Perioperative Medicine  |   April 2018
Dopamine D2-receptor Antagonist Droperidol Deepens Sevoflurane Anesthesia
Author Notes
  • From the Kyoto Chubu Medical Center, Kyoto, Japan (R.A., K.H.); and Kyoto Prefectural University of Medicine, Kyoto, Japan (R.A., K.H., T.S.).
  • Submitted August 2, 2017. Accepted November 24, 2017.
    Submitted August 2, 2017. Accepted November 24, 2017.×
  • Presented at the 10th International Symposium on Memory and Awareness in Anesthesia (MAA10), June 19 to 21, 2017, Helsinki, Finland.
    Presented at the 10th International Symposium on Memory and Awareness in Anesthesia (MAA10), June 19 to 21, 2017, Helsinki, Finland.×
  • Address correspondence to Dr. Hayashi: Yagi Ueno 25, Nantan, Kyoto, 629-0141, Japan. zukko@koto.kpu-m.ac.jp. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Pharmacology
Perioperative Medicine   |   April 2018
Dopamine D2-receptor Antagonist Droperidol Deepens Sevoflurane Anesthesia
Anesthesiology 4 2018, Vol.128, 754-763. doi:10.1097/ALN.0000000000002046
Anesthesiology 4 2018, Vol.128, 754-763. doi:10.1097/ALN.0000000000002046
Abstract

Background: Although midbrain dopaminergic pathways are known to contribute to arousal and emergence from anesthesia, few reports exist regarding the anesthetic effects of dopamine D2 receptor antagonism in humans. This study examined the effect of the D2 receptor antagonist droperidol on sevoflurane anesthesia by examining α and slow wave electroencephalogram oscillations.

Methods: Forty-five patients, age 20 to 60 yr, were enrolled. Frontal electroencephalograms were continuously collected for offline analysis via Bispectral Index monitoring. After induction of anesthesia, end-tidal sevoflurane concentration was deliberately maintained at 1%, and intravenous droperidol (0.05 mg/kg bolus) was administered. Electroencephalogram changes were examined in power spectrum and bicoherence, before and 10 min after droperidol injection, then compared using the Wilcoxon signed-ranks test and/or paired t test.

Results: Droperidol significantly augmented the α-bicoherence peak induced by sevoflurane from 30.3% (24.2%, 42.4%) to 50.8% (41.7%, 55.2%) (median [25th, 75th percentiles]; P < 0.0001), Hodges-Lehman median difference, 15.8% (11.3 to 21.4%) (95% CI). The frequency of the α-bicoherence peak was simultaneously shifted to the lower frequency; from 11.5 (11.0, 13.0) to 10.5 (10.0, 11.0) Hz (median [25th, 75th percentiles], P < 0.0001). Averaged bicoherence in the δ-θ area increased conspicuously from 17.2% (15.6 to 18.7%) to 25.1% (23.0 to 27.3%) (mean [95% CI]; P < 0.0001), difference, 8.0% (6.0 to 9.9%).

Conclusions: Droperidol augments both α and δ-θ bicoherences while shifting the α-bicoherence peaks to lower frequencies, and enhances the effect of sevoflurane anesthesia on the electroencephalogram via γ-aminobutyric acid–mediated oscillatory network regulation.