Potency of propofol for inducing loss of consciousness in end-stage kidney disease patients.

Abstract

It can be difficult for anesthesiologists to determine the optimal dose of propofol for end-stage kidney disease (ESKD) patients due to changes in drug disposition. The purpose of this study was to evaluate the potency of propofol for inducing loss of consciousness in ESKD patients. Patients with normal kidney function (Control group, n = 15), those with ESKD (ESKD group, n = 15), and those with ESKD undergoing cervical epidural anesthesia (ESKD-CEB group, n = 15) were administered propofol by target-controlled infusion (TCI) using the Schneider model. The effect-site concentration (Ce) of propofol started at 0.5 μg/ml and increased in increments of 0.5 μg/ml until the patient did not respond to verbal commands. The relationship between the probability (P) of loss of consciousness and the Ce of propofol was analyzed in each group using logistic regression. The Ce values of propofol at the time of loss of consciousness were 4.3 ± 0.9, 3.7 ± 0.9, and 3.3 ± 1.0 μg/ml for the Control, ESKD, and ESKD-CEB* groups, respectively (*significant difference vs. control, P < 0.05). The estimated Ce50 values for lost ability to respond to verbal command were 4.56, 3.75, and 3.21 μg/ml for the Control, ESKD, and ESKD-CEB groups, respectively. In conclusion, when inducing anesthesia in ESKD patients, we recommend using an initial dose similar to that of patients with normal kidney function, or rather starting with a lower dose.

• Authors: Mi Roung Jun, Mun Gyu Kim, Ki Seob Han, Ji Eun Park, Ho Bum Cho, Sun Young Park, Sanghoon Song, Jae Hwa Yoo, Ji Won Chung, Sang Ho Kim
• Journal: PloS one (PLoS One) Vol. 16 Issue 8 Pg. e0254520 ( 2021) ISSN: 1932-6203 [Electronic] United States
• PMID: 34383773 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anesthetics, Intravenous
• Propofol

Topics

• Aged
• Anesthesia, Epidural (adverse effects)
• Anesthesia, Intravenous (adverse effects)
• Anesthetics, Intravenous
• Consciousness (drug effects, physiology)
• Dose-Response Relationship, Drug
• Female
• Humans
• Kidney Failure, Chronic (complications, drug therapy, pathology)
• Logistic Models
• Male
• Middle Aged
• Propofol (administration & dosage, adverse effects)
• Unconsciousness (chemically induced, complications, pathology)