Prediction of effect-site concentration of sufentanil by dose–response target controlled infusion of sufentanil and propofol for analgesic and sedation maintenance in burn dressing changes

Abstract

This study was to investigate the feasibility and efficiency of by target-controlled infusion (TCI) for analgesia and sedation during burn dressing change, and to predict the effect-site concentration of sufentanil. Eighty burn patients were randomly and evenly divided into four groups according to target sufentanil effect-site concentration (0.2, 0.3, 0.4 and 0.5ng/ml). The sufentanil–propofol TCI was carried out during dressing changes. The effect-site concentration of propofol was maintained at 1.2μg/ml. The dose–response relationships of sufentanil for providing adequate analgesia were evaluated by visual analog scales and Ramsay sedation scores. The effect-site concentration of sufentanil was calculated by Probit regression analysis. Incidence of respiratory depression, doctors and patients’ satisfaction and adverse events were assessed. The EC50 and EC95 of sufentanil to maintain anesthesia for uncovering the inner layer dressings during TCI were 0.278ng/ml (95% CI 0.231–0.318ng/ml) and 0.394ng/ml (95% CI 0.366–0.530ng/ml), respectively, while the EC50 and EC95 of sufentanil to maintain anesthesia for wound management were 0.349ng/ml (95% CI 0.299–0.366ng/ml) and 0.465ng/ml (95% CI 0.430–0.563ng/ml), respectively. Doctors and patients’ satisfaction were significantly higher in the 0.4 and 0.5ng/ml groups than the 0.2ng/ml group. One and three patients had respiratory depression in the 0.4 and 0.5ng/ml groups, respectively. No adverse events occurred after operations. In conclusion, low dose sufentanil–propofol TCI for anesthesia and sedation maintenance in burn dressing changes is feasible and effective, and wound management requires higher effect-site concentrations of sufentanil than disclosing inner layer dressings.