British Journal of Anaesthesia, Vol 80, Issue 3 324-331, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia
VLB. Oei-Lim, M. White, C. J. Kalkman, FHM. Engbers, P. C. Makkes and W. G. Ooms
Infusion of propofol by a target-controlled infusion (TCI) system is
effective in achieving conscious sedation for anxious patients presenting
for dental surgery. It is a common clinical observation that anxious
patients require more anaesthetic drugs than non-anxious individuals. In
study 1 we have defined blood propofol concentrations necessary for
conscious sedation in both anxious (n = 23) and non- anxious (n = 18)
patients. The pump performance of the TCI system, using Gepts'
pharmacokinetic model, was evaluated in these two patient groups.
Subsequently, clearance of propofol was compared in the two groups. Mean
measured venous serum propofol concentrations obtained between 20 and 35
min after the optimal sedation level was reached were 1.6 (SD 0.2)
micrograms ml-1 in the anxious patients compared with 1.7 (0.3) micrograms
ml-1 in the control group (study 1) and 1.4 (0.27) micrograms ml-1 in study
2. The pump systematically overpredicted measured propofol concentrations
in both groups (study 1). There was no significant difference in propofol
clearance between the two groups. In study 2, an optimized set of
microconstants was derived which should more accurately predict the
pharmacokinetic profile of the anxious population and this set was tested
prospectively in another group of 12 anxious dental patients. Bias and
precision with the optimized kinetic set were significantly less than the
values obtained in study 1. We conclude that there was no significant
pharmacokinetic differences between anxious and non-anxious subjects
receiving subanaesthetic doses of propofol for conscious sedation.
CLINICAL INVESTIGATIONS
Pharmacokinetics of propofol during conscious sedation using target- controlled infusion in anxious patients undergoing dental treatment
Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Anaesthesiology, Leiden University Hospital, Leiden, The Netherlands; Centre for Special Dental Care, Amsterdam, The Netherlands
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