Required propofol dose for anesthesia and time to emerge are affected by the use of antiepileptics: prospective cohort study

BACKGROUND We investigated the impact of the type of neurological disorder on the required propofol dose for anesthesia and the time to emerge from anesthesia during dental treatment in patients with autism (AU), cerebral palsy (CP), and intellectual disability (ID), some of whom also had epilepsy. METHODS We studied 224 patients with a neurological disorder who underwent dental treatment under intravenous general anesthesia. Patients were categorized according to neurological disorder (AU, CP, and ID; and with or without an antiepileptic). The propofol dose required for anesthesia, time to emerge, and modeled propofol blood concentration at emergence were evaluated. RESULTS In patients not given an antiepileptic, we found no significant differences in the propofol dose, modeled propofol blood concentration at emergence, or time to emerge among patients with AU, CP, and ID (P > 0.05). When using an antiepileptic, the dose of propofol (5.7 ± 1.51 mg/kg/h) was significantly lower than without an antiepileptic (6.8 ± 1.27 mg/kg/h) (P < 0.0001). The modeled propofol blood concentration at emergence in patients given an antiepileptic (0.5 ± 0.03 μg/ml) was significantly lower than without an antiepileptic (0.7 ± 0.02 μg/ml) (P < 0.0001). The time to emerge in patients given an antiepileptic (29.5 ± 12.5 min) was significantly longer than without an antiepileptic (21.6 min ± 10.0 min) (P < 0.0001). CONCLUSION The propofol dose required for anesthesia and the time to emerge from anesthesia are not affected by the type of neurological disorder, but are affected by antiepileptic use. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry (UMIN000014179), Date of registration 4 June 2014.