Effect-site concentrations of propofol to induce loss of consciousness in patients with Parkinson's disease

doi:10.3969/j.issn.1006-7795.2025.06.021

Abstract

Abstract: Objective To observe the effect-site concentration (Ce) of propofol required for loss of consciousness during induction in patients with Parkinsons disease (PD) and non-PD patients. Methods From October 16, 2022 to October 14, 2023, 37 PD patients (PD group) aged 50－80 years, with American Society of Anesthesiologists (ASA) Ⅱ－Ⅲ, who underwent bilateral deep brain stimulation (DBS) surgery at Beijing Tiantan Hospital, Capital Medical University, were enrolled. Another 37 non-PD patients (Non-PD group), who were age and gender matched with PD patients and underwent non-neurosurgical and non-cardiac surgeries during the same period, were selected as control group. Propofol was administered via target-controlled infusion (TCI) using the Schnider model. The level of consciousness was assessed 20 s after the Observer’s Assessment of Alertness/Sedation (OAA/S) score dropped to 1. The administration of propofol was stopped after 5 mins of clinical trial data collection. The Ce of propofol and patient state index (PSI) were recorded at loss of consciousness (OAA/S=1) and upon recovery of consciousness (OAA/S=3) . Results The dose of propofol required to induce unconsciousness in the PD group was significantly lower than that in the Non-PD group ［(2.2±0.4)mg/L vs (3.1±0.4)mg/L, P＜0.05］. Compared with the Non-PD group, the PD group had higher PSI values both at the time of loss of consciousness and consciousness recovery (P＜0.05), significantly longer consciousness recovery time (P＜0.05), and lower propofol Ce at the time of consciousness recovery (P＜0.05). Conclusion PD patients require a lower dose of propofol to induce loss of consciousness and need to recover at a lower Ce. Their consciousness recovery time is significantly longer than that of Non-PD patients, and their PSI values are higher than those of Non-PD patients both at the time of loss of consciousness and recovery. These characteristics should be taken into account in anesthesia management for PD patients.

Key words: Parkinson's disease, propofol, OAA/S, effect-site concentration, PSI, loss of consciousness, recovery of consciousness

CLC Number:

R614

Wang Jinfei, Xiong Wei, Wang Yunzhen, Yu Yun, Han Ruquan. Effect-site concentrations of propofol to induce loss of consciousness in patients with Parkinson's disease[J]. Journal of Capital Medical University, 2025, 46(6): 1126-1132.

