Cation metabolism during propofol sedation with and without EDTA in patients with impaired renal function.
OBJECTIVE
To compare the effects of propofol with and without disodium edetate (EDTA) on cation metabolism in intensive care unit (ICU) patients with renal insufficiency who received propofol or propofol plus EDTA (propofol EDTA) for sedation and mechanical ventilation.


METHODS
Double-blind, randomised, multicentre study.


METHODS
Medical and surgical ICUs from 5 hospitals.


METHODS
Thirty-nine ICU patients with acute and chronic renal impairment expected to require at least 24 hours of continuous sedation and respiratory failure necessitating mechanical ventilation.


METHODS
Propofol or propofol EDTA administered for sedation by continuous intravenous infusion.


RESULTS
The depth of sedation, as measured by the Modified Ramsay Sedation Scale, was similar in the 2 groups, when adjusted for dosing differences. The amount of propofol required to maintain adequate sedation was decreased in both groups compared to propofol requirements in ICU patients with normal renal function. EDTA levels were elevated at baseline in both groups. In the propofol EDTA group, the EDTA levels increased further by 20 % but decreased to below baseline EDTA levels at 48 hours after sedation. In the propofol group, EDTA levels decreased during sedation and remained below baseline levels at 48 hours after sedation. PATIENTS in both groups were hypocalcaemic and hyperphosphataemic at baseline with low levels of 1,25-dihydroxyvitamin D and elevated parathyroid hormone (PTH) levels. Other than a slight difference in ionised serum calcium levels at 4 h after the start of sedation, there were no significant differences observed in serum calcium levels between the two groups. There were no significant differences in 1,25-dihydroxyvitamin D or PTH levels over time between the two groups. There was no significant effect on renal function in either group.


CONCLUSIONS
The results of this study suggest that adding EDTA to propofol does not adversely affect cation homeostasis or renal function when used for sedation of ICU patients with renal insufficiency. Although EDTA levels increased over time from baseline levels in patients with renal insufficiency who receive propofol EDTA, this increase does not appear to be clinically significant, and EDTA levels return to below baseline levels within 48 hours of discontinuing the propofol EDTA infusion. The efficacy of propofol with and without EDTA also appears comparable in these patients.
Barr
J
J
VA Palo Alto Health Care System, CA 94304, USA.
Zaloga
G P
GP
Haupt
M T
MT
Weinmann
M
M
Murray
M J
MJ
Bandi
V
V
Teres
D
D
D000293:Adolescent; D000328:Adult; D018686:Anesthetics, Intravenous / Q000493:pharmacokinetics* / Q000494:pharmacology; D002118:Calcium / Q000378:metabolism; D002412:Cations / Q000378:metabolism*; D002614:Chelating Agents / Q000493:pharmacokinetics* / Q000494:pharmacology; D004311:Double-Blind Method; D004492:Edetic Acid / Q000493:pharmacokinetics* / Q000494:pharmacology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007668:Kidney / Q000187:drug effects; D016015:Logistic Models; D008274:Magnesium / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D011310:Preservatives, Pharmaceutical / Q000493:pharmacokinetics* / Q000494:pharmacology; D015742:Propofol / Q000493:pharmacokinetics* / Q000494:pharmacology; D051437:Renal Insufficiency / Q000188:drug therapy*; D012121:Respiration, Artificial; D018709:Statistics, Nonparametric
D018686:Anesthetics, Intravenous; D002412:Cations; D002614:Chelating Agents; D010281:Parathyroid Hormone; D011310:Preservatives, Pharmaceutical; D004492:Edetic Acid; D008274:Magnesium; D002118:Calcium; D015742:Propofol