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NEUROSURGICAL ANESTHESIA

Bolus Configuration Affects Dose Requirements of Intracarotid Propofol for Electroencephalographic Silence

Shailendra Joshi, MD^*, Mei Wang, MPH^*, Joshua J. Etu, BA^*, and John Pile-Spellman, MD

Departments of *Anesthesiology and Radiology and Neurosurgery, College of Physicians and Surgeons of Columbia University, New York, New York.

Address correspondence to Shailendra Joshi, MD, Irving Assistant Professor, Department of Anesthesiology, P&S P Box 46, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032. Address e-mail to sj121{at}columbia.edu.

We hypothesized that an intracarotid bolus injection of propofol to produce electroencephalographic (EEG) silence would require a smaller dose of the drug compared with the continuous infusion of the drug. Furthermore, the bolus propofol dose will be a function of the bolus characteristics in each bolus (mass/volume). We compared the dose requirements of intracarotid propofol needed to maintain EEG silence when delivered as bolus injections to continuous infusions in rabbits. Subsequently, we compared whether four different bolus characteristics (concentration and volume) of propofol (0.33% x 0.1 mL, 0.33% x 0.3 mL, 1% x 0.1 mL, and 1% x 0.3 mL) affected the dose required to produce EEG silence. We found that the infusion rate of propofol required to sustain EEG silence was three-fold larger than the dose required by bolus injections, 22.8 ± 11.9 vs 6.2 ± 2.9 mL/h for infusion versus bolus, respectively (n = 7, P < 0.004). Furthermore, during bolus injection, the doses of propofol required to produce EEG silence were a direct function of the bolus volume and the mass of drug in each bolus, total dose = 3.6 + 29 x mg/bolus, n = 32, r = 0.85. For maximum regional effects of the bolus intracarotid drug injection, the bolus characteristics (volume and drug concentration) have to be optimized.

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				M. Wang and S. Joshi Electrocerebral Silence After Intracarotid Propofol Injection Is a Function of Transit Time Anesth. Analg., June 1, 2007; 104(6): 1498 - 1503. [Abstract] [Full Text] [PDF]