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Anesth Analg 2007;105:616-619
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000275188.56157.a2

PEDIATRIC ANESTHESIOLOGY

The Effect of Varying Continuous Propofol Infusions on Plasma Cyclic Guanosine 3',5'-Monophosphate Concentrations in Anesthetized Children

Thomas Engelhardt, MD, PhD, FRCA, Man K. Chan, ART, MSc, Alan J. McCheyne, MBChB, FRCA, Cengiz Karsli, MD, FRCPC, Igor Luginbuehl, MD, and Bruno Bissonnette, MD, FRCPC

From the Department of Anaesthesia and Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Address correspondence and reprint requests to Thomas Engelhardt, MD, PhD, FRCA, Department of Anaesthesia and Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Address e-mail to t.engelhardt{at}nhs.net.

Abstract

BACKGROUND: The glutamate–nitric oxide–cyclic guanosine 3',5'-monophosphate (cGMP) pathway is potentially an effective target for general anesthetics. Plasma cGMP concentrations are reduced after an increase in predicted plasma propofol concentrations during sedation in healthy adult volunteers. We hypothesized that an increase in measured plasma propofol concentration leads to a reduction in plasma cGMP in anesthetized children.

METHODS: Eighteen healthy children aged 46.8 (±19.6) mo, requiring general anesthesia for lower body surgical procedures were enrolled. After inhaled induction, tracheal intubation and initiation of intermittent positive pressure ventilation, caudal epidural analgesia was performed. Anesthesia was maintained using a continuous propofol infusion adapted from a previously published regimen to achieve predicted propofol plasma concentration of 6, 3, and 1.5 µg/mL after 30, 50, and 70 min, respectively. Samples for propofol and cGMP plasma concentrations were collected and analyzed using high-performance liquid chromatography and an enzyme immunoassay system.

RESULTS: The plasma cGMP concentrations varied significantly (median [range]) 19.2 [11.8–23.5], 21.3 [14.6–30.8], and 24.9 [15.7–37.8] nmol/L among each predicted plasma propofol concentration, P < 0.0001. The correlation coefficient (r) was –0.62.

CONCLUSIONS: This study demonstrates that an increase in plasma propofol concentration leads to a decrease in plasma cGMP in healthy children, and could serve as a biochemical marker for depth of propofol anesthesia in children.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.