Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2015 | Research article

Required propofol dose for anesthesia and time to emerge are affected by the use of antiepileptics: prospective cohort study

Authors: Kentaro Ouchi, Kazuna Sugiyama

Published in: BMC Anesthesiology | Issue 1/2015

Login to get access

Abstract

Background

We investigated the impact of the type of neurological disorder on the required propofol dose for anesthesia and the time to emerge from anesthesia during dental treatment in patients with autism (AU), cerebral palsy (CP), and intellectual disability (ID), some of whom also had epilepsy.

Methods

We studied 224 patients with a neurological disorder who underwent dental treatment under intravenous general anesthesia. Patients were categorized according to neurological disorder (AU, CP, and ID; and with or without an antiepileptic). The propofol dose required for anesthesia, time to emerge, and modeled propofol blood concentration at emergence were evaluated.

Results

In patients not given an antiepileptic, we found no significant differences in the propofol dose, modeled propofol blood concentration at emergence, or time to emerge among patients with AU, CP, and ID (P > 0.05). When using an antiepileptic, the dose of propofol (5.7 ± 1.51 mg/kg/h) was significantly lower than without an antiepileptic (6.8 ± 1.27 mg/kg/h) (P < 0.0001). The modeled propofol blood concentration at emergence in patients given an antiepileptic (0.5 ± 0.03 μg/ml) was significantly lower than without an antiepileptic (0.7 ± 0.02 μg/ml) (P < 0.0001). The time to emerge in patients given an antiepileptic (29.5 ± 12.5 min) was significantly longer than without an antiepileptic (21.6 min ± 10.0 min) (P < 0.0001).

Conclusion

The propofol dose required for anesthesia and the time to emerge from anesthesia are not affected by the type of neurological disorder, but are affected by antiepileptic use.

