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Impact of patient age on propofol consumption during propofol–remifentanil anaesthesia

Published online by Cambridge University Press:  13 April 2005

S. Kreuer ,
J. U. Schreiber ,
J. Bruhn  and
W. Wilhelm
S. Kreuer
Affiliation:
University of Saarland, Department of Anaesthesiology and Intensive Care Medicine, Homburg/Saar, Germany
J. U. Schreiber
Affiliation:
University of Saarland, Department of Anaesthesiology and Intensive Care Medicine, Homburg/Saar, Germany
J. Bruhn
Affiliation:
University of Bonn, Department of Anaesthesiology and Intensive Care Medicine, Bonn, Germany
W. Wilhelm
Affiliation:
St.-Marien-Hospital Lünen, Department of Anaesthesiology and Intensive Care Medicine, Lünen, Germany
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Abstract

Summary

Background: This study was designed to investigate the impact of patient age on propofol consumption and recovery time using a propofol–remifentanil anaesthetic standardized with Narcotrend™ EEG monitoring. The Narcotrend is a monitor for measuring the depth of anaesthesia based upon a six-letter classification from A (awake) to F (increasing burst suppression) including 14 substages.

Methods: In 200 patients scheduled for minor orthopaedic surgery Narcotrend EEG electrodes were positioned on the patient's forehead as recommended by the manufacturer. Anaesthesia was induced with remifentanil 0.4 μg kg−1 min−1 and 2 mg kg−1 propofol. Immediately after intubation remifentanil was reduced to a constant rate of 0.2 μg kg−1 min−1 whereas a propofol infusion was now started at 3 mg kg−1 h−1 and then adjusted accordingly to achieve a target Narcotrend stages of D0–2 indicating general anaesthesia. At the end of surgery the propofol and remifentanil infusions were stopped without tapering, the time to unstimulated opening of eyes was determined, and the propofol consumption (given as mg kg−1 h−1) was calculated from the total amount of infused propofol but without the induction bolus, from the actual body weight and the duration of propofol infusion. Furthermore, a linear regression analysis was applied for propofol consumption vs. age.

Results: The ages of the patients studied ranged from 16 to 83 yr old and patients were classified as ASA I–III. Propofol consumption significantly decreased with the patients' age: 30 yr of age or below the propofol consumption was calculated as 5.9 ± 1.7 mg kg−1 h−1, for 31–50 yr as 5.4 ± 1.8 mg kg−1 h−1, for 51–70 yr as 4.5 ± 1.7 mg kg−1 h−1 and above 70 yr as 3.5 ± 1.4 mg kg−1 h−1. Linear regression analysis revealed propofol (mg kg−1 h−1) = 9.136 − (0.0597 × age (yr)); R = 0.53. Concomitantly, the recovery time to opening of eyes increased with the patients' age: ≤30 yr, 7.4 ± 3.7 min; 31–50 yr, 9.5 ± 4.0 min; 51–70 yr, 9.8 ± 4.1 min; and ≥71 yr, 14.9 ± 12.1 min.

Conclusions: We conclude that with Narcotrend guidance, mean propofol consumption and recovery times are age dependent. However, as a result of large inter-individual variability, age per se does not allow a prediction of individual propofol need or recovery time.

Keywords

ANAESTHETICS, INTRAVENOUS, propofolOPIOIDS, remifentanilANAESTHESIA GENERAL, measurement, NarcotrendAGE FACTORS, outcome
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 2 , February 2005 , pp. 123 - 128
Copyright
2005 European Society of Anaesthesiology

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References

Stanski DR, Maitre PO. Population pharmacokinetics and pharmacodynamics of thiopental: the effect of age revisited. Anesthesiology 1990; 72: 412–422.Google Scholar
Arden J, Holley F, Stanski D. Increased sensitivity to etomidate in the elderly: initial distribution versus altered brain response. Anesthesiology 1986; 65: 19–27.Google Scholar
Minto CF, Schnider TW, Egan TD, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. Anesthesiology 1997; 86: 10–23.Google Scholar
Kirkpatrick T, Cockshott ID, Douglas EJ, Nimmo WS. Pharmacokinetics of propofol (diprivan) in elderly patients. Br J Anaesth 1988; 60: 146–150.Google Scholar
Dyck JB, Shafer SL. Effects of age on propofol pharmacokinetic. Semin Anesth 1992; 11: 2–4.Google Scholar
Schnider T, Minto C, Shafer S, et al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999; 90: 1502–1516.Google Scholar
Kreuer S, Biedler A, Larsen R, Altmann S, Wilhelm W. Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol–remifentanil anesthesia. Anesthesiology 2003; 99: 34–41.Google Scholar
Kreuer S, Biedler A, Larsen R, Schoth S, Altmann S, Wilhelm W. The Narcotrend – a new EEG monitor designed to measure the depth of anaesthesia. A comparison with bispectral index monitoring during propofol–remifentanil-anaesthesia. Anaesthesist 2001; 50: 921–925.Google Scholar
Schmidt GN, Bischoff P, Standl T, et al. Narcotrend, bispectral index, and classical electroencephalogram variables during emergence from propofol/remifentanil anesthesia. Anesth Analg 2002; 95: 1324–1330.Google Scholar
Wilhelm W, Kreuer S, Larsen R. Narcotrend EEG monitoring during total intravenous anaesthesia in 4,630 patients. Anaesthesist 2002; 51: 980–988.Google Scholar
Scheepstra GL, Booij LH, Rutten CL, Coenen LG. Propofol for induction and maintenance of anaesthesia: comparison between younger and older patients. Br J Anaesth 1989; 62: 54–60.Google Scholar
Doze VA, Shafer A, White PF. Propofol–nitrous oxide versus thiopental–isoflurane–nitrous oxide for general anesthesia. Anesthesiology 1988; 69: 63–71.Google Scholar
Schultz B, Kreuer S, Wilhelm W, Grouven U, Schultz A. Der Narcotrend®-Monitor Entwicklung und Interpretationsalgorithmus. Anaesthesist 2003; 52: 1143–1148 [in German].Google Scholar
Shafer SL. The pharmacology of anesthetic drugs in elderly patients. Anesthesiol Clin North America 2000; 18: 1–29.Google Scholar
Schüttler J, Ihmsen H. Population pharmacokinetics of propofol: a multicenter study. Anesthesiology 2000; 92: 727–738.Google Scholar
Wynne HA, Cope LH, Mutch E, Rawlins MD, Woodhouse KW, James OF. The effect of age upon liver volume and apparent liver blood flow in healthy man. Hepatology 1989; 9: 297–301.Google Scholar
Schnider T, Minto C, Gambus P, et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology 1998; 88: 1170–1182.Google Scholar
Brody H. The aging brain. Acta Neurol Scand 1992; 137: 40–44.Google Scholar
Brody H. Structural changes in the aging nervous system. In: Blumenthal HT, ed. Interdisciplinary Topics in Gerontology. Basel: Karger, 1970: 9–21.
Christian W. [The electroencephalogram in advanced age.] Nervenarzt 1984; 55: 517–524.Google Scholar