British Journal of Anaesthesia, 2000, Vol. 85, No. 2 299-316
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia
Brief Communication |
Safety of patient-maintained propofol sedation using a target-controlled system in healthy volunteers
University Department of Anaesthesia, Glasgow Royal Infirmary, 10 Alexandra Parade,Glasgow G31 2ER, UK
This research was presented in
part at the Annual Meeting of the American Society of Anesthesiologists,
Dallas, 1999.
Abstract
We investigated the safety of a patient-maintained system that allows individuals to operate a target-controlled infusion of propofol to achieve sedation. Ten healthy volunteers were recruited and instructed to try to anaesthetize themselves with the system. A target-controlled infusion of propofol was set to deliver a target propofol concentration of 1 µg ml–1, and the subjects allowed to increase the target in increments of 0.2 µg ml–1 by pressing a control button twice in 1 s. There was a lockout time of 2 min and a maximum permitted target concentration of 3 µg ml–1. Heart rate and pulse oximetry oxygen saturation (SpO2) were monitored continuously, and non-invasive arterial pressure, ventilatory frequencies and sedation scores were measured every 5 min. Sedation was continued until the subject stopped pressing the button. A keyword was then read for the individual to remember and sedation discontinued. There were no instances of significant decrease of SpO2 or loss of airway control. Maximum target blood concentration of propofol recorded ranged from 1.4 to 3 µg ml–1. Two subjects became oversedated, one of whom was unrousable with loss of eyelash reflex. No subject could recall the keyword, although one recognized it from a list of 10 words. We conclude that the patient-maintained sedation system described could not be guaranteed to produce only conscious sedation in all patients, and that close clinical supervision by an anaesthetist would still be required for safe operation.
Br J Anaesth 2000; 85: 299–301
Footnotes
* Corresponding author: Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, North Carolina 27710, USA
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