Does propofol and alfentanil-induced sedation cause periodic apnoea in chronic renal failure patients?
OBJECTIVE
There is evidence suggesting that the respiratory response to sedation is different in patients with sleep apnoea, which is common in patients with chronic renal failure (CRF). This study examined the respiratory response of sedation with propofol and alfentanil, whose pharmacokinetics are not affected by the renal function, in CRF patients.


METHODS
Chronic renal failure patients who underwent arteriovenous-fistular surgery (CRF group) and patients who underwent chemoport insertion (control group) were enrolled in this study. Sedation was induced by infusing propofol 1.5 micro/ml and alfentanil 0.2 micro/kg/min continuously in both groups. In the desaturation study, the respiratory rate and peripheral oxygen saturation in room air were checked. In the apnoea-hypopnoea study, the patient's sedation (Observer's Assessment of Alertness/Sedation) score, apnoea-hypopnoea index (AHI) was recorded using a portable ventilation effort recorder (microMesam) while applying 5 l/min of oxygen through a facial mask.


RESULTS
The desaturation event was more common (21.5/h vs. 2/h, p = 0.001) in the CRF patients. Apnoea and hypopnoea (AHI: 13.0 vs. 1.6, p = 0.012, per cent of patients with an AHI > 5: 53.3% vs. 7.1%, p = 0.014) occurred more frequently in the CRF patients but the sedation score was not different.


CONCLUSIONS
Chronic renal failure patients have a higher risk of developing apnoea and hypopnoea during sedation, which highlights the need for careful monitoring and management in these patients.
Lee
S M
SM
Department of anesthesiology and pain medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Kim
G H
GH
Lee
J J
JJ
Kim
J A
JA
Choi
S J
SJ
Kim
G S
GS
Jung
H H
HH
D015760:Alfentanil / Q000008:administration & dosage / Q000009:adverse effects*; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001049:Apnea / Q000139:chemically induced*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D012891:Sleep Apnea Syndromes / Q000139:chemically induced
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D015760:Alfentanil; D015742:Propofol