Propofol infusion for induction and maintenance of anaesthesia in patientswith end-stage renal disease

We have investigated the pharmacokinetics and pharmacodynamics of propofol in 11 patients with end-stage renal disease (ESRD) compared with nine healt hy patients during and after a manually controlled three-stage infusion of propofol 21, 12 and 6 mg kg(-1) h(-1) lasting a minimum of 2 h. Mean total body clearance was not reduced significantly in the ESRD group (30.66 (SD 8 .47) mi kg(-1) min(-1)) compared with the control group (33.75 (7.8) mi kg( -1) min(-1)). ESRD patients exhibited a greater, but not statistically sign ificant, volume of distribution at steady state compared with patients in t he control group (11.25 (8.86) vs 5.79 (2.14) litre kg(-1), respectively). Elimination half-life values were unchanged by renal failure. Mean times to induction of anaesthesia were similar in both groups: 177 (SD 57) and 167 (58) s for the ESRD and control groups, respectively. Waking time after ces sation of propofol infusion was significantly shorter in the ESRD group (47 4 (156) s) compared with the control group (714 (240) s) (P<0.05). Mean pla sma concentrations on waking were similar. We conclude that the pharmacokin etic and pharmacodynamic profiles of propofol after infusion were not marke dly affected by renal failure.