The Combined Effect of Age and Premedication on the Propofol Requirements for Induction by Target-Controlled Infusion

Abstract

In this prospective study, we evaluated the combined influence of age and premedication on propofol requirements for the induction of anesthesia and their hemodynamic effects using a target-controlled infusion. We studied 180 patients separated into three age groups: 20–39 yr, 40–59 yr, and more than 59 yr. In each age group, patients were randomly allocated to receive either no premedication (n = 20), fentanyl (2 μg/kg) (n = 20), or midazolam (0.03 mg/kg) plus fentanyl (2 μg/kg) (n = 20). The concentration of propofol targeted for the induction was 5 μg/mL, to be reached in 2 min. The dose, time, and predicted plasma concentration of propofol at hypnosis were measured. Baseline and postinduction heart rate and arterial blood pressure were registered. Computer simulation was used to calculate the effect site propofol concentration at hypnosis. The concentration of propofol, effect site propofol concentration, time, and induction dose and their hemodynamic effect were significantly different among groups with respect to age and premedication. The combined effect of the two factors was additive, but without significant interaction. The propofol requirements were significantly less in the midazolam-fentanyl groups, regardless of age, and among the premedicated patients older than 60 yr compared with the other age groups. We conclude that the combined effect of age and premedication on the requirements of propofol for the induction of anesthesia should be considered when the concentration is targeted with a target-controlled infusion system. Implications Induction of anesthesia by using a target-controlled infusion system is influenced by both age and premedication. We define the effect site propofol concentration required for hypnosis with an alternative system to that of plasma-effect site equilibration. These findings may have an impact on the induction with pumps targeting an effect site concentration.