Sensitivity to propofol in the elderly

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Abstract
Summary: Two studies were carried out on 609 fit, unpremedicated patients to assess the influence of patient age on the response to the rapidly‐acting hindered phenol, propofol, which is being evaluated for induction of anaesthesia. In the first study, 1.25 mg/kg was injected over 20 seconds followed by 10‐mg increments every 15 seconds until loss of verbal contact. This showed a great individual variation in response to the drug. A reduction in the ‘induction’ dose was found in elderly patients, which became marked around 60 years. In the second (340), doses ranging from 1.5–3.0 mg/kg in patients under 60 years and 1.25–2.25 mg/kg in those over 60 years were injected as a bolus over 20 seconds. Doses of 2.25–2.5 mg/kg were required to induce anaesthesia in patients under 60 years, whilst 1.5–1.75 mg/kg was adequate in those over 60 years. Side effects were more marked with the rapid injection and doses in excess of 1.75 mg/kg caused significant hypotension and apnoea in the elderly. These studies reveal marked sensitivity to propofol in the elderly with respect to both induction dose and acute toxicity.