Pharmacodynamic Estimate of Propofol-Induced Sedation and Airway Obstruction Effects in Obstructive Sleep Apnea-Hypopnea Syndrome.
10.3349/ymj.2015.56.5.1408
- Author:
Bon Nyeo KOO
1
;
Seokyung SHIN
;
So Yeon KIM
;
Young Ran KANG
;
Kyu Hee JEONG
;
Dong Woo HAN
Author Information
1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. hanesth@yuhs.ac
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Airway obstruction;
obstructive sleep apnea-hypopnea syndrome;
propofol;
pharmacodynamic modeling;
sedation;
target-controlled infusion
- MeSH:
Adult;
Aged;
Airway Obstruction/*drug therapy;
Anesthesia;
Anesthetics, Intravenous/blood/pharmacokinetics/*pharmacology;
Female;
Humans;
Hypnotics and Sedatives/*pharmacology/therapeutic use;
Male;
Middle Aged;
Probability;
Propofol/*pharmacology/therapeutic use;
Sleep Apnea, Obstructive/physiopathology
- From:Yonsei Medical Journal
2015;56(5):1408-1414
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Sedatives must be carefully titrated for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) as oversedation may lead to disastrous respiratory outcomes. This study aimed to investigate the relations between the effect-site concentration (Ce) of propofol and sedation and airway obstruction levels in patients with OSAHS. MATERIALS AND METHODS: In 25 patients with OSAHS, sedation was induced by 2% propofol using target-controlled infusion. Sedation and airway obstruction levels were assessed using the Observer's Assessment of Alertness/Sedation Scale and a four-category scale, respectively. The relationships between propofol Ce and sedation and airway obstruction were evaluated using a sigmoid Emax model. Pharmacodynamic modeling incorporating covariates was performed using the Nonlinear Mixed Effects Modeling VII software. RESULTS: Increased propofol Ce correlated with the depth of sedation and the severity of airway obstruction. Predicted Ce50(m) (Ce associated with 50% probability of an effect> or =m) for sedation scores (m> or =2, 3, 4, and 5) and airway-obstruction scores (m> or =2, 3, and 4) were 1.61, 1.78, 1.91, and 2.17 microg/mL and 1.53, 1.64, and 2.09 microg/mL, respectively. Including the apnea-hypopnea index (AHI) as a covariate in the analysis of Ce50(4) for airway obstruction significantly improved the performance of the basic model (p<0.05). CONCLUSION: The probability of each sedation and airway obstruction score was properly described using a sigmoid Emax model with a narrow therapeutic range of propofol Ce in OSAHS patients. Patients with high AHI values need close monitoring to ensure that airway patency is maintained during propofol sedation.
