Variation in propofol induction doses administered to surgical patients over age 65.
Variation in propofol induction doses administered to surgical patients over age 65.
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DOI：
10.1111/jgs.17139
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发表时间：
2021-08
影响因子：
6.3
通讯作者：
Shah N
中科院分区：
文献类型：
--
作者：
Schonberger RB;Bardia A;Dai F;Michel G;Yanez D;Curtis JP;Vaughn MT;Burg MM;Mathis M;Kheterpal S;Akhtar S;Shah N
高龄与丙泊酚急性不良反应的易感性增加相关。本研究的目的是描述在全国范围内的老年人手术样本中，气管插管前诱导全身麻醉的丙泊酚给药模式。使用多中心围手术期结局组数据集的回顾性观察性研究。美国36家机构。2014年至2018年期间，350，766名65岁以上的患者接受丙泊酚进行全身麻醉诱导和气管插管。无丙泊酚诱导推注总剂量。平均（SD）体重调整丙泊酚剂量为1.7（0.6）mg/kg。在检查的每个年龄组中，平均普遍丙泊酚诱导剂量超过了被描述为典型老年剂量要求的上限。接受丙泊酚诱导剂量高于所述典型老年范围的患者百分比为64.8%（95% CI 64.6-65.0），从65-69岁患者的73.8%至80岁或以上患者的45.8%不等。目前的一项大型多中心队列研究表明，在全国麻醉实践中，普遍的丙泊酚剂量通常福尔斯高于已发表的年龄≥ 65岁患者的典型要求剂量范围。诱导剂量给药的广泛变异性仍不能完全由已知的患者变量解释。这些无法解释的给药决定的性质和临床后果仍然是进一步研究的重要课题。观察到的预期和实际诱导剂量之间的不一致性提出了一个问题，即是否应该重新考虑广泛的供应商实践，或者是否应该重新考虑已公布的典型丙泊酚诱导剂量范围。
Advanced age is associated with increased susceptibility to acute adverse effects of propofol. The present study aimed to describe patterns of propofol dosing for induction of general anesthesia prior to endotracheal intubation in a nationwide sample of older adults presenting for surgery. Retrospective observational study using the Multicenter Perioperative Outcomes Group dataset. 36 institutions across the United States. 350,766 patients over age 65 who received propofol for general anesthetic induction and endotracheal intubation between 2014 and 2018. None Total induction bolus dose of propofol administered. The mean (SD) weight-adjusted propofol dose was 1.7 (0.6) mg/kg. The mean prevalent propofol induction dose exceeded the upper bound of what has been described as the typical geriatric dose requirement across every age category examined. The percent of patients receiving propofol induction doses above the described typical geriatric range was 64.8% (95% CI 64.6-65.0), varying from 73.8% among patients age 65-69 to 45.8% among patients age 80 or over. The present study of a large multicenter cohort demonstrates that prevalent propofol dosing commonly falls above the published typically required dose range for patients age ≥ 65 in nationwide anesthetic practice. Widespread variability in induction dose administration remains incompletely explained by known patient variables. The nature and clinical consequences of these unexplained dosing decisions remain important topics for further study. Observed discordance between expected and actual induction dosing raises the question of whether there should be reconsideration of widespread provider practice, or alternatively, whether what is published as the typical propofol induction dose range should be revisited.
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影响因子：
5.7
作者：
Colquhoun DA;Shanks AM;Kapeles SR;Shah N;Saager L;Vaughn MT;Buehler K;Burns ML;Tremper KK;Freundlich RE;Aziz M;Kheterpal S;Mathis MR
通讯作者：
Mathis MR
影响因子：
39.2
作者：
Mangano, CM;Diamondstone, LS;Mangano, DT
通讯作者：
Mangano, DT
影响因子：
8.8
作者：
Glance, Laurent G.;Hasley, Steve;Dick, Andrew W.
通讯作者：
Dick, Andrew W.
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
10.7
作者：
Natarajan, A.;Strandvik, G. F.;Morley, A. P.
通讯作者：
Morley, A. P.