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LETTERS TO THE EDITOR

On the Effect of Propofol on Human Colonic Muscle

Department of Anesthesiology William Morey Hospital 71321 Chalon sur Saône, France

To the Editor:

We read with great interest the article by Lee et al. (1). This well designed study was the first to demonstrate a dose-dependent effect of propofol on acetylcholine-induced contractions of human colonic smooth muscles.

Propofol has gained wide acceptance as a sedative drug (2) suitable in ambulatory colonoscopies. Like others, we currently have used it in more than 2000 patients in the past five years for this procedure. The manipulation of the endoscope and insufflation in the sigmoid could provoke intense but brief visceral pain as a result of colonic muscle spasms and/or stimulation of the autonomic nervous system (3).

Even if it is difficult to translate in vitro to in vivo conditions, this study seemed to prove 1) that the desired pharmacologic effect might be not only sedation and analgesia but also relaxation of colonic smooth muscles which could facilitate the procedure, and 2) that this effect could be obtained by a small target propofol blood concentration, above 2 µg/mL, permitting both clinically acceptable results and avoidance of cardiorespiratory problems. As the prediction of the measured concentration increases with the decreasing target concentration (4), propofol target-controlled infusion appeared to be a promising technique for colonoscopies.

References

1. Lee TL, Ang SB, Dambisya YM, et al. The effect of propofol on human gastric and colonic muscle contractions. Anesth Analg 1999; 89: 1246–9.[Abstract/Free Full Text]
2. Smith I, White PF, Nathanson M, Gouldson R. Propofol: an update on its clinical uses. Anesthesiology 1994; 81: 1005–43.[Web of Science][Medline]
3. Cotton PB, Williams CB. Colonoscopy. In: Cotton PB, Williams CB, eds. Practical gastro-intestinal endoscopy? Oxford: Blackwell Scientific Publications, 1990: 160–223.
4. Vuyk J, Engbers FHM, Burm AGL, et al. Performance of computer-controlled infusion of propofol: an evaluation of five pharmacokinetic parameter sets. Anesth Analg 1995; 81: 1275–82.[Abstract]

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