Targeting effect compartment or central compartment concentration of propofol - What predicts loss of consciousness?

Background: An effect compartment has been postulated, and the k(e0) has been quantified for several intravenous anesthetic drugs using electroencephalography (EEG) as the measure of effect. The authors wanted to validate that loss of responsiveness (LOW was related to targeting an effect compartment concentration rather than a central compartment (plasma) concentration. Methods: Twenty American Society of Anesthesiologists physical status I and II patients were randomized to receive propofol administered to a target central compartment or target effect compartment site concentration of 5.4 mu g/ml propofol administered by a target-controlled infusion (TCI) using a previously validated set of pharmacokinetic parameters and a k(e0) of 0.63 min(-1). Every 30 s for the first 5 min and every minute for the second 5 min the patients were asked to open their eyes. The time to LOR was measured by a blinded investigator. The authors also simulated the time to reach the desired target effect site concentration using varying k(e0) values. Results: The median time to LOR in the group targeted to a predicted plasma propofol concentration was 3.02 min and 1.23 min in the group targeted to a predicted effect compartment propofol concentration CP < 0.05). LOR to command in both groups occurred at a predicted median effect compartment concentration of 4.55 mu g/ml. Simulations demonstrated that the time predicted to LOR targeting an effect site concentration of 5.4 mu g/ml is markedly altered by the value chosen for the k(e0). Conclusions: This study confirms the utility of the k(e0) value to describe the effect compartment for propofol The authors also illustrate the importance of selecting the correct k(e0) value for the pharmacokinetic parameters used within the TCI system.