Optimal Propofol Concentration at Effect Site for Esophagogastroduodenoscopy under Moderate to Deep Sedation with Target-controlled Infusion
Background: The target-controlled infusion (TCI) of propofol is being increasingly used for moderate-to-deep sedation during esophagogastroduodenoscopies (EGDs). Objective: To determine the target effect-site concentration (Cet) of propofol required for EGD scope insertions during sedation using TCI...
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th-mahidol.872112023-06-20T12:23:43Z Optimal Propofol Concentration at Effect Site for Esophagogastroduodenoscopy under Moderate to Deep Sedation with Target-controlled Infusion Rojanapithayakorn N. Mahidol University Medicine Background: The target-controlled infusion (TCI) of propofol is being increasingly used for moderate-to-deep sedation during esophagogastroduodenoscopies (EGDs). Objective: To determine the target effect-site concentration (Cet) of propofol required for EGD scope insertions during sedation using TCI. Materials and Methods: Dixon’s up-and-down sequential allocation method was used with patients scheduled for elective EGD at Srinagarind Hospital, Thailand. The patients were divided into Group A aged 18 to 64 years and Group B aged over 65 years. Anesthesia was induced with propofol via TCI (Schnider model). The propofol Cet commenced at 3 mcg/mL and 2 mcg/mL in Groups A, and B, respectively. The response during an EGD scope insertion determined the Cet for the next patient, with intervals of 0.3 mcg/mL. Calculations of the effective concentration without response during EGD scope insertion in 50% and 95% of patients (EC50 and EC95) values of propofol, with 95% confidence intervals (CIs), were performed using the isotonic regression method. Results: Twenty-one and nineteen patients were enrolled in Groups A, and B, respectively. In Group A, the EC50 of propofol for EGD was 3.30 mcg/ mL (95% CI 3.05 to 3.55), while the EC95 was 3.75 mcg/mL (95% CI 3.34 to 4.16). In the case of Group B, the EC50 was 3.05 mcg/mL (95% CI 2.75 to 3.35) and the EC95 was 3.05 mcg/mL (95% CI 2.92 to 3.18). Hypotension occurred in 52.3% and 31.5% of patients in group A, and B, respectively. Conclusion: The appropriate Cet of propofol for anesthesia during EGD using TCI is 3.75 mcg/mL for patients aged 18 to 64 years, and 3.05 mcg/ mL for patients aged 65 years and over. Hypotension is the most common adverse event of moderate-to-deep sedation with propofol using TCI. 2023-06-20T05:23:43Z 2023-06-20T05:23:43Z 2022-11-01 Article Journal of the Medical Association of Thailand Vol.105 No.11 (2022) , 1045-1051 10.35755/jmedassocthai.2022.11.13691 01252208 2-s2.0-85141946271 https://repository.li.mahidol.ac.th/handle/123456789/87211 SCOPUS |
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Medicine Rojanapithayakorn N. Optimal Propofol Concentration at Effect Site for Esophagogastroduodenoscopy under Moderate to Deep Sedation with Target-controlled Infusion |
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Background: The target-controlled infusion (TCI) of propofol is being increasingly used for moderate-to-deep sedation during esophagogastroduodenoscopies (EGDs). Objective: To determine the target effect-site concentration (Cet) of propofol required for EGD scope insertions during sedation using TCI. Materials and Methods: Dixon’s up-and-down sequential allocation method was used with patients scheduled for elective EGD at Srinagarind Hospital, Thailand. The patients were divided into Group A aged 18 to 64 years and Group B aged over 65 years. Anesthesia was induced with propofol via TCI (Schnider model). The propofol Cet commenced at 3 mcg/mL and 2 mcg/mL in Groups A, and B, respectively. The response during an EGD scope insertion determined the Cet for the next patient, with intervals of 0.3 mcg/mL. Calculations of the effective concentration without response during EGD scope insertion in 50% and 95% of patients (EC50 and EC95) values of propofol, with 95% confidence intervals (CIs), were performed using the isotonic regression method. Results: Twenty-one and nineteen patients were enrolled in Groups A, and B, respectively. In Group A, the EC50 of propofol for EGD was 3.30 mcg/ mL (95% CI 3.05 to 3.55), while the EC95 was 3.75 mcg/mL (95% CI 3.34 to 4.16). In the case of Group B, the EC50 was 3.05 mcg/mL (95% CI 2.75 to 3.35) and the EC95 was 3.05 mcg/mL (95% CI 2.92 to 3.18). Hypotension occurred in 52.3% and 31.5% of patients in group A, and B, respectively. Conclusion: The appropriate Cet of propofol for anesthesia during EGD using TCI is 3.75 mcg/mL for patients aged 18 to 64 years, and 3.05 mcg/ mL for patients aged 65 years and over. Hypotension is the most common adverse event of moderate-to-deep sedation with propofol using TCI. |
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Mahidol University |
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Mahidol University Rojanapithayakorn N. |
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Rojanapithayakorn N. |
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Rojanapithayakorn N. |
title |
Optimal Propofol Concentration at Effect Site for Esophagogastroduodenoscopy under Moderate to Deep Sedation with Target-controlled Infusion |
title_short |
Optimal Propofol Concentration at Effect Site for Esophagogastroduodenoscopy under Moderate to Deep Sedation with Target-controlled Infusion |
title_full |
Optimal Propofol Concentration at Effect Site for Esophagogastroduodenoscopy under Moderate to Deep Sedation with Target-controlled Infusion |
title_fullStr |
Optimal Propofol Concentration at Effect Site for Esophagogastroduodenoscopy under Moderate to Deep Sedation with Target-controlled Infusion |
title_full_unstemmed |
Optimal Propofol Concentration at Effect Site for Esophagogastroduodenoscopy under Moderate to Deep Sedation with Target-controlled Infusion |
title_sort |
optimal propofol concentration at effect site for esophagogastroduodenoscopy under moderate to deep sedation with target-controlled infusion |
publishDate |
2023 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/87211 |
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1781415882995531776 |