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

 Bon-Nyeo Koo  ;  Seokyung Shin  ;  So Yeon Kim  ;  Young Ran Kang  ;  Kyu Hee Jeong  ;  Dong Woo Han 
 YONSEI MEDICAL JOURNAL, Vol.56(5) : 1408-1414, 2015 
Journal Title
Issue Date
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
Coronary artery disease ; atrial fibrillation ; heart failure ; left ventricular hypertrophy ; peripheral artery disease ; peritoneal dialysis ; stroke ; sudden cardiac death
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.
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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
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