Propofol infusion for sedation during spinal anesthesia

Nishiyama, Tomoki

doi:10.1007/s00540-006-0489-3

Cited by 7 publications

(7 citation statements)

References 17 publications

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“…The dose of propofol necessary to cause loss of consciousness is reduced by 43% following pretreatment with midazolam 0.1 mg·kg −1 [9]. In our previous study [10], to keep the OAAS scale at 3 or 4 during spinal anesthesia after premedication with midazolam 0.04 mg·kg −1 , the mean propofol infusion dose was 2.5 mg·kg −1 ·h −1 , which is consistent with the present results. Atropine was also administered as a premedication in the present study.…”

Section: Discussionsupporting

confidence: 92%

Auditory evoked potentials index versus bispectral index during propofol sedation in spinal anesthesia

Nishiyama

2009

J Anesth

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Section: Discussionsupporting

confidence: 92%

Auditory evoked potentials index versus bispectral index during propofol sedation in spinal anesthesia

Nishiyama

2009

J Anesth

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“…Our typical propofol Ce 50 value for adequate sedation was similar to the findings obtained by Skipsey, who showed that patients with a plasma propofol concentration of about 1 μg/ml responded to verbal stimulation under neuraxial blockade . However, other studies have revealed that the propofol Ce for an OAA/S score of 3–4 was 1.0–1.5 μg/ml and the propofol Ce for an OAA/S score of 1–2 was 1.8–2.1 μg/ml , which were higher than our typical respective values for the propofol Ce 50 . The different findings might result from younger patients, local procedure which can provoke pain, or lower sensory block level during spinal anaesthesia, in comparison with our result.…”

Section: Discussionsupporting

confidence: 88%

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

Roh

Youngsoon

et al. 2016

Basic Clin Pharma Tox

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Sedation can increase patient comfort during spinal anaesthesia. Understanding the relationship between the propofol effect-site concentration (Ce) and patient sedation level could help clinicians achieve the desired sedation level with minimal side effects. We aimed to model the relationship between the propofol Ce and adequate and deep sedation and also incorporate covariates. Thirty patients scheduled for orthopaedic surgery received spinal anaesthesia with 0.5% bupivacaine. Propofol was administered via an effect-site target-controlled infusion device using the Schnider pharmacokinetic model. The pharmacodynamic models for both adequate sedation [Observer's Assessment of Alertness/Sedation (OAA/S) scores of 3-4] and deep sedation (OAA/S scores of 1-2) were developed using nonlinear mixed-effects modelling. Increments in the propofol Ce were associated with increased depths of sedation. In the basic model, the estimated population Ce 50 values for adequate and deep sedation were 0.94 and 1.52 lg/ml, respectively. The inclusion of the patient's age and sensory block level for adequate sedation and of age for deep sedation as covariates significantly improved the basic model by decreasing the objective function's minimum value from 10696.72 to 10677.92 (p = 0.0003). The simulated Ce 50 values for adequate sedation in 20-year-old patients with a T 12 sensory level and in 80-year-old patients with a T 4 level were 1.63 and 0.53 lg/ml, respectively. Both age and sensory block level should be considered for adequate sedation, and the propofol concentration should be reduced for elderly patients with a high spinal block to avoid unnecessarily deep levels of sedation.Propofol is one of the most commonly used drugs for sedation during spinal anaesthesia because of its rapid onset, easy titration and rapid offset. However, propofol frequently induces unnecessary deep sedation or side effects such as respiratory and cardiovascular depression because it has a narrow therapeutic range [1][2][3]. The use of a target-controlled infusion (TCI) system for propofol administration allows rapid induction and safe maintenance of the desired level of sedation, thereby making it ideal for technically demanding procedures [4][5][6]. Understanding the concentration-response relationship of sedation is fundamental for the safe use of propofol with incorporating factors influencing the sedative effect. However, few studies have evaluated the quantitative relationship between the effect-site concentration (Ce) of propofol and its sedative effect under spinal anaesthesia, although propofol is considered to induce sedation in a dose-dependent manner [7]. Therefore, we attempted to model the relationship between propofol Ce and sedation and also to characterize the covariates in the pharmacodynamic relationship between propofol Ce and adequate and deep sedation in patients undergoing spinal anaesthesia. Materials and MethodsStudy population. This study was approved by the ethics committee of the Yonsei University Health System (4...

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“…Nishiyama [10] reported that the effect site concentration that induces loss of consciousness after spinal anesthetization is 1.9 mcg/ml, and that the effect site concentration for proper sedation is 1.0-1.8 mcg/ml.…”

Section: Discussionmentioning

confidence: 99%

“…This shows that respiratory depression occurs at a certain concentration level of propofol, which is the same or higher than that required for spinal sedation [10]. …”

Section: Discussionmentioning

confidence: 99%

The effect-site concentration of propofol producing respiratory depression during spinal anesthesia

Lee

Yang

Lee

et al. 2011

Korean J Anesthesiol

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BackgroundPropofol is used worldwide for its sedative effective; nonetheless, has the serious side effect of respiratory depression. An increased blood concentration of propofol is well known to be associated with increased respiratory depression. However, there are no studies of the effect site concentration inducing respiratory depression. The purpose of this study was to determine the effect site concentration inducing respiratory depression of propofol when sedating a patient after spinal anesthesia.MethodsThis study included thirty seven males who received operations with spinal anesthesia, which was performed on L3-4 and L4-5. All patients were monitored with the bispectral index and were continuously infused with propofol using target controlled infusion. Respiratory depression was diagnosed when one of the following was evident without upper respiratory obstructive signs: a greater than 20% increase of end tidal carbon dioxide from baseline pressure or pulse oximetry oxygen saturation lower than 95%. We obtained the EC5, EC10, and EC50 of the effect site propofol for respiratory depression.ResultsThe EC5 of propofol for respiratory depression was 3.09 mcg/ml (95% CI, 2.60-3.58). The EC10 of propofol for respiratory depression was 3.18 mcg/ml (95% CI, 2.57-3.80). The EC50 of propofol for respiratory depression was 3.99 mcg/ml (95% CI, 2.36-5.61).ConclusionsThe EC5, EC10, and EC50 of effect site propofol for respiratory depression during spinal anesthesia were 3.09 mcg/ml ,3.18 mcg/ml, and 3.99 mcg/ml, respectively.

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Propofol infusion for sedation during spinal anesthesia

Abstract: Propofol infusion, starting with 10 mg.kg(-1).h(-1), decreasing to 5 mg.kg(-1).h(-1) after 1 minute, and then decreasing to 2.5 mg.kg(-1).h(-1) after another min induced rapid onset of sedation and kept the OAAS score at 3 or 4 during spinal anesthesia.

Cited by 7 publications

References 17 publications

Auditory evoked potentials index versus bispectral index during propofol sedation in spinal anesthesia

Auditory evoked potentials index versus bispectral index during propofol sedation in spinal anesthesia

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

The effect-site concentration of propofol producing respiratory depression during spinal anesthesia

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