Trial registration

University Hospital Medical Information Network Clinical Trials Registry (UMIN000014179), Date of registration 4 June 2014.
Literature
1.
Cumella S, Ransford N, Lyons J, Burnham H. Needs for oral care among people with intellectual disability not in contact with Community Dental Services. J Intellect Disabil Res. 2000;44(Pt 1):45–52.PubMedCrossRef
2.
Abanto J, Carvalho TS, Bonecker M, Ortega AO, Ciamponi AL, Raggio DP. Parental reports of the oral health-related quality of life of children with cerebral palsy. BMC Oral Health. 2012;12:15.PubMedPubMedCentralCrossRef
3.
Chi DL, Rossitch KC, Beeles EM. Developmental delays and dental caries in low-income preschoolers in the USA: a pilot cross-sectional study and preliminary explanatory model. BMC Oral Health. 2013;13:53.PubMedPubMedCentralCrossRef
4.
Manley MC, Skelly AM, Hamilton AG. Dental treatment for people with challenging behaviour: general anaesthesia or sedation? Br Dent J. 2000;188(7):358–60.PubMed
5.
Miyawaki T, Kohjitani A, Maeda S, Egusa M, Mori T, Higuchi H, et al. Intravenous sedation for dental patients with intellectual disability. J Intellect Disabil Res. 2004;48(Pt 8):764–8.PubMedCrossRef
6.
Asahi Y, Kubota K, Omichi S. Dose requirements for propofol anaesthesia for dental treatment for autistic patients compared with intellectually impaired patients. Anaesth Intensive Care. 2009;37(1):70–3.PubMed
7.
Lee JD, Park HJ, Park ES, Kim DG, Rha DW, Kim EY, et al. Assessment of regional GABA(A) receptor binding using 18 F-fluoroflumazenil positron emission tomography in spastic type cerebral palsy. Neuroimage. 2007;34(1):19–25.PubMedCrossRef
8.
Patsalos PN, Froscher W, Pisani F, van Rijn CM. The importance of drug interactions in epilepsy therapy. Epilepsia. 2002;43(4):365–85.PubMedCrossRef
9.
Marsh B, White M, Morton N, Kenny GN. Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth. 1991;67(1):41–8.PubMedCrossRef
10.
Perucca E. Pharmacological and therapeutic properties of valproate: a summary after 35 years of clinical experience. CNS Drugs. 2002;16(10):695–714.PubMedCrossRef
11.
Anderson GD. A mechanistic approach to antiepileptic drug interactions. Ann Pharmacother. 1998;32(5):554–63.PubMedCrossRef
12.
Oda Y, Hamaoka N, Hiroi T, Imaoka S, Hase I, Tanaka K, et al. Involvement of human liver cytochrome P4502B6 in the metabolism of propofol. Br J Clin Pharmacol. 2001;51(3):281–5.PubMedPubMedCentralCrossRef
13.
Court MH, Duan SX, Hesse LM, Venkatakrishnan K, Greenblatt DJ. Cytochrome P-450 2B6 is responsible for interindividual variability of propofol hydroxylation by human liver microsomes. Anesthesiology. 2001;94(1):110–9.PubMedCrossRef
14.
Guitton J, Buronfosse T, Desage M, Flinois JP, Perdrix JP, Brazier JL, et al. Possible involvement of multiple human cytochrome P450 isoforms in the liver metabolism of propofol. Br J Anaesth. 1998;80(6):788–95.PubMedCrossRef
15.
16.
Ragueneau-Majlessi I, Levy RH, Bergen D, Garnett W, Rosenfeld W, Mather G, et al. Carbamazepine pharmacokinetics are not affected by zonisamide: in vitro mechanistic study and in vivo clinical study in epileptic patients. Epilepsy Res. 2004;62(1):1–11.PubMedCrossRef
17.
Wen X, Wang JS, Kivisto KT, Neuvonen PJ, Backman JT. In vitro evaluation of valproic acid as an inhibitor of human cytochrome P450 isoforms: preferential inhibition of cytochrome P450 2C9 (CYP2C9). Br J Clin Pharmacol. 2001;52(5):547–53.PubMedPubMedCentralCrossRef
18.
Sachdeo RC, Sachdeo SK, Levy RH, Streeter AJ, Bishop FE, Kunze KL, et al. Topiramate and phenytoin pharmacokinetics during repetitive monotherapy and combination therapy to epileptic patients. Epilepsia. 2002;43(7):691–6.PubMedCrossRef
19.
Levy RH BM. Phenytoin: interactions with other drugs: mechanistic aspects. In: Levy RH MR, Meldrum BS, editors. Antiepileptic drugs. 4th ed. New York: Raven; 1995. p. 329–44.
20.
Yap KY, Chui WK, Chan A. Drug interactions between chemotherapeutic regimens and antiepileptics. Clin Ther. 2008;30(8):1385–407.PubMedCrossRef
21.
Ethell BT, Anderson GD, Burchell B. The effect of valproic acid on drug and steroid glucuronidation by expressed human UDP-glucuronosyltransferases. Biochem Pharmacol. 2003;65(9):1441–9.PubMedCrossRef
22.
Mutlib AE, Goosen TC, Bauman JN, Williams JA, Kulkarni S, Kostrubsky S. Kinetics of acetaminophen glucuronidation by UDP-glucuronosyltransferases 1A1, 1A6, 1A9 and 2B15, potential implications in acetaminophen-induced hepatotoxicity. Chem Res Toxicol. 2006;19(5):701–9.PubMedCrossRef
23.
Kostrubsky SE, Sinclair JF, Strom SC, Wood S, Urda E, Stolz DB, et al. Phenobarbital and phenytoin increased acetaminophen hepatotoxicity due to inhibition of UDP-glucuronosyltransferases in cultured human hepatocytes. Toxicol Sci. 2005;87(1):146–55.PubMedCrossRef
24.
Kuipers JA, Boer F, Olieman W, Burm AG, Bovill JG. First-pass lung uptake and pulmonary clearance of propofol: assessment with a recirculatory indocyanine green pharmacokinetic model. Anesthesiology. 1999;91(6):1780–7.PubMedCrossRef
25.
Raoof AA, Van Obbergh LJ, De Ville De Goyet J, Verbeeck RK. Extrahepatic glucuronidation of propofol in man: possible contribution of gut wall and kidney. Eur J Clin Pharmacol. 1996;50:91–6.PubMedCrossRef
26.
Hamaoka N, Oda Y, Hase I, Mizutani K, Nakamoto T, Ishizaki T, et al. Propofol decreases the clearance of midazolam by inhibiting CYP3A4: an in vivo and in vitro study. Clin Pharmacol Ther. 1999;66(2):110–7.PubMedCrossRef
27.
Ishii M, Higuchi H, Maeda S, Tomoyasu Y, Egusa M, Miyawaki T. The influence of oral VPA on the required dose of propofol for sedation during dental treatment in patients with mental retardation: a prospective observer-blinded cohort study. Epilepsia. 2012;53(1):e13–6.PubMedCrossRef
28.
Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology. 1997;86(4):836–47.PubMedCrossRef
29.
Pilge S, Jordan D, Kreuzer M, Kochs EF, Schneider G. Burst suppression-MAC and burst suppression-CP50 as measures of cerebral effects of anaesthetics. Br J Anaesth. 2014;112(6):1067–74.PubMedCrossRef
30.
Moller Petrun A, Kamenik M. Bispectral index-guided induction of general anaesthesia in patients undergoing major abdominal surgery using propofol or etomidate: a double-blind, randomized, clinical trial. Br J Anaesth. 2013;110(3):388–96.PubMedCrossRef
31.
Bresil P, Nielsson MS, Malver LP, Kraemer K, Schjorring O, Dethlefsen C, et al. Impact of bispectral index for monitoring propofol remifentanil anaesthesia, a randomised clinical trial. Acta Anaesthesiol Scand. 2013;57(8):978–87.PubMedCrossRef
32.
Altermatt FR, Bugedo DA, Delfino AE, Solari S, Guerra I, Munoz HR, et al. Evaluation of the effect of intravenous lidocaine on propofol requirements during total intravenous anaesthesia as measured by bispectral index. Br J Anaesth. 2012;108(6):979–83.PubMedCrossRef
Metadata
Title
Required propofol dose for anesthesia and time to emerge are affected by the use of antiepileptics: prospective cohort study
Authors
Kentaro Ouchi
Kazuna Sugiyama
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-015-0006-z

Other articles of this Issue 1/2015

BMC Anesthesiology 1/2015 Go to the issue

Research article

Femoral nerve block-sciatic nerve block vs. femoral nerve block-local infiltration analgesia for total knee arthroplasty: a randomized controlled trial

Research article

Prevalence and predictive factors of preoperative hypomagnesaemia among adult surgical patients in a large tertiary hospital in Ghana

Research article

Comparison of fentanyl versus meperidine as supplements to epidural clonidine-bupivacaine in patients with lower limb orthopedic surgery under combined spinal epidural anesthesia

Research article

Bispectral index-guided general anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine

Research article

Intraoperative burst suppression is associated with postoperative delirium following cardiac surgery: a prospective, observational study

Research article

Impact of fast-track discharge from cardiothoracic intensive care on family satisfaction