Determination of Plasma Concentrations of Propofol Associated with 50% Reduction in Postoperative Nausea

Gan, Tong J.; Glass, Peter S. A.; Howell, Scott; Canada, Andrew T.; Grant, Alan; Ginsberg, Brian

doi:10.1097/00000542-199710000-00010

Cited by 132 publications

(71 citation statements)

References 26 publications

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“…The estimates of C 50 reported previously in the literature varied as a function of the pharmacodynamic endpoints studied; values of 0.31 g/ml were estimated for the ability of propofol to prevent postoperative nausea and vomiting, 31 and a higher C 50 of 1.38 g/ml was found for the electroencephalogram effects. 18 The value reported by Wakeling et al 13 of 4.5 g/ml when loss of consciousness was explored could be compared with the concentrations needed in the current study to achieve a score of 6 in the Ramsay scale.…”

Section: Discussionmentioning

confidence: 96%

Modeling of the Sedative and Airway Obstruction Effects of Propofol in Patients with Parkinson Disease undergoing Stereotactic Surgery

Fàbregas

Rapado²,

Gambús

et al. 2002

Anesthesiology

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Background: Functional stereotactic surgery requires careful titration of sedation since patients with Parkinson disease need to be rapidly awakened for testing. This study reports a population pharmacodynamic model of propofol sedation and airway obstruction in the Parkinson disease population.Methods: Twenty-one patients with advanced Parkinson disease undergoing functional stereotactic surgery were included in the study and received propofol via target-controlled infusion to achieve an initial steady state concentration of 1 g/ml. Sedation was measured using the Ramsay Sedation Scale. Airway obstruction was measured using a four-category score. Blood samples were drawn for propofol measurement. Individual pharmacokinetic profiles were constructed nonparametrically using linear interpolation. Time course of sedation and respiratory effects were described with population pharmacodynamic models using NONMEM. The probability (P) of a given level of sedation or airway obstruction was related to the estimated effect-site concentration of propofol (Ce) using a logistic regression model. Results:The concentrations predicted by the target-controlled infusion system generally exceeded the measured concentrations. The estimates of C 50 for Ramsay scores 3, 4, and 5 were 0.1, 1.02, and 2.28 g/ml, respectively. For airway obstruction scores 2 and 3, the estimates of C 50 were 0.32 and 2.98 g/ml, respectively. Estimates of k e0 were 0.24 and 0.5 1/min for the sedation and respiratory effects, respectively.Conclusions: The pharmacokinetic behavior of propofol in patients with Parkinson disease differs with respect to the population from which the model used by the target-controlled infusion device was developed. Based on the results from the final models, a typical steady state plasma propofol concentration of 0.35 g/ml eliciting a sedation score of 3 with only minimal, if any, airway obstruction has been defined as the therapeutic target.

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Section: Discussionmentioning

confidence: 96%

Modeling of the Sedative and Airway Obstruction Effects of Propofol in Patients with Parkinson Disease undergoing Stereotactic Surgery

Fàbregas

Rapado²,

Gambús

et al. 2002

Anesthesiology

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“…8 -11,14,17 Several antiemetic mechanisms for propofol have been postulated, including direct depression of the chemoreceptor trigger zone and centres implicated in nausea and vomiting. 24 Weak 5-hydroxytryptamine receptor type 3 antagonistic effects have been suggested. 25 The proposed concentration ranges for sedation and general anaesthesia using propofol are 1500 -2000 ng/ml and 3000 -10 000 ng/ml, respectively, 26 -28 and the proposed concentrations required to treat PONV are lower than these values.…”

Section: Discussionmentioning

confidence: 99%

The Incidence of Postoperative Nausea and Vomiting after Thyroidectomy using Three Anaesthetic Techniques

et al. 2011

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The choice of anaesthetics can affect the incidence of postoperative nausea and vomiting (PONV). This study compared the incidence of PONV in 177 female patients who underwent thyroidectomy, with anaesthesia induced and maintained using one of three regimens: (i) sevoflurane (thiopental sodium 4 -5 mg/kg and sevoflurane 2.0 -2.5 vol% in 50% air); (ii) total intravenous anaesthesia (TIVA; propofol-remifentanil [target blood concentrations 2.5 -3.5 µg/ml and 3.5 -4.5 ng/ml, respectively]); or (iii) combined inhalation and intravenous anaesthesia (sevoflurane 1.0 vol% in 50% air plus propofol-remifentanil [target blood concentrations 1.5 -2.5 µg/ml and 2.5 -3.5 ng/ml, respectively]). The incidence and severity of PONV and the need for rescue antiemetics were assessed at 0 -24 h postoperatively. Overall, the incidence of PONV was significantly lower in the TIVA and combined groups compared with the sevoflurane group (33.9%, 39.0% and 64.4%, respectively). In conclusion, the maintenance of anaesthesia with propofol-remifentanil or sevofluranepropofol-remifentanil decreased the incidence of PONV compared with sevoflurane alone.

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“…This is much lower than the range required for sedation (900-1,300 ng·mL -1 ) and anesthesia (3,000-10,000 ng·mL -1 ). 88 …”

Section: B Propofolmentioning

confidence: 99%

Evidence-based management of postoperative nausea and vomiting: a review

Habib

Gan

2004

Can J Anesth/J Can Anesth

196

106

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P Pu ur rp po os se e: : To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).S So ou ur rc ce e: : Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.C Co on nc cl lu us si io on n: : PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature. Objectif : Énoncer des lignes de conduite fondées sur des données probantes pour la prévention et le traitement des nausées et des vomissements postopératoires (NVPO). Source : Les publications d'essais contrôlés et randomisés, les études méthodiques, les analyses de régression logistique et l'opinion d'experts sur le traitement des NVPO. Constatations principales : L'origine des NVPO est multifactorielle. Les facteurs de risque reliés au patient, à l'anesthésie et au type de chirurgie sont connus. La prévention universelle des NVPO n'est pas rentable. L'identification des patients à haut risque de NVPO permet

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Determination of Plasma Concentrations of Propofol Associated with 50% Reduction in Postoperative Nausea

Cited by 132 publications

References 26 publications

Modeling of the Sedative and Airway Obstruction Effects of Propofol in Patients with Parkinson Disease undergoing Stereotactic Surgery

Modeling of the Sedative and Airway Obstruction Effects of Propofol in Patients with Parkinson Disease undergoing Stereotactic Surgery

The Incidence of Postoperative Nausea and Vomiting after Thyroidectomy using Three Anaesthetic Techniques

Evidence-based management of postoperative nausea and vomiting: a review

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