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A840
October 14, 2007 2:00 PM - 4:00 PM Room Hall D, Area K, |
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| Effect of Anxiety on Estimated Propofol Effect-Site Concentration for Loss of Consciousness | |||||||||||||||
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Jean Guglielminotti, M.D., Severine Gras, M.D., Frederique Servin, M.D., Ph.D., Philippe Montravers, M.D., Ph.D., Jean-Marie Desmonts, M.D. Anesthesiology, Bichat Hospital, Paris, France |
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Background: A large inter-individual variability of propofol effect-site concentration (Ceff) required for loss of consciousness is observed. Preoperative anxiety may account for this variability. Indeed, baseline but not situational anxiety is responsible for increased propofol dose requirement for induction of anesthesia (1). However, hemodynamic status at the time of induction may also be responsible (2). We have therefore conducted this study to adress the effect of preoperative anxiety on estimated Ceff. Methods: After IRB approval and informed consent, 37 ASA I-II female patients undergoing gynecologic surgery were studied. None received preanesthetic medication. Preoperative anxiety was assessed using the Spielberger's State-Trait Anxiety Inventory form (STAI). State refers to situational anxiety at a precise time and trait to baseline proneness to anxiety. Patients filled in the form in the surgical ward at 8 a.m. on the operative day. Heart rate (HR) and systolic blood pressure (BP) were measured immediately before induction. Anesthesia was induced with a 200 mL/h continuous 1% propofol infusion (Base Primea®, Fresenius-Vial Company) without lidocaine coadministration. At the time of loss of consciousness, defined as loss of verbal contact, dose and Ceff (Schnider's model) were recorded with the Rugloop® software. Statistical analysis used Spearman test (p<0.05). Results: Mean (± 1SD) propofol dose and Ceff required for loss of consciousness were 111 ± 18 mg and 4.8 ± 0.6 µg/mL, respectively. Relationships between dose, Ceff, STAI and hemodynamic variables are presented in Table 1. Discussion: No relationship was observed between preoperative anxiety and propofol dose or Ceff. On the contrary, the higher the HR, the higher the Ceff or dose. The latter suggests an effect of hemodynamic status on dose and Ceff, probably through cardiac output changes (2). References: (1) Maranets I. Anesth Analg 1999; 89: 1346-51; (2) Adachi YU. Anesth Analg 2001; 92: 656-61.[table1] Anesthesiology 2007; 107: A840 |
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