J Korean Geriatr Soc.
2010 Dec;14(4):203-211.
Development of an Adequate Propofol Sedation Model in Elderly Patients for Elective Surgery under Regional Anesthesia
- Affiliations
-
- 1Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 2Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea. facharzt@gmail.com
- 3Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 4Department of Orthopedic Surgery, Bundang CHA Medical Center, CHA University, Seongnam, Korea.
- 5Department of Surgery, Inha University School of Medicine, Incheon, Korea.
Abstract
- BACKGROUND
Propofol, an ultrashort-acting anesthetic agent, is being increasingly used for sedation during regional anesthesia. The goal of this study was to characterize the pharmacodynamic relation between the effect site concentration of propofol and the occurrence of loss of consciousness (LOC) and apnea in elderly patients undergoing regional anesthesia.
METHODS
Twenty patients aged 65 years or older presenting for elective surgery requiring regional anesthesia were enrolled. After performing spinal anesthesia, the target effect site concentration of propofol was set at 1.0 microg/mL. Effect site concentration was increased by 0.2 or 0.3 microg/mL until LOC and apnea were observed. LOC was determined by the loss of response to verbal command ("open your eyes") and apnea as the loss of spontaneous breathing for 20 seconds. The pharmacodynamic relation between effect site concentrations of propofol and LOC or apnea was characterized by population analysis using nonlinear mixed effects model. Approximate entropy (ApEn) as a surrogate measure of central nervous effect of propofol was calculated from raw electroencephalogram, retrospectively. The correlation between effect site concentration of propofol and ApEn was tested.
RESULTS
The estimates (standard error) of Ce50 for LOC and apnea (the effect site concentration of propofol associated with 50% probability of LOC and apnea) were 1.74 (0.09) and 2.35 (0.11) microg/mL, respectively. The Spearman correlation coefficient between effect site concentration of propofol and ApEn was -0.8164 (p<0.0001).
CONCLUSION
These results provide an adequate guidance for sedation in elderly patients for elective surgery under regional anesthesia.
Keyword
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- Titration of Effect Site Concentration of Propofol for Conscious Sedation in Elderly Patients
- Propofol IV Sedation during Epidural Anesthesia in the Elderly
- Correlations between the Modified Observer's Assessment of Alertness/Sedation Scale, Bispectral Index and Propofol Effect Site Concentrations in Sedated Elderly Patients under Regional Anesthesia
- Correlation between the observer's assessment of alertness/sedation and the EEG-entropy during propofol infusion for sedation under spinal anesthesia
- The relationship between postoperative cognitive dysfunction and the depth of sedation with propofol during spinal anesthesia in elderly patients
