The impact of insomnia on propofol and remifentanil requirements during total intravenous anesthesia

Insomnia, characterized by difficulty initiating or maintaining sleep, is associated with altered gamma-aminobutyric acid (GABA) neurotransmission and a hyperarousal state.General anesthetics, such as propofol, act on GABA receptors.Previous studies suggest that insomnia may increase anesthetic requirements, particularly for volatile agents.This retrospective study included 228 patients from the same surgical cohort: 114 with insomnia and 114 in a control group.Controls were selected in a 1:1 ratio using a predefined covariate-based approach based on age, sex, body mass index, American Society of Anesthesiologists physical status, and type of surgery to improve comparability.All patients underwent surgery under total intravenous anesthesia with propofol and remifentanil.Baseline characteristics and anesthesia time were comparable between groups.Propofol requirements were 0.10±0.02mg/kg/min in the insomnia group and 0.10±0.03mg/kg/min in controls, whereas remifentanil requirements were 0.13±0.04μg/ kg/min in both groups.Postoperative fentanyl consumption in the post-anesthesia care unit was also similar (1.96±0.79 vs. 1.85±0.69μg/kg).No significant differences were observed in anesthetic or opioid requirements.These findings suggest that insomnia does not significantly affect propofol or remifentanil doses required to maintain bispectral index-guided anesthetic depth or postoperative opioid consumption.Other ion channels could be modulating anesthetic responses among patients with insomnia.