{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T14:28:07Z","timestamp":1761920887960,"version":"3.40.5"},"reference-count":34,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T00:00:00Z","timestamp":1624924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Fundamemntal Clinical Pharma"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A quick literature search using \u201csex\/gender\u201d vs. the commonly used hypnotic propofol or neuromuscular\u2010blocking agent cisatracurium will reveal numerous contradictory sex difference publications depending on the ethnic\u2010geographic location of where these studies were conducted. We induced anesthesia with cisatracurium besylate (GlaxoSmithKline) 100\u00a0\u03bcg\u00a0kg<jats:sup>\u22121<\/jats:sup> administered exactly 1\u00a0minute following propofol (AstraZeneca) 2\u00a0mg\u00a0kg<jats:sup>\u22121<\/jats:sup>. In 20\u00a0male and 20 female ethnic Han\u2010Chinese test set patients (Xi'an China), and in similar ethnic white Austrian validation set patients (Graz Austria), we quantified propofol\/cisatracurium pharmacodynamic parameters namely propofol onset time, lag time, plasma concentrations (C<jats:sub>p<\/jats:sub>) at loss\u2010of\u2010behavioral response (LOBR) using bispectral index (BIS); cisatracurium onset time, lag time, and C<jats:sub>p<\/jats:sub> at T<jats:sub>1<\/jats:sub>% (first twitch of train\u2010of\u2010four) complete twitch suppression using mechanomyography (MMG). Serial arterial blood samples were collected for population pharmacokinetic (PopPK) analysis of all demographic and biological covariates (region, sex, age, weight, and height) versus volumes of distribution and clearances pharmacokinetic parameters. In Chinese women (but not in white women), propofol C<jats:sub>p<\/jats:sub> at LOBR was 33.60% lower than men and cisatracurium C<jats:sub>p<\/jats:sub> at T<jats:sub>1<\/jats:sub>% complete twitch suppression was 21.49% lower than men, a clear pharmacodynamic assertion. Region and weight were significant PopPK covariates. We demonstrated that sex differences are influenced by ethnic\u2010geographic location as only in Chinese women (but not in white women) propofol C<jats:sub>p<\/jats:sub> at LOBR and cisatracurium C<jats:sub>p<\/jats:sub> at T<jats:sub>1<\/jats:sub>% complete twitch suppression were lower than in men. When defining sex differences, ethnic\u2010geographic location should be taken into consideration as a predictive factor for optimizing propofol\/cisatracurium initial loading recommended dosages.<\/jats:p>","DOI":"10.1111\/fcp.12704","type":"journal-article","created":{"date-parts":[[2021,5,29]],"date-time":"2021-05-29T18:02:26Z","timestamp":1622311346000},"page":"182-198","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Location matters: Overlooked ethnic\u2010geographic effect in China and Austria on propofol\/cisatracurium sex differences among a population pharmacokinetic\/pharmacodynamic (PopPK\/PD) covariate analysis in men, women, and one transgender subject"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8513-3643","authenticated-orcid":false,"given":"Ashraf A.","family":"Dahaba","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine Suez Canal University  Ismailia Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaoyang","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Xijing Hospital of Fourth Military Medical University  Xi\u2019an, Shanxi China"},{"name":"Department of Anesthesiology Second Affiliated Hospital of Dalian Medical University  Dalian China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoling","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Xijing Hospital of Fourth Military Medical University  Xi\u2019an, Shanxi China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Oettl","sequence":"additional","affiliation":[{"name":"Otto\u2010Loewi Research Center for Physiological Chemistry Medical University of Graz  Graz Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hailong","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Xijing Hospital of Fourth Military Medical University  Xi\u2019an, Shanxi China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lize","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Xijing Hospital of Fourth Military Medical University  Xi\u2019an, Shanxi China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sieglinde","family":"Zelzer","sequence":"additional","affiliation":[{"name":"Institute for Medical and Chemical Diagnostics Medical University of Graz  Graz Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuiyu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Shanghai Qiangshi Information Technology Co. Ltd  Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilbert","family":"Reibnegger","sequence":"additional","affiliation":[{"name":"Otto\u2010Loewi Research Center for Physiological Chemistry Medical University of Graz  Graz Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,6,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0166-2236(86)90158-X"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-6576.2003.00036.x"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S026502150800402X"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1012015719694"},{"key":"e_1_2_11_6_1","first-page":"1287","article-title":"Impact of gender on the dose\u2010effect relationship of cisatracurium","volume":"31","author":"Shi HJ","year":"2011","journal-title":"Nan Fang Yi Ke Da Xue Xue Bao"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199905000-00010"},{"key":"e_1_2_11_8_1","first-page":"S10","article-title":"The initial clinical experience of 1819 physicians in maintaining anesthesia with propofol: characteristics associated with prolonged time to awakening","volume":"77","author":"Apfelbaum JL","year":"1993","journal-title":"Anesth Analg"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7288.710"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1373\/49.1.7"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer495"},{"key":"e_1_2_11_12_1","first-page":"244","article-title":"Validity and reliability of the Observer\u2019s Assessment of Alertness\/Sedation Scale: study with intravenous midazolam","volume":"10","author":"Chernik DA","year":"1990","journal-title":"J Clin Psychopharmacol"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000223681.77120.ca"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01627635"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2006.04548.x"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0378-4347(98)00576-3"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-018-0672-3"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01061469"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2003.11.003"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1208\/s12248-011-9255-z"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000154534.71371.4F"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198210000-00012"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq040"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-6576.2000.440918.x"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeg258"},{"issue":"2","key":"e_1_2_11_26_1","first-page":"264+","article-title":"Body composition during growth. 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