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GENERAL ARTICLES

The Target Plasma Concentration of Propofol Required to Place Laryngeal Mask Versus Cuffed Oropharyngeal Airway

Andrea Casati, MD^*, Guido Fanelli, MD^*, Elisabetta Casaletti, MD^*, Valeria Cedrati, MD^*, Fabrizio Veglia, MD, and Giorgio Torri, MD^*

*Department of Anesthesiology, University of Milan; and Department of Biostatistics, IRCCS, Milan, Italy

Address correspondence and reprint requests to Dr. A. Casati, Department of Anesthesiology, IRCCS H San Raffaele, Via Olgettina 60, 20132 Milan, Italy. Address e-mail to casati.andrea{at}hsr.it

To determine the target plasma concentration of propofol required to place either a laryngeal mask airway (LMA) or a cuffed oropharyngeal airway (COPA), we started a continuous target-controlled infusion of propofol in 60 ASA physical status I or II unpremedicated patients scheduled for minor orthopedic surgery with peripheral nerve block. The target plasma concentration of propofol was initially set at 2 µg/mL. When the effect-site calculated concentration of propofol was equal to the plasma concentration according to the computer simulation, the target plasma concentration was increased by 0.5-µg/mL steps until successful placement of either the LMA (n = 30) or the COPA (n = 30). The mean target plasma concentration of propofol required to place a LMA was 4.3 ± 0.8 µg/mL compared with 3.2 ± 0.6 µg/mL to place a COPA (P < 0.001). To successfully place the airways in 95% of patients, the target plasma concentration of propofol had to be increased up to 4 µg/mL for the COPA and 6 µg/mL for the LMA. We conclude that placing a LMA in healthy, unpremedicated patients requires target plasma concentrations of propofol higher than those required for placing a COPA.

Implications: We evaluated the use of target-controlled infusion of propofol to place extratracheal airways in this prospective, randomized study and demonstrated that the target plasma concentration of propofol required to successfully place a laryngeal mask in >95% of healthy, unpremedicated patients is 6 µg/mL, compared with 4 µg/mL to place a cuffed oropharyngeal airway.

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