Effect of 1% and 2% propofol on blood lipids during long-term sedation
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Objectives. To compare the effects of 1% and 2% propofol on the maximum and average lipid levels, the relative frequency of hyperlipidaemia, the propofol dose required to achieve an equivalent degree of sedation, the pharmacodynamie effects at the required infusion rates, and the effect on respiratory function. Design. Open, randomised, parallel group, multicentre comparison study. Setting. Intensive care units (ICUs) at the Faculty of Medicine, University of Stellenbosch and at Vergelen Medicity, Somerset West. Subjects. Patients who were artificially ventilated for at least 72 hours in the ICUs and who required sedation or analgesia. Outcome measures. Continuous intravenous infusion of 1% or 2% propofol to provide an administration rate in the range of 1 - 4 mg/kg/h. The initial infusion rate was about 2 mg/kg/h, adjusted to achieve the appropriate level of sedation. Results and conclusions. Seventy-five patients were enrolled in the study, of which 72 were evaluable for safety analysis and 58 were evaluable for efficacy analysis. The total daily dose of propofol (ml/day) in the 2% propofol group was about 60% of that in the 1% propofol group, indicating that the lipid load in the 2% propofol group had only slightly more than half the lipid load in the 1% propofol group. Thirteen of 27 patients (48%) int 2% propofol group had abnormally high triglyceride levels compared with 19 of 31 patients (61%) in the 1% propofol group. Similarly, 1 of 22 patients (4%) in the 2% propofol group had lipaemia compared with 4 of 30 patients (13%) in the 1% propofol group. Abnormal cholesterollevels, alveolar-arterial oxygen tension gradient and daily percentage of time with desired sedation were comparable between the two groups. The observed incidence of raised plasma triglyceride concentrations, and of lipaemia, was lower in the 2% propofol group than in the 1% propofol group, although the differences were not statistically significant. The 2% formulation of propofol appears to be as effective and at least as safe as 1% propofol.
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