Guiding Drug Titration through Procedural Sedation

Hane Lee, George Verghese

Procedural sedation uses drugs such as propofol to relieve pain and anxiety associated with medical procedures performed outside the operating room. There is currently no objective measure of sedation level to guide the titration of medications, leading to the risk of under- or over-sedation. This research uses pharmacokinetic models to estimate the time course of the sedation agent in the body, in order to provide more objective markers of sedation. A database containing detailed information from procedural sedations carried out at two collaborating hospitals permits evaluation of this approach. The results of this work may be used to inform the development of a tool to guide the physician in real-time, displaying the estimated sedation state and recommendations regarding how much additional sedation agent to administer and when, based on the anticipated remaining duration of the procedure.

Figure 1. A three-compartment PK model, commonly used for propofol.

Equation 1. State-space system of equations for the three-compartment PK model in Figure 1. 

Figure 2: Time-course plot of plasma concentration.

Figure 3. Individual and average estimated titration thresholds.

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