Effect site concentrations of propofol producing hypnosis in children and adults: comparison using the bispectral index
No study has determined the concentration of propofol producing a degree of hypnosis compatible with anaesthesia in children. As a result, concentrations determined in adults are recommended for children. As this can result in an inadequate depth of anaesthesia, we determined the predicted effect site concentration (Ce) of propofol necessary to obtain a bispectral index (BIS) of 50 in 50% (ECe50) of children and adults. Methods:
Twenty adults (aged 33–44 years) and 20 children (aged 3–11 years) undergoing surgery under general anaesthesia were studied. All were monitored with a BIS monitor, and a target controlled infusion of propofol aiming for a constant Ce value was started. After 10 min, patients were evaluated using a sedation scale, and the last 5 min was used to determine the mean BIS for this Ce value. The Ce value of propofol was defined using the up-and-down method of Dixon and Massey. The first patient in each group received Ce= 6 g/ml; thereafter, it was modified in 0.5 g/ml decrements/increments with positive or negative responses, respectively. A positive response was BIS < 50 and a negative response was BIS ≥ 50. The ECe50 value was compared using unpaired Student’s t-test. The prediction probability (PK) was used to study the association between BIS and the sedation score. Results:
The mean ECe50 (95% confidence interval) values were 3.75 g/ml (2.97–4.75 g/ml) in adults and 3.65 g/ml (3.36–3.96 g/ml) in children (not significant). All patients with BIS < 50 were unarousable with tactile stimulation. The PK value was 0.99 in both groups. Conclusions:
The predicted Ce value of propofol resulting in BIS = 50 was similar in adults and children aged 3–11 years. The predicted Ce value of propofol producing hypnosis in adults also seems to be useful in this paediatric population.