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Pharmacodynamic Estimate of Propofol-Induced Sedation and Airway Obstruction Effects in Obstructive Sleep Apnea-Hypopnea Syndrome

Authors
 Bon-Nyeo Koo  ;  Seokyung Shin  ;  So Yeon Kim  ;  Young Ran Kang  ;  Kyu Hee Jeong  ;  Dong Woo Han 
Citation
 YONSEI MEDICAL JOURNAL, Vol.56(5) : 1408-1414, 2015 
Journal Title
YONSEI MEDICAL JOURNAL
ISSN
 0513-5796 
Issue Date
2015
MeSH
Adult ; Aged ; Airway Obstruction/drug therapy* ; Anesthesia ; Anesthetics, Intravenous/blood ; Anesthetics, Intravenous/pharmacokinetics ; Anesthetics, Intravenous/pharmacology* ; Female ; Humans ; Hypnotics and Sedatives/pharmacology* ; Hypnotics and Sedatives/therapeutic use ; Male ; Middle Aged ; Probability ; Propofol/pharmacology* ; Propofol/therapeutic use ; Sleep Apnea, Obstructive/physiopathology
Keywords
Coronary artery disease ; atrial fibrillation ; heart failure ; left ventricular hypertrophy ; peripheral artery disease ; peritoneal dialysis ; stroke ; sudden cardiac death
Abstract
PURPOSE: Sedatives must be carefully titrated for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) as oversedation may lead to disastrous respiratory outcomes. This study aimed to investigate the relations between the effect-site concentration (Ce) of propofol and sedation and airway obstruction levels in patients with OSAHS.
MATERIALS AND METHODS: In 25 patients with OSAHS, sedation was induced by 2% propofol using target-controlled infusion. Sedation and airway obstruction levels were assessed using the Observer's Assessment of Alertness/Sedation Scale and a four-category scale, respectively. The relationships between propofol Ce and sedation and airway obstruction were evaluated using a sigmoid Emax model. Pharmacodynamic modeling incorporating covariates was performed using the Nonlinear Mixed Effects Modeling VII software.
RESULTS: Increased propofol Ce correlated with the depth of sedation and the severity of airway obstruction. Predicted Ce50(m) (Ce associated with 50% probability of an effect≥m) for sedation scores (m≥2, 3, 4, and 5) and airway-obstruction scores (m≥2, 3, and 4) were 1.61, 1.78, 1.91, and 2.17 μg/mL and 1.53, 1.64, and 2.09 μg/mL, respectively. Including the apnea-hypopnea index (AHI) as a covariate in the analysis of Ce50(4) for airway obstruction significantly improved the performance of the basic model (p<0.05).
CONCLUSION: The probability of each sedation and airway obstruction score was properly described using a sigmoid Emax model with a narrow therapeutic range of propofol Ce in OSAHS patients. Patients with high AHI values need close monitoring to ensure that airway patency is maintained during propofol sedation.
Files in This Item:
T201503169.pdf Download
DOI
10.3349/ymj.2015.56.5.1408
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Young Ran(강영란)
Koo, Bon-Nyeo(구본녀) ORCID logo https://orcid.org/0000-0002-3189-1673
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Shin, Seokyung(신서경) ORCID logo https://orcid.org/0000-0002-2641-0070
Han, Dong Woo(한동우) ORCID logo https://orcid.org/0000-0002-8757-663X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/140992
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