Abstract
Purpose
To determine the plasma concentrations of propofol required to achieve different levels of sedation during monitored anesthesia care.
Methods
Sixty ASA 1-11, 18–65 yr-old patients, received a target-controlled continuousiv infusion of propofol. The target plasma concentration of propofol (Cpt) was initially set at 0.4 μ·g·ml−1. Two minutes after calculated equilibrium between plasma and effect-site concentrations, the Cpt of propofol was increased by 0.2 μg·ml−1 steps until the patient showed no reaction to squeezing the trapezius. The level of sedation was assessed immediately before each increase in propofol Cpt using the Observer’s Assessment of Alertness/Sedation (OAA/S) scale.
Results
The Cpt of propofol required to induce lethargic response to name was 1.3 μg·ml−1 (5° and 95° percentiles: 1.0 – 1.8 μg·ml−1), to obtain response after loud and repeated calling name was 1.7 μg·ml−1 (1.2 – 2.2 μg·ml−1), to obtain response after prodding or shaking was 2.0 μg·ml−1(1.6 – 2.6 μg·ml−1), to obtain response after squeezing the trapezius was 2.4 μg·ml−1 (1.8 – 3.0 μg·ml−1). Patients showed no response after squeezing the trapezius at 2.8 μg·ml−1 (2.0 – 3.6 μg·ml−1). Correlation between Cpt propofol and sedation scores were r =0.76, P< 0.0001.
Conclusions
Target-controlled infusion of propofol provided easy and safe management of intraoperative sedation, allowing fast and predictable deepening in the level of sedation, while minimizing systemic side effects of intravenous sedation due to the minimal risk of overdosing the drug.
Résumé
Objectif
Déterminer les concentrations plasmatiques de propofol nécessaire pour fournir différents niveaux de sédation monitorés.
Méthode
Soixante patients ASA 1–11 de 18–65 ans ont reçu une perfusion continue de propofoliv à cible contrôlée. La concentration plasmatique ciblée de propofol (Cpc) était d’abord de 0,4 μg·ml−1. Deux minutes après avoir atteint l’équilibre entre la concentration plasmatique et celle du site d’effet, la Cpc de propofol a été augmenté par paliers de 0,2μg·ml−1 jusqu’à ce que le patient ne réagisse plus à une pression sur le trapèze. Le niveau de sédation a été évalué immédiatement avant chaque augmentation de la Cpc de propofol à l’aide de l’échelle de cotation de la vigilance par l’observateur/sédation (CVO/S).
Résultats
La Cpc de propofol nécessaire pour induire une réaction léthargique du patient à l’appel de son nom était de 1,3 μg·ml−1(5° et 95° percentiles: 1,0 – 1,8 μg · ml−1, pour obtenir une réaction après l’appel du nom répété et à voix forte était de 1,7 μg·ml−1 (1,2–2,2 μg·ml−1), pour réagir à une poussée ou une secousse, 2.0 μg·ml−1 (1.6 -2.6μg·ml−1), et pour réagir à une pression sur le trapèze, 2,4μg·ml−1 (1,8 – 3,0μg·ml−1). Les patients n’ont pas réagi à la pression sur le trapèze avec une concentration de 2,8 μg·ml−1 (2,0 – 3,6μg·ml−1). La corrélation entre la Cpc de propofol et les niveaux de sédation a été aussi observée, r = 0,76, P < 0,0001.
Conclusion
La perfusion de propofol à cible contrôlée fournit une ligne de conduite facile et sûre pour la sédation peropératoire, permettant l’approfondissement rapide et prévisible de la sédation tout en réduisant les effets secondaires généraux de la sédation intraveineuse causés par le risque minimal d’une surdose de médicament.
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Casati, A., Fanelli, G., Casaletti, E. et al. Clinical assessment of target-controlled infusion of propofol during monitored anesthesia care. Can J Anesth 46, 235–239 (1999). https://doi.org/10.1007/BF03012602
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DOI: https://doi.org/10.1007/BF03012602