Jaya Velraj, Madhula P, Kumar Vr Hemanth, Rajadurai Daniel
Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal, Puducherry, India.
Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India.
Indian J Anaesth. 2022 Mar;66(3):174-179. doi: 10.4103/ija.ija_547_21. Epub 2022 Mar 24.
Propofol is the drug of choice for sedation in daycare procedures due to its pharmacokinetic properties. Propofol delivery using target-controlled infusion (TCI) pump reduces adverse effects like hypotension and apnoea. In this study, we estimated the median effective effect-site concentration of propofol in patients undergoing dilatation and curettage.
Patients of the American Society of Anesthesiologists physical status class I-III, aged 40-70 years, undergoing elective dilatation and curettage were recruited for the study. All patients received 1 μg/kg fentanyl and 20 mg lignocaine. The first patient received an effect-site concentration of propofol at 4 μg/mL with TCI Schneider pharmacokinetic model. Failure was defined as patient movement at any time during the procedure. According to the 'BiasedCoin Design' up-and-down sequential method, the response of the previous patient determined the effect-site concentration of propofol of the next patient. The study was terminated once forty patients completed the procedures successfully. Probit analysis was used to determine EC50.
Fifty-three patients were recruited for the study. The various effect-site concentrations of propofol EC50, EC90, and EC95 in providing sedation for dilatation and curettage were 3.38 μg/mL, 4.29 μg/mL, and 4.60 μg/mL, respectively. The incidence of hypotension and apnoea were comparable among the various concentrations of propofol. The mean duration of the propofol infusion was 20 ± 2.86 min. The time to recovery from propofol sedation was 6.97 ± 1.76 min.
A median effective effect-site concentration of 3.38 μg/mL of propofol is required to prevent patient movement during uterine dilatation and curettage.
由于其药代动力学特性，丙泊酚是日间手术镇静的首选药物。使用靶控输注（TCI）泵输注丙泊酚可减少低血压和呼吸暂停等不良反应。在本研究中，我们估算了接受刮宫术患者丙泊酚的半数有效效应室浓度。
招募年龄在40 - 70岁、美国麻醉医师协会身体状况分级为I - III级、接受择期刮宫术的患者进行研究。所有患者均接受1 μg/kg芬太尼和20 mg利多卡因。首例患者采用TCI施奈德药代动力学模型给予效应室浓度为4 μg/mL的丙泊酚。失败定义为手术过程中任何时间患者出现移动。根据“偏倚硬币设计”上下序贯法，前一位患者的反应决定下一位患者丙泊酚的效应室浓度。40例患者成功完成手术时研究终止。采用概率分析确定半数有效浓度（EC50）。
53例患者纳入本研究。丙泊酚在刮宫术中提供镇静作用的不同效应室浓度，即EC50、EC90和EC95分别为3.38 μg/mL、4.29 μg/mL和4.60 μg/mL。不同浓度丙泊酚的低血压和呼吸暂停发生率相当。丙泊酚输注的平均持续时间为20 ± 2.86分钟。从丙泊酚镇静状态恢复的时间为6.97 ± 1.76分钟。
刮宫术中预防患者移动所需丙泊酚的半数有效效应室浓度为3.38 μg/mL。
