Expanding factor of maximum difference between ‘estimated effect-site concentration of propofol at optimal sedation during induction’ and ‘target blood concentration of propofol during surgery’

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  • 導入期至適鎮静時のプロポフォール予測脳内濃度と術中目標血中濃度との較差が大きくなる要因の検討

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Sensitivity to sedative medication varies greatly from individual to individual. Therefore, it is difficult to predict the optimal dosage of a sedative during intravenous sedation for each case. 　In a previous study on 14 patients, the authors investigated the usefulness of a new management method for intravenous propofol sedation using a target-controlled infusion pump, in which the estimated effect-site concentration of propofol at optimal sedation during induction was measured. The target blood concentration was reset to that value. The results showed that this method enabled the prediction of optimal intraoperative target blood concentrations of propofol for each individual with a minimal error range. However, some cases with a large error range during maintenance were observed. 　We enrolled 82 patients who underwent oral surgery under local anesthesia using this method in the present study. Cases with a large maximum difference between estimated effect-site concentration of propofol at optimal sedation during induction and target blood concentration at each point during surgery (hereafter, ‘maximum difference’) were investigated. A search for the expanding factor of ‘maximum difference’ was performed. 　The number of patients whose ‘maximum difference’ was 0.5μg/ml or greater (‘maximum difference ≧0.5’ group) and 0.1μg/ml or smaller (‘maximum difference ≦0.1’ group) was 9 and 11, respectively. The mean age of the ‘maximum difference ≧0.5’ group was significantly younger than the ‘maximum difference ≦0.1’ group {23.7±7.4 (minimum-maximum values, 16-37) vs. 37.5±14.2 (minimum-maximum values, 17-57) years, ｐ<0.05}. 　Our results suggest that we should be mindful of the potential discrepancy between estimated and actual measured values of target blood concentrations of propofol when the above sedation method is applied to younger patients.

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