title: Increase of paradoxical excitement response during propofol-induced sedation in hazardous and harmful alcohol drinkers.
abstract: BACKGROUND
  Paradoxical excitement response during sedation consists of loss of affective control and abnormal movements. Chronic alcohol abuse has been proposed as a predisposing factor despite lack of supporting evidence. Because alcohol and propofol have a common site of action, we postulated that paradoxical excitement responses during propofol-induced sedation occur more frequently in hazardous and harmful alcohol drinkers than in social or non-drinkers.
  
  
  METHODS
  One hundred and ninety patients undergoing orthopaedic knee joint surgery were enrolled in this prospective and observational study. Subjects were divided into Group HD (hazardous and harmful drinkers) or Group NHD (no hazardous drinkers) according to the alcohol use disorder identification test (AUDIT). In study 1, propofol infusion was adjusted to achieve the bispectral index at 70-80 using target-controlled infusion. In study 2, the target concentration of propofol was fixed at 0.8 (study 2/Low) or 1.4 μg ml(-1) (study 2/High). Paradoxical excitement responses were categorized by intensity into mild, moderate, or severe.
  
  
  RESULTS
  The overall incidence of paradoxical excitement response was higher in Group HD than in Group NHD in study 1 (71.4% vs 43.8%; P=0.022) and study 2/High (70.0% vs 34.5%; P=0.006) but not in study 2/Low. The incidence of moderate-to-severe response was significantly higher in Group HD of study 1 (28.6% vs 3.1%; P=0.0005) and study 2/High (23.3% vs 3.4%; P=0.029) with no difference in study 2/Low. Severe excitement response occurred only in Group HD of study 1 and study 2/High.
  
  
  CONCLUSIONS
  Paradoxical excitement occurred more frequently and severely in hazardous and harmful alcohol drinkers than in social drinkers during propofol-induced moderate-to-deep sedation, but not during light sedation.
authors: Department of Anesthesiology and Pain Medicine,  Chonnam National University Medical School and Hospital, 671 Jebongro Dong-gu, Gwangju 501-757,  Republic of Korea.
authors: S
authors: S
authors: Jeong
authors: H G
authors: HG
authors: Lee
authors: W M
authors: WM
authors: Kim
authors: C W
authors: CW
authors: Jeong
authors: S H
authors: SH
authors: Lee
authors: M H
authors: MH
authors: Yoon
authors: J I
authors: JI
authors: Choi
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000503:physiopathology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol