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ANESTHETIC PHARMACOLOGY

The Determinants of Propofol Induction of Anesthesia Dose

Yushi U. Adachi, MD^*, Kazuhiko Watanabe, MD, PhD^*, Hideyuki Higuchi, MD, PhD, and Tetsuo Satoh, MD, PhD^*

*Department of Anesthesiology, National Defense Medical College, Saitama, Japan; and Department of Anesthesia, Self Defense Force Central Hospital, Tokyo, Japan

Address correspondence and reprint requests to Yushi U Adachi, Department of Anesthesiology, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513 Japan. Address e-mail to grd1117{at}gr.ndmc.ac.jp

Recently it was reported that the pharmacokinetics of propofol are modified by changes in cardiac output. The objective of this study was to evaluate the effects of cardiac output and other factors on the hypnotic dose of propofol. One-hundred surgical patients were administered indocyanine green immediately before the induction of anesthesia to measure their cardiac outputs and blood volumes. Propofol (250 µg · kg^-1 · min^-1) was infused IV for 8 min, and the hypnotic dose of propofol and the time to hypnosis were recorded. The plasma concentration of propofol immediately after 2 mg/kg infusion was measured. Multiple regression analysis showed that, in addition to age and weight, cardiac output was a small but significant factor for predicting the hypnotic dose of propofol (R² = 0.468, P < 0.001), the time to hypnosis (R² = 0.454, P < 0.001), and the plasma concentration of propofol (R² = 0.248, P < 0.01). Cardiac output, age, and weight showed similar partial coefficients for the hypnotic dose (0.128, 0.137, and 0.140, respectively).

Implications: This study demonstrates a significant relationship between cardiac output and the hypnotic dose of propofol. We suggest that anesthesiologists should include cardiac output, as well as age and weight, in calculating the induction dose of propofol.

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