Anesth Pain Med.  2023 Jan;18(1):29-36. 10.17085/apm.22201.

Effect of neoadjuvant chemotherapy on effect-site concentration of propofol for sedation in patients with breast cancer

• Kim M
• Lee J
• Kim J
• Choi B
• Ki S

• KMID: 2540331
• DOI: http://doi.org/10.17085/apm.22201

Abstract

Background
Some studies have demonstrated that chemotherapy drugs enhance sensitivity to anesthetics owing to its systemic toxicity, while others have demonstrated that chemotherapy drugs have no effect. This study aimed to determine whether neoadjuvant chemotherapy influences the effect-site concentration (Ce) of propofol for sedation in patients withbreast cancer.Methods: This study included patients aged 19–75 years who were scheduled to undergobreast cancer surgery under general anesthesia. Patients who received neoadjuvant chemotherapy were assigned to group C, whereas those who never received chemotherapy wereassigned to group N. Propofol was administered through an effect-site target-controlled infusion, and the Modified Observer’s Assessment of Alertness/Sedation scale (MOAA/S) scoreand Bispectral Index (BIS) were recorded. When the plasma concentration and Ce wereequal to the target Ce, and if the MOAA/S score did not change, the target Ce was increasedby 0.2 μg/ml; otherwise, the Ce was maintained for 2 min and then increased. This processwas repeated until the MOAA/S score became 0.Results: No significant differences were observed in Ce values at each sedation level between both groups. Ce values for loss of consciousness (LOC) of groups C and N were 2.76± 0.29 and 2.67 ± 0.27 μg/ml (P = 0.285), respectively. However, the BIS value at LOC ofgroup C (63.87 ± 7.04) was lower than that (68.44 ± 6.01) of group N (P = 0.018).Conclusions: Neoadjuvant chemotherapy for breast cancer has no effect on the Ce ofpropofol for sedation.

Keyword

Antineoplastic agent; Breast neoplasm; Neoadjuvant treatment; Propofol; Unconsciousness

Figure

• 

  Fig. 1. (A) BIS value for each MOAA/S score (B) Ce of propofol for each MOAA/S score. Orange: group C (those who received neoadjuvant chemotherapy for the treatment of breast cancer), Green: group N (those who never received chemotherapy). In this box-and-whisker plot, the center line of the box represents the median value, whiskers are 2.5–97.5 percentiles, and the plus sign (+) represents the mean value. BIS: Bispectral Index, Ce: effect-site concentration of propofol, MOAA/S: Modified Observer’s Alertness/Sedation scale. *Group C vs. Group N, t-test, P value < 0.05.

• 

  Fig. 2. (A) BIS values at LVC and LOC (B) Ce of propofol for LVC and LOC. Orange: group C (those who received neoadjuvant chemotherapy for the treatment of breast cancer), green: group N (those who never received chemotherapy), middle bold line and error bar: median and 95% CI, gray circle: individual’s value. BIS: Bispectral Index, Ce: effect-site concentration of propofol, CI: confidence interval, LVC: loss of verbal contact (when the Modified Observer’s Alertness/Sedation [MOAA/S] score was 3 or 2), LOC: loss of consciousness (when the MOAA/S score was 1 or 0).

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  Fig. 3. Relationship between Ce of propofol and BIS. A dotted orange line is drawn with actual data obtained from group C, a dotted green line is drawn with actual data obtained from group N, and a purple line is drawn with calculated data based on the final PD model. Group C: those who received neoadjuvant chemotherapy for the treatment of breast cancer, Group N: those who never received chemotherapy, Ce: effect-site concentration of propofol, BIS: Bispectral Index, PD: pharmacodynamic.

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