio 1.38, 95% confidence interval [CI] 1.09-1.75) and connected consciousness during anaesthesia (three studies, OR 2.09, 95% CI 1.04-4.23) than males. Time to emergence was faster in females, including time to eye-opening (10 studies, mean difference -2.28 min, 95% CI -3.58 to -0.98), and time to response to command (six studies, mean difference -2.84 min, 95% CI -4.07 to -1.62). Data on depth of anaesthesia were heterogenous, limiting synthesis to a qualitative review which did not identify sex differences.ConclusionsFemale sex was associated with a greater incidence of awareness under general anaesthesia, and faster emergence from anaesthesia. These data suggest reappraisal of anaesthetic care, including whether similar drug dosing for females and males represents best care.Systematic Review RegistrationPROSPERO CRD42022336087.Copyright © 2023 British Journal of Anaesthesia. All rights reserved.

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