Objective The median effective dose (ED50) of patients with Crohn's disease using propofol for painless gastrointestinal endoscopy is determined by sequential method.
Methods Twenty-four patients with Crohn's disease (group D) and twenty-three healthy physical examination patients (group C), 23 males and 24 females, aged 18-64 years, BMI 18-30 kg/m2, ASA physical status Ⅰ or Ⅱ were selected. HR, BP, SpO2, and BIS were monitored. Propofol was injected intravenously for painless gastrointestinal endoscopy. According to the sequential method, the initial dose of group D was 2.2 mg/kg, and the initial dose of group C was 2.4 mg/kg. When BIS reached 60, endoscopy was started. If a positive reaction was appeared in the patient, the dose of the next patient increased by 0.2 mg/kg, otherwise it decreased by 0.2 mg/kg. If the patient's BIS cannot be reduced to 60 after anesthesia induction, or the cough or body movement reaction occured at level 2 or above when entering the mirror, it was defined as positive recation. The frequency of painless gastroenteroscopy and general anesthesia before operation, as well as the incidence of hypotension and respiratory depression were recorded. The ED50, 95% effective dose (ED95) and 95% confidence interval (CI) of the two groups were calculated by probability regression analysis.
Results Compared with group C, the number of painless gastrointestinal endoscopy and general anesthesia in group D was significantly increased (P < 0.05). The ED50 of propofol for painless gastrointestinal endoscopy in group D was 2.80 mg/kg (95% CI 2.72-2.88 mg/kg) and the ED95 was 3.20 mg/kg (95% CI 3.12-3.32 mg/kg). The ED50 of propofol for painless gastrointestinal endoscopy in group C was 2.42 mg/kg (95% CI 2.38-2.46 mg/kg). The ED95 was 2.60 mg/kg (95 % CI 2.51-2.70 mg/kg). The ED50 and ED95 of propofol for painless gastrointestinal endoscopy in group D was significantly higher than that in group C (P < 0.05). There were no significant differences in hypotension and respiratory depression between the two groups.
Conclusion The ED50 of propofol for painless gastrointestinal endoscopy was 2.80 mg/kg (95% CI 2.72-2.88 mg/kg) in patients with Crohn's disease and 2.42 mg/kg (95% CI 2.38-2.46 mg/kg) in controls. Patients with Crohn's disease may have repeated line of propofol anesthesia that leds to its increased does of propofol than physical examination patients for painless gastrointestinal endoscopy. It is necessary to increase the dose of propofol to meet the needs of clinical sedation. |
