1
|
Manivannan A, Madani S, Woodall M, McKelvey G, Kemper S. Propofol Sedation in Pediatric Upper Endoscopy: A Study of Pharmacodynamics and the Effects of Gastroenterologists, Anesthesiologists, and Supervised Participants on the Procedure Time and Sedation Time. Cureus 2024; 16:e54841. [PMID: 38533143 PMCID: PMC10964119 DOI: 10.7759/cureus.54841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/28/2024] Open
Abstract
Background and aims Propofol combined with fentanyl is a commonly used sedative for pediatric upper endoscopies (UEs). The primary aim was to study the association between propofol dose and procedure and sedation time. The secondary aims were to assess the pharmacodynamics of propofol use with fentanyl and evaluate if gastroenterologists' and anesthesiologists' years of experience or the presence of supervised participants (such as students, residents, and fellows) have any influence on the procedure and sedation time. Methods A retrospective study was performed at the Children's Hospital of Michigan on patients under 18 years who underwent UEs with propofol sedation with fentanyl over a two-year period. Results A correlation was found between the propofol amount used expressed per body mass index (BMI)/body surface area (BSA), procedure time, and sedation time (p < 0.0001). Throat pain was the most common post-procedural adverse event (4.48%). The impact of psychoactive drugs on these events was not statistically significant, but attention-deficit/hyperactivity disorder (ADHD) medication use was related to increased post-procedural pain complaints. The use of prescribed psychoactive medications was associated with larger propofol dose usage (p = 0.007) without a significant increase in sedation time. Individual gastroenterologists, their years of experience, and the presence of supervised participants were associated with different procedure times (p <0.0001, <0.0001, 0.01). Fellow participation was associated with a 1.11-minute procedure time increase (p = 0.04). Individual anesthesiologists, their years of experience, and the presence of supervised participants were associated with different sedation times (p <0.0001, <0.0001, 0.01). Conclusion We found a novel correlation between propofol dosing expressed by the BMI/BSA and sedation time. The UE procedure time and sedation time are associated with individual gastroenterologists and anesthesiologists, their years of experience, and the presence of supervised participants.
Collapse
Affiliation(s)
| | - Shailender Madani
- Pediatric Gastroenterology, Children's Hospital of Michigan, Troy, USA
| | - Michael Woodall
- Pediatrics, NorthShore/Endeavor Health Medical Group, Evanston, USA
| | | | - Sharon Kemper
- Pediatric Anesthesiology, Children's Hospital of Michigan, Detroit, USA
| |
Collapse
|
2
|
Le Roux C, Destère A, Hervy S, Lloret-Linares C, Reignier J, Caillet P, Jolliet P, Mégarbane B, Boels D. Potential drug-drug interactions when managing status epilepticus patients in intensive care: A cohort study. Br J Clin Pharmacol 2021; 88:2408-2418. [PMID: 34907586 DOI: 10.1111/bcp.15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS The risk for drug-drug interactions (DDIs) associated with antiseizure drugs (ASDs) used to manage status epilepticus (SE) patients in the intensive care unit (ICU) has been poorly investigated. We aimed to quantify and describe those potential DDIs and determine SE patient risk profiles. METHODS We conducted an observational bi-centric cohort study including all SE patients admitted to the ICU in the period 2016-2020. RESULTS Overall, 431 SE patients were included and 5504 potential DDIs were identified including 1772 DDIs (33%) between ASDs, 2610 DDIs (47%) between ASDs and previous usual treatments (PUTs), and 1067 DDIs (20%) between ASDs and ICU treatments (ICUTs). DDIs were moderate (n = 4871), major (n = 562) or severe (n = 16). All patients exhibited potential DDIs, which were major-to-severe DDIs in 47% of the cases. DDIs were pharmacokinetic (n = 1972, 36%), mostly involving cytochrome P450 modulators, and pharmacodynamic (n = 3477, 64%), mainly leading to increased sedation. ASD/PUT DDIs were the most frequent and severe. Age, PUT and ASD drug numbers and length of ICU stay were significantly associated with increased DDI number. We identified four SE patient profiles with different DDI risks and outcomes including (1) epileptic or brain trauma patients, (2) withdrawal syndrome patients, (3) older patients with comorbidities and (4) self-poisoned patients with psychiatric disorders and/or past epilepsy. CONCLUSION SE patients are subject to potential DDIs between ASDs, ASD/PUT and ASD/ICUT. Major-to-severe DDIs mostly occur between ASDs and PUTs. Physicians should pay attention to SE patient characteristics and history to limit DDI numbers and prevent their consequences.
Collapse
Affiliation(s)
- Clémentine Le Roux
- Inserm UMRS 1144, University of Paris, France.,Clinical Toxicology Unit, Pharmacology Department, Nantes University Hospital, Nantes, France
| | | | - Sarah Hervy
- SPIN Unit, Public Health Department, Nantes University Hospital, Nantes, France
| | - Célia Lloret-Linares
- Inserm UMRS 1144, University of Paris, France.,Department of Nutritional and Metabolic Diseases, Ramsay Générale de Santé, Pays de Savoie Private Hospital, Annemasse, France
| | - Jean Reignier
- Department of Medical Critical Care, Nantes University Hospital, Nantes, France
| | - Pascal Caillet
- SPIN Unit, Public Health Department, Nantes University Hospital, Nantes, France
| | - Pascale Jolliet
- Clinical Toxicology Unit, Pharmacology Department, Nantes University Hospital, Nantes, France
| | - Bruno Mégarbane
- Inserm UMRS 1144, University of Paris, France.,Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris, France
| | - David Boels
- Inserm UMRS 1144, University of Paris, France.,Clinical Toxicology Unit, Pharmacology Department, Nantes University Hospital, Nantes, France.,SPIN Unit, Public Health Department, Nantes University Hospital, Nantes, France
| |
Collapse
|
3
|
Harbell MW, Dumitrascu C, Bettini