Effect of ethnicity on the hypnotic and cardiovascular characteristics of propofol induction

Abstract

We compared the propofol dose causing loss of verbal response and suppression of bispectral index to 50, between 50 white and 50 black patients, aged 18-65 years. Propofol was administered at 40 mg.kg )1 .h )1 and reduced to 8 mg.kg.h )1 when bispectral index fell to 50. We recorded heart rate and mean arterial pressure for 15 min in total and calculated, for this period, maximal percentage change from baseline for each. A statistician, blinded to patient ethnicity, found mean (SD) propofol dose for loss of verbal response in white and black patients to be 1.41 (0.37) mg.kg change in heart rate were 14.1 (12.6) % and 7.5 (14.0) % (p = 0.015). Other differences were non-significant. The dose of propofol required for loss of verbal response, but not for suppression of bispectral index to 50, is lower in black than in white patients. In the last decade it has been suggested that ethnicity may affect the clinical response to general anaesthetics [1-4], with Caucasian subjects generally shown to be less susceptible to the anaesthetic effects of propofol than other races [1][2][3]. To date, however, the effect of ethnicity on the induction dose of propofol has not been fully investigated. In our earlier study on anxiety and propofol induction [5], we used multivariate analysis to investigate factors independently predictive of propofol dose requirement for loss of verbal response. In doing so, we established that white ethnicity was associated with greater propofol dose requirement than other ethnic groups.To investigate this incidental finding further, we studied a new group of patients using a study design better suited to address specifically the issue of ethnicity. Our aim was to determine whether the induction dose of propofol differs between British patients describing themselves as white and black. Our null hypothesis was that ethnicity does not affect the dose of propofol required to produce loss of verbal response. We also sought to establish whether the initial cardiovascular characteristics of propofol anaesthesia differ between white and black patients. MethodsWith Research Ethics Committee approval and written informed consent, we recruited 269 patients of ASA physical status 1-2, aged 18-65 years, scheduled for surgery under general anaesthesia. We did not study patients who were of neither white nor black ⁄ black

Practice patterns of sedation for colonoscopy

“…The reasons why black patients received more propofol than non-black patients is unclear; data on differing response rates to propofol based on ethnicity is unconvincing. 32,33 …”

Race‐Specific Pharmacodynamic Model of Propofol‐Induced Loss of Consciousness

“…Natarajan et al 6 did not use a Diprifusor™ TCI pump in their study comparing propofol response between 50 British white and 50 British black patients (ASA status I and II, aged 18–65 years). An Asena Mk III (Alaris Medical Systems, San Diego, CA) non-TCI pump was used to administer a constant (Propofol-Lipuro 1%) propofol infusion of 40 mg/kg/h.…”

Board 364 - Research Abstract Development and Validation of a Virtual Human Vignette to Explore PICU Nurses Assessment and Intervention Choices for Children’s Pain (Submission #1226)

“…We adapted data on ethnicity and propofol 1,2 to scale the loss and recovery of consciousness (LOC, ROC) thresholds for Caucasians in the Fechner propofol model 3 to Indians (South Asians from the Indian subcontinent) and Africans, based on email confirmation from Dr. Fechner that his data was from Caucasians. Thus, using Caucasians as the norm (1.0), the mean propofol consumption to achieve similar BIS (bispectral index) value was set for Africans at 0.82 [2] and for Indians at 0.78 [1]. The mean time to eye opening from propofol anesthesia was set for Africans at 1.6 [2] and for Indians at 1.9 [1].…”

“…Thus, using Caucasians as the norm (1.0), the mean propofol consumption to achieve similar BIS (bispectral index) value was set for Africans at 0.82 [2] and for Indians at 0.78 [1]. The mean time to eye opening from propofol anesthesia was set for Africans at 1.6 [2] and for Indians at 1.9 [1]. We did not simulate inter-patient variability within an ethnic group because it would have been a confounding factor.…”

“…This process included the adaptation of validated written vignettes, content review by advanced practice nurses with PICU expertise, and translation to a virtual format with experts in computer science and the facial action coding system. 2 Four VH vignettes were piloted (see image) with 40 PICU nurses from two urban, mid-west hospitals. After viewing each vignette, nurses rated the child's pain (0 to 10) and described whether/how they would intervene.…”