The Variability of Response to Propofol Is Reduced When a Clinical Observation Is Incorporated in the Control

Abstract

Our system reduces the impact of biological variability by including the operator in the control loop. The utility of this approach in clinical practice will require further evaluation.

Upper airway stimulation therapy and prior airway surgery for obstructive sleep apnea

“…Subsequently, patients were evaluated for pattern of airway collapse using drug‐induced sleep endoscopy (DISE) in the operating room. A probability ramp infusion of propofol was used for sedation during all DISE procedures . Following DISE, patients were seen back in the office to discuss their personalized surgical options given their pattern of airway collapse; this typically included ablative procedures or neurostimulation.…”

“…A probability ramp infusion of propofol was used for sedation during all DISE procedures. 21,22 Following DISE, patients were seen back in the office to discuss their personalized surgical options given their pattern of airway collapse; this typically included ablative procedures or neurostimulation. Patients included in this study are those who elected to undergo implantation.…”

Safety and Efficacy of Drug-Induced Sleep Endoscopy Using a Probability Ramp Propofol Infusion System in Patients with Severe Obstructive Sleep Apnea

“…5 The system uses the Cortínez et al 6 pharmacokinetic model and the Johnson pharmacodynamic model 7 to determine an infusion sequence comprised a bolus, initial infusion, secondary infusion, and a time for transition from the initial to secondary infusion using the age and weight of the individual patient. Ninety-seven patients were enrolled in a prospective study of transoral robotic resection of the tongue base (ClinicalTrials.gov #NCT01187160); this study was a secondary outcome measure of that study.…”

“…5 We hypothesized that such an approach, with a hybrid pharmacokinetic/pharmacodynamic model, would permit reliable and efficient titration of propofol to an end point of visible airway collapse and/or loss of genioglossus tone in a population with severe OSA. Moreover, titration by TCI requires small serial increments in the target to achieve the desired clinical end point, a time-consuming process that is not well suited to high-volume throughput or patient comfort.…”

Patient-controlled sedation in procedural care

“…Although differences exist between simulated and measured concentrations, and different timeframes for target concentrations [100,101], and the individual clinical response to a specific C e is hard to predict, patient's adjustments of sedation using target-controlled propofol infusion have supported dental treatment [102,103] and colonoscopy [104]. Inclusion of a clinical observation approach to control the loss of consciousness may reduce the impact of biological variability if TCI of propofol is used [105], but its use with TCI or PCS in clinical practice is unclear. The evidence of age as an explanatory variable is confirmed.…”