title: Intrathecal fentanyl decreases the optimal effect site concentration of propofol during spinal anaesthesia.
abstract: BACKGROUND
  The aim of this study was to assess the possible difference in the optimal effect site concentration of propofol for conscious sedation during spinal anaesthesia with or without intrathecal fentanyl in patients undergoing urologic surgery. The hypothesis was that intrathecal fentanyl would decrease the effect site concentration of propofol needed for conscious sedation.
  
  
  METHODS
  Among 43 patients, 23 patients received fentanyl 25 mcg and 20 patients received normal saline in addition to hyperbaric bupivacaine 10 mg during spinal anaesthesia. Propofol was infused at a dose determined by a modified Dixon's up-and-down method. The Cerebral State Index was recorded once target effect site concentration was reached to determine the effect of the successfulness of the conscious sedation.
  
  
  RESULTS
  The half maximal effective concentration (EC50) of the effect-site concentration of propofol for sedation was 1.67 ± 0.28 mcg/ml in the control group and 0.87 ± 0.15 mcg/ml in the fentanyl group (P = 0.02). The propofol dose for conscious sedation during spinal anaesthesia was decreased by 48% when intrathecal fentanyl 25 mcg was added to local anaesthetics.
  
  
  CONCLUSIONS
  The EC50 of the effect-site concentration of propofol for sedation decreased from 1.67 ± 0.28 mcg/ml to 0.87 ± 0.15 mcg/ml with the addition of 25 mcg fentanyl to a spinal anaesthetic in patients undergoing urologic surgery.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Lee
authors.forename: J S
authors.initials: JS
authors.lastname: Kim
authors.forename: M K
authors.initials: MK
authors.lastname: Kim
authors.forename: S H
authors.initials: SH
authors.lastname: Kim
authors.forename: J Y
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000494:pharmacology*; D000368:Aged; D000775:Anesthesia, Spinal / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000493:pharmacokinetics*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D016292:Procedural Sedation / Q000379:methods*; D056805:Consciousness Monitors; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004809:Ephedrine / Q000627:therapeutic use; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000493:pharmacokinetics*; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D060186:Infusions, Spinal; D007278:Injections, Spinal; D007431:Intraoperative Complications / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D015742:Propofol / Q000008:administration & dosage / Q000493:pharmacokinetics*; D011446:Prospective Studies; D013520:Urologic Surgical Procedures
chemical_list: D000759:Adjuvants, Anesthesia; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D004809:Ephedrine; D005283:Fentanyl; D002045:Bupivacaine; D015742:Propofol