title: Individual effect-site concentrations of propofol are similar at loss of consciousness and at awakening.
abstract: Reported effect-site concentrations of propofol at loss of consciousness and recovery of consciousness vary widely. Thus, no single concentration based on a population average will prove optimal for individual patients. We therefore tested the hypothesis that individual propofol effect-site concentrations at loss and return of consciousness are similar. Propofol effect-site concentrations at loss and recovery of consciousness were estimated with a target-control infusion system in 20 adults. Propofol effect-site concentrations were gradually increased until the volunteers lost consciousness (no response to verbal stimuli); unconsciousness was maintained for 15 min, and the volunteers were then awakened. This protocol was repeated three times in each volunteer. Our major outcomes were the concentration producing unconsciousness and the relationship between the estimated effect-site concentrations at loss and recovery of consciousness. The target effect-site propofol concentration was 2.0 +/- 0.9 at loss of consciousness and 1.8 +/- 0.7 at return of consciousness (P <0.001). The average difference between individual effect-site concentrations at return and loss of consciousness was only 0.17 +/- 0.32 microg/mL (95% confidence interval for the difference 0.09-0.25 microg/mL). Our results thus suggest that individual titration to loss of consciousness is an alternative to dosing propofol on the basis of average population requirements.
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan; Department of Anesthesiology, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan; and Outcomes Research™ Institute and Departments of Anesthesiology and Perioperative Medicine and Pharmacology, University of Louisville, Louisville, Kentucky.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Iwakiri
authors.forename: Noboru
authors.initials: N
authors.lastname: Nishihara
authors.forename: Osamu
authors.initials: O
authors.lastname: Nagata
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsukawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Ozaki
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000097:blood / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D015742:Propofol / Q000097:blood / Q000494:pharmacology*; D014474:Unconsciousness / Q000139:chemically induced* / Q000523:psychology
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol