RT Book, Section
A1 Mandel, Jeff E.
A2 Johnson, Ken B.
SR Print(0)
ID 1103965212
T1 Application of Pharmacokinetic and Pharmacodynamic Modeling to Guide Propofol Administration for Endoscopy Procedures
T2 Clinical Pharmacology for Anesthesiology
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071736169
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1103965212
RD 2024/04/25
AB Sedation  for  endoscopy  is  a  rapidly  emerging  endeavor  in  anesthesia.  Growth  in  this  area  has  been  steady,  and  anesthesiologists  are  increasingly  becoming  involved  in  endoscopic  sedation.  Endoscopy  is  distinguished  from  other  anesthetic  challenges  by  2  factors.  First,  these  procedures  are  performed  with  natural  airways,  and  excessive  sedation  may  induce  obstruction  and  respiratory  depression.  Second,  the  procedure  time  is  short,  and  there  is  insufficient  time  to  tune  the  anesthetic.  These  factors  affect  the  anesthetic  strategy.  Anesthesiologists  assume  that  the  skills  learned  in  the  operating  room  transfer  to  the  endoscopy  suite,  but  a  bolus  of  propofol  sufficient  for  a  99%  probability  of  obtunding  response  to  intubation  may  exceed  the  total  propofol  requirement  for  a  diagnostic  esophagogastroduodenoscopy  (EGD)  several  times  and  result  in  a  prolonged  period  of  jaw  thrust  to  overcome  obstruction.  Conversely,  starting  a  propofol  infusion  at  the  infusion  rate  for  maintenance  of  loss  of  consciousness  will  take  a  considerable  period  of  time  to  achieve  this  outcome.  Target-controlled  infusion  (TCI)  may  achieve  a  specified  effect-site  concentration  reliably,  but  the  variability  of  patient  response  complicates  the  selection  of  the  target.1  Thus,  in  a  relatively  short  encounter,  anesthesiologists  must  pick  the  appropriate  induction  dose  for  deep  sedation  and  from  this  infer  the  proper  maintenance  dose.