孕早期麻醉诱导和苏醒时的丙泊酚预测效应室浓度。

Predicted propofol effect-site concentration for induction and emergence of anesthesia during early pregnancy.

作者信息

Mongardon Nicolas, Servin Frédérique, Perrin Mathilde, Bedairia Ennoufous, Retout Sylvie, Yazbeck Chadi, Faucher Philippe, Montravers Philippe, Desmonts Jean-Marie, Guglielminotti Jean

机构信息

Département d'Anesthésie et de Réanimation Chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France.

出版信息

Anesth Analg. 2009 Jul;109(1):90-5. doi: 10.1213/ane.0b013e3181a1a700. Epub 2009 May 13.

DOI:10.1213/ane.0b013e3181a1a700

PMID:19439683

Abstract

BACKGROUND

Pregnancy is associated with decreased hypnotic requirement, allegedly related to progesterone. However, the effects of pregnancy and progesterone on propofol requirement have not been thoroughly investigated. We conducted this study to determine whether propofol dose and predicted effect-site concentration for loss of consciousness (LOC) during induction of anesthesia, and eye opening during emergence from anesthesia, are decreased during early pregnancy. We also investigated whether blood progesterone was correlated with propofol dose and effect-site concentration for LOC.

METHODS

We studied 57 ASA I-II women patients undergoing elective termination of pregnancy and 55 control patients undergoing transvaginal oocyte puncture for in vitro fertilization. Anesthesia was induced by administration of a 1% propofol infusion at 200 mL/min. Propofol dose and calculated effect-site concentration (Schnider model) were recorded at the time of LOC during induction. We also calculated effect-site concentration at the time of eye opening upon emergence from anesthesia. Blood progesterone was measured after surgery.

RESULTS

Mean (+/-1 SD) propofol dose at LOC was significantly reduced in the pregnant patients compared with the nonpregnant control patients (108.57 +/- 20.04 vs 117.59 +/- 17.98 mg, respectively; P = 0.014). Similarly, the calculated propofol effect-site concentration at LOC was significantly lower in the pregnant patients than the nonpregnant control patients (4.59 +/- 0.72 vs 5.01 +/- 0.64 microg/mL, respectively; P = 0.0014). There was no difference in the calculated effect-site concentration on eye opening upon emergence. No significant relationship was observed between blood progesterone and propofol dose or calculated propofol effect-site concentration at LOC.

CONCLUSION

Propofol dose and predicted propofol effect-site concentration at LOC are decreased during early pregnancy. Progesterone does not explain this result.

摘要

背景

妊娠与催眠药物需求量减少有关，据称与孕酮有关。然而，妊娠和孕酮对丙泊酚需求量的影响尚未得到充分研究。我们进行这项研究以确定在妊娠早期麻醉诱导期间意识消失（LOC）以及麻醉苏醒期间睁眼时丙泊酚剂量和预测的效应室浓度是否降低。我们还研究了血孕酮水平与LOC时丙泊酚剂量和效应室浓度是否相关。

方法

我们研究了57例接受择期终止妊娠的美国麻醉医师协会（ASA）I-II级女性患者和55例接受经阴道卵母细胞穿刺体外受精的对照患者。通过以200 mL/min的速度输注1%丙泊酚诱导麻醉。记录诱导期间LOC时的丙泊酚剂量和计算的效应室浓度（施奈德模型）。我们还计算了麻醉苏醒时睁眼时的效应室浓度。术后测量血孕酮水平。

结果

与未怀孕的对照患者相比，怀孕患者LOC时的平均（±1标准差）丙泊酚剂量显著降低（分别为108.57±20.04 mg和117.59±17.98 mg；P = 0.014）。同样，怀孕患者LOC时计算的丙泊酚效应室浓度显著低于未怀孕的对照患者（分别为4.59±0.72 vs 5.01±0.64 μg/mL；P = 0.0014）。苏醒时睁眼时计算的效应室浓度没有差异。未观察到血孕酮水平与LOC时丙泊酚剂量或计算的丙泊酚效应室浓度之间存在显著关系。