A. Casati et al., Clinical assessment of target-controlled infusion of propofol during monitored anesthesia care, CAN J ANAES, 46(3), 1999, pp. 235-239
Citations number
22
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
Purpose: To determine the plasma concentrations of propofol required to ach
ieve different levels of sedation during monitored anesthesia care.
Methods: Sixty ASA I-II, 18-65 yr-old patients, received a target-controlle
d continuous iv infusion of propofol. The target plasma concentration of pr
opofol (Cp-t) was initially set at 0.4 mu g.ml(-1). Two minutes after calcu
lated equilibrium between plasma and effect-site concentrations, the Cp-t o
f propofol was increased by 0.2 mu g.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 Cp-t using the Observer's Asse
ssment of Alertness/Sedation (OAA/S) scale.
Results: The Cp-t of propofol required to induce lethargic response to name
was 1.3 mu g.ml(-1) (5 degrees and 95 degrees percentiles: 1.0 - 1.8 mu g.
ml(-1)), to obtain response after loud and repeated calling name was 1.7 mu
g.ml(-1) (1,2 - 2.2 mu g.ml(-1)), to obtain response after prodding or sha
king was 2.0 mu g.ml(-1) (1.6 - 2.6 mu g.ml(-1)), tc,obtain response after
squeezing the trapezius was 2.4 mu g.ml(-1) (1.8 - 3.0 mu g.ml(-1)). Patien
ts showed no response after squeezing the trapezius at 2.8 mu g.ml(-1) (2.0
- 3.6 mu g.ml(-1)). Correlation between Cp-t 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 deepen
ing in the level of sedation, while minimizing systemic side effects of int
ravenous sedation due to the minimal risk of overdosing the drug.