A target-controlled infusion (TCI) Propofol in major trauma patients.
Alisher Irisvaevich Agzamov, A. M. Al Qattan, M. Shamsha, M. Bahzad.
Department of Anesthesiology & ICU, Al sabah & zain Hospitals, MOH, Kuwait City, Kuwait.
BACKGROUND:
Many pathophysiologic alterations in major trauma patients can cause changes in the distribution of, and perhaps response to, drugs commonly used in anesthesia practice. This study was conducted to assess changes in BIS caused by increasing the target Propofol effect-site concentration during a TCI in major trauma patients.
METHODS:
120 patients, ASA physical status II, III - IV, aged from 19 to 65 years old, weighing 50-170 kg, with poly multiple major trauma, scheduled for emergency surgery less than a 2 – 10 hours after injury were recruited. A further 120 ASA physical status class II, III - IV, emergency non- trauma surgical patients, age, sex- and weight-matched adult patients scheduled for emergency surgery under general anesthesia were recruited as controls. During anesthesia induction, target Propofol effect-site concentrations were increased by increments of 0.5 mcg/ml up to 5.0 mcg/ml. The BIS responses to each target concentration using TCI were compared in both groups.
RESULTS:
In the trauma group, significantly greater BIS values relating to increasing Propofol TCI were noted at deeper anesthesia when compared with controls; at > or =3.0 – 5.0 mcg/ml; mean BIS remained at a plateau of about 40. Patients with traumas had higher cardiac indices, and lower hemoglobin and albumin concentrations than the controls. They consumed more cisatracurium to maintain the same degree of neuromuscular blockade than the controls.
CONCLUSIONS:
In major trauma patients, the final biphasic BIS responses appeared to be determined by numerous other variables such as BIS algorithm, TCI performance, and altered Propofol pharmacokinetics and pharmacodynamics.
According to our results the importance of an individually tailored approach, including careful anesthetic titration, based upon the patient's clinical condition and responses can not be overemphasized.
