The Influence of Age on Propofol Pharmacodynamics

Schnider, Thomas W.; Minto, Charles F.; Shafer, Steven L.; Gambús, Pedro L.; Andresen, Corina; Goodale, David; Youngs, Elizabeth J.

doi:10.1097/00000542-199906000-00003

Cited by 920 publications

(598 citation statements)

References 24 publications

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“…There were also significant differences between the light and deep sedation groups in median [IQR] PACU discharge times (18 [15][16][17][18][19][20][21][22] min vs 20 [17][18][19][20][21][22][23][24][25] min, respectively; P = 0.013) and median [IQR] hospital discharge times (65 [57-80] min vs 74 [63-86] min, respectively; P = 0.001) favouring the light sedation group, although the magnitudes of the respective differences (i.e., 2 min and 9 min) were small ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Sedation was then commenced with a fentanyl bolus (age\ 70 yr = fentanyl 0.7 lgÁkg -1 up to maximum of 100 lg; age C 70 yr = fentanyl 0.5 lgÁkg -1 up to maximum of 75 lg) and an effect-site-guided target-controlled propofol infusion using the Schnider model. 16 Once the BIS target was achieved, the procedure commenced and the propofol target concentration was adjusted by the anesthesiologist as required to maintain the BIS within range.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

Allen

Leslie

Hebbard

et al. 2015

Can J Anesth/J Can Anesth

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A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery Une étude randomisée contrôlée sur la sédation légère vs profonde au propofol pour la colonoscopie non urgente en ambulatoire: le souvenir, les conditions entourant l'intervention et la récupération sedation; P \ 0.0001). The incidence of recall was 12% in the light sedation group and 1% in the deep sedation group. The risk difference for recall was 0.11 (90% confidence interval, 0.05 to 0.17) in the intention-to-treat analysis, thus refuting equivalence in recall between light and deep sedation (0.05 significance level; 10% equivalence margin). Overall sedation-related complications were more frequent with deep sedation than with light sedation (66% vs 47%, respectively; P = 0.008). Recovery was more rapid with light sedation than with deep sedation as determined by the mean (SD) time to reach a score of 5 on the Modified Observer's Assessment of Alertness/Sedation Scale [3 (4) min vs 7 (4) min, respectively; P \ 0.001] and by the median [IQR] time to min, respectivement; P = 0.001). L'incidence des troubles cognitifs post-procéduraux était semblable chez les personnes randomisées à recevoir une sédation légère (19 %) ou profonde (16 %) (P = 0,554). Conclusion La sédation légère n'était pas équivalente à la sédation profonde en matière de souvenir de l'intervention, du spectre de complications ou des temps de récupération. Cette étude procure des données probantes nécessaires pour informer les patients concernant la sédation pour la colonoscopie. Cette étude a été enregistrée au Registre australien et néozélandais des études cliniques, no. 12611000320954.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

Allen

Leslie

Hebbard

et al. 2015

Can J Anesth/J Can Anesth

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“…[15][16][17] Such systems must account for identified pharmacokinetic and pharmacodynamic covariates in the population of interest. 18 The goal of this study was to model the relation between plasma propofol concentration and sedation or respiratory obstruction in patients with PD undergoing functional stereotactic pallidotomy receiving propofol with the TCI device Diprifusor ® (Master TCI, Fresenius Vial S.A., Brezins, France). The pharmacodynamic model was then used to determine the therapeutic propofol concentration that would keep a patient with PD sedated without inducing dangerous airway obstruction.…”

mentioning

confidence: 99%

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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“…There are several possible explanations for our findings. First, similar to many other anesthetics,25 the reduced dose of dexmedetomidine required in older patients could primarily be a function of changes in the pharmacodynamics of dexmedetomidine with age. Second, there was a negative correlation between age and dexmedetomidine clearance.…”

Section: Discussionmentioning

confidence: 99%

Effective dose of dexmedetomidine as an adjuvant sedative to peripheral nerve blockade in elderly patients

Wang

Zhang

2018

Acta Anaesthesiol Scand

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BackgroundThe median effective dose (ED 50) of sedative dexmedetomidine adjuvant to peripheral nerve block (PNB) has not yet been verified in elderly patients. This study assessed the ED 50 of intravenous dexmedetomidine for sedation in elderly patients who were undergoing total knee arthroplasty (TKA) with PNB.MethodsForty‐two patients aged 65–85 years were included and stratified into two groups according to age: young‐old group (aged 65–74 years) and middle‐old group (aged 75–85 years). After the PNB was performed, a pre‐calculated dose of dexmedetomidine was administered for 10 min. The Observer's Assessment of Alertness/Sedation scale, bispectral index score, blood pressure and heart rate were recorded. ED 50 values of dexmedetomidine for adequate sedation were estimated by the up‐and‐down method of Dixon and probit regression.ResultsThe ED 50 of single‐dose dexmedetomidine adjuvant to PNB was 0.57 μg/kg (95% confidence interval [CI], 0.47–0.65) in the young‐old group and 0.38 μg/kg (95% CI, 0.28–0.46) in the middle‐old group. The ED 50 of dexmedetomidine differed significantly between the two groups (P < 0.001). In addition, no significant adverse hemodynamic or hypoxemic effects were noted.ConclusionWe determined the ED 50 for sedation using intravenous dexmedetomidine adjuvant to PNB in elderly patients. The ED 50 of dexmedetomidine in the middle‐old group decreased by 33% compared with that in the young‐old group with a mean age difference of 11 years between the two groups.

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The Influence of Age on Propofol Pharmacodynamics

Cited by 920 publications

References 24 publications

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery

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

Effective dose of dexmedetomidine as an adjuvant sedative to peripheral nerve blockade in elderly patients

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