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

Abstract

We have investigated the pharmacokinetics and pharmacodynamics of propofol in 11 patients with end-stage renal disease (ESRD) compared with nine healthy 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) ml kg-1 min-1) compared with the control group (33.75 (7.8) ml kg-1 min-1). ESRD patients exhibited a greater, but not statistically significant, volume of distribution at steady state compared with patients in the 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 cessation of propofol infusion was significantly shorter in the ESRD group (474 (156) s) compared with the control group (714 (240) s) (P < 0.05). Mean plasma concentrations on waking were similar. We conclude that the pharmacokinetic and pharmacodynamic profiles of propofol after infusion were not markedly affected by renal failure.

Anesthetic management in a patient of autosomal dominant polycystic kidney disease with end stage renal disease undergoing endovascular coiling for multiple intracranial aneurysms

“…[1415] The anesthetic end-points such as patient immobility, hemodynamic stability, and maintenance of cerebral perfusion pressure, were met with. [16] As the patient was not presented with SAH or mass effect, a reduced intracranial compliance was ruled out, and normocapnia was maintained.…”

Effect of low dose dexmedetomidine premedication on propofol consumption in geriatric end stage renal disease patients

“…17,18 It has been reported that the pharmacokinetics of bolus or infusion doses are not affected markedly and can be used safely in ESRD patients. 19,20 DEX is a highly selective ␣2 adrenoceptor agonist drug with sedative, sympatholytic, and analgesic actions. It is metabolized into its inactive metabolites in liver and its elimination is unaffected by renal disease.…”

Patient-controlled sedation using propofol in eight patients with endstage renal failure

“…In our study, the PCS parameters (PCS dose of 0.2 mg·kg Ϫ1 of propofol with a delay interval of 3 min; basal infusion of 2 mg·kg·h Ϫ1 following 0.4 mg·kg Ϫ1 bolus injection) was selected based on our experience with this technique, and based on evidence [6] for the normal pharmacokinetics and pharmacodynamics of propofol even in endstage renal failure. Although these dosages were not associated with any clinically serious complications, a deeper sedation than we anticipated was observed in two of the eight patients after the start of PCS.…”