[Recovery from propofol anesthesia is delayed in hepatectomy patients due to altered pharmacodynamics].
BACKGROUND
Liver dysfunction has major impacts on the pharmacokinetics and pharmacodynamics of anesthetics. This study was designed to evaluate propofol concentrations during and at the end of total intravenous anesthesia (TIVA) for hepatectomy.


METHODS
Fifty patients receiving hepatectomy (n = 25) or other epigastric surgeries (controls, n = 25) were anesthetized with TIVA. Fentanyl was injected repeatedly to insure maintenance of the effect-site concentration in the 2.0 to 2.5 ng x ml(-1) range with off line computer similation program. Propofol was administered with target-controlled infusion at the initial target concentration of 3.0 mcg x kg(-1), and then titrated to maintain bispectral index (BIS) values between 40 and 50. The intervals after propofol discontinuation to emergence and extubation and the predicted propofol and fentanyl concentrations were recorded. Propofol concentrations at emergence were measured with blood sample in eight cases.


RESULTS
The propofol dose in hepatectomy patients as well as both measured and predicted concentrations of propofol at extubation, were lower than in control patients. The extubation time was longer in hepatectomy than in control subjects.


CONCLUSIONS
Recovery from TIVA is delayed in hepatectomy patients. We speculate that this is attributable to altered pharmacodynamics in these patients.
Department of Anesthesiology, Tokyo Womens' Medical University, Tokyo 162-8666.
Fumiko
F
Murata
Motoyo
M
Iwade
Gumi
G
Hidano
Chiharu
C
Tsunoda
Osamu
O
Nagata
Makoto
M
Ozaki
D000368:Aged; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D003198:Computer Simulation; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000493:pharmacokinetics*
D015742:Propofol