References

［1］Bloem B R, Okun M S, Klein C. Parkinson's disease［J］. Lancet, 2021, 397(10291): 2284－3303.
［2］Kulcsarova K, Skorvanek M, Postuma R B, et al. Defining Parkinson's disease: past and future［J］. J Parkinsons Dis, 2024, 14(S2): S257－S271.
［3］Meng D T, Wu J Y, Huang X Y, et al. Prevalence of Parkinson's disease among adults aged 45 years and older in China: a cross-sectional study based on the China health and retirement longitudinal study［J］. BMC Public Health, 2024, 24(1): 1218.
［4］孟凡刚, 陈玲, 刘钰晔, 等. 中国帕金森病脑深部电刺激疗法专家共识(第二版)解读［J］. 中华神经外科杂志, 2021, 37(5): 439－442.
［5］Holewijn R A, Zoon T J C, Verbaan D, et al. Cognitive and psychiatric outcomes in the GALAXY trial: effect of anaesthesia in deep brain stimulation［J］. J Neurol Neurosurg Psychiatry, 2024, 95(3): 214－221.
［6］陈良, 谢思宁, 李享佳卉, 等. 帕金森病患者行脑深部电刺激手术的麻醉管理:基于国内多中心的横断面调查［J］. 国际麻醉学与复苏杂志, 2022, 43(10): 1054－1058.
［7］Izzo A, Piano C, D'ercole M,et al.Intraoperative microelectrode recording during asleep deep brain stimulation of subthalamic nucleus for Parkinson disease. A case series with systematic review of the literature［J］. Neurosurg Rev, 2024, 47(1): 342.
［8］刘志永, 丁翠青, 姚长青, 等. 帕金森病患者行下腹或下肢手术全麻苏醒质量及认知功能的变化［J］. 临床麻醉学杂志, 2015, 31(5): 472－475.
［9］Xu X P, Yu X Y, Wu X, et al. Propofol requirement for induction of unconsciousness is reduced in patients with Parkinsons disease: a case control study［J］. Biomed Res Int, 2015, 2015: 953729.
［10］Wang P, Zhao L, Wang T L, et al. Comparison of half-effective concentration of propofol in patients with Parkinsons disease and Non-Parkinson's disease［J］. Clin Interv Aging, 2023, 18: 307－315.
［11］Goettel N, Bharadwaj S, Venkatraghavan L, et al. Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial［J］. Br J Anaesth, 2016, 116(6): 811－821.
［12］Morris H R, Spillantini M G, Sue C M, et al. The pathogenesis of Parkinson's disease［J］. Lancet, 2024, 403(10423): 293－304.
［13］Di Michele F, Luchetti S, Bernardi G, et al. Neurosteroid and neurotransmitter alterations in Parkinson’s disease［J］. Front Neuroendocrinol, 2013, 34(2): 132－142.
［14］O'Gorman Tuura R L, Baumann C R, Baumann-Vogel H. Beyond dopamine: GABA, glutamate, and the axial symptoms of Parkinson disease［J］. Front Neurol, 2018, 9: 806.
［15］Calon F, Di Paolo T. Levodopa response motor complications——GABA receptors and preproenkephalin expression in human brain［J］. Parkinsonism Relat Disord, 2002, 8(6): 449－454.
［16］Philip A B, Brohan J, Goudra B. The role of GABA receptors in anesthesia and sedation: an updated review［J］. CNS Drugs, 2025, 39(1): 39－54.
［17］Chen Z W, Chintala S M, Bracamontes J, et al. Three classes of propofol binding sites on GABAA receptors［J］. J Biol Chem, 2024, 300(10): 107778.
［18］滕云娟. 丙泊酚中枢麻醉作用机制的研究进展［J］. 现代诊断与治疗, 2023, 34(1): 38－40.
［19］Mellone M, Zianni E, Stanic J, et al. NMDA receptor GluN2D subunit participates to levodopa-induced dyskinesia pathophysiology［J］. Neurobiol Dis, 2019, 121: 338－349.
［20］Kong M, Ba M W, Liu C Y, et al. NR2B antagonist CP-101,606 inhibits NR2B phosphorylation at tyrosine-1472 and its interactions with Fyn in levodopa-induced dyskinesia rat model［J］. Behav Brain Res, 2015, 282: 46－53.
［21］Kotani Y, Shimazawa M, Yoshimura S, et al. The experimental and clinical pharmacology of propofol, an anesthetic agent with neuroprotective properties［J］. CNS Neurosci Ther, 2008, 14(2): 95－106.
［22］Flores-Ponce X, Velasco I. Dopaminergic neuron metabolism: relevance for understanding Parkinson’s disease［J］. Metabolomics, 2024, 20(6): 116.
［23］朱秋宇, 付豹, 张宇, 等. 多巴胺能神经元参与全身麻醉苏醒的研究进展［J］. 国际麻醉学与复苏杂志, 2018, 39(7): 705－708.
［24］Solt K, Van Dort C J, Chemali J J, et al. Electrical stimulation of the ventral tegmental area induces reanimation from general anesthesia［J］. Anesthesiology, 2014, 121(2): 311－319.
［25］Lau K, Kotzur R, Richter F. Blood-brain barrier alterations and their impact on Parkinsons disease pathogenesis and therapy［J］. Transl Neurodegener, 2024, 13(1): 37.
［26］朱丽娟, 毛幸, 于泳浩. 复合丙泊酚－瑞芬太尼麻醉时不同剂量艾司氯胺酮对患者状态指数的影响［J］. 中华麻醉学杂志, 2023, 43(12): 1495－1498.
［27］Jones J H, Nittur V R, Fleming N, et al. Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trial［J］. BMC Anesthesiol, 2021, 21(1): 105.
［28］Bae M I, Bae J, Song Y, et al. Comparative analysis of the performance of electroencephalogram parameters for monitoring the depth of sedation during remimazolam Target-controlled infusion［J］. Anesth Analg, 2024, 138(6): 1295－1303.［29］Lee K H, Kim Y H, Sung Y J, et al. The patient state index is well balanced for propofol sedation［J］. Hippokratia, 2015, 19(3): 235－238.
［30］Struys M, Versichelen L, Byttebier G, et al. Clinical usefulness of the bispectral index for titrating propofol target effect-site concentration［J］. Anaesthesia, 1998, 53(1): 4－12.
［31］Sahinovic M M, Struys M M R F, Absalom A R. Clinical pharmacokinetics and pharmacodynamics of propofol［J］. Clin Pharmacokinet, 2018, 57(12): 1539－1558.

[1]	Wang Xinxin, Liang Yi, Chen Yiwei, Ma Bo, Liu Haiyang, Han Ruquan, Jian Minyu. Correlation between auditory event-related potential and sedation depth during propofol sedation [J]. Journal of Capital Medical University, 2025, 46(5): 805-811.
[2]	Fu Yuxuan, Zhou Yang, Cui Yidan, Wu Youxuan, Yu Yun, Han Ruquan. Effects of desflurane on the quality of the anesthesia emergence period in patients undergoing transnasal pituitary adenoma resection: a randomized controlled study [J]. Journal of Capital Medical University, 2025, 46(5): 812-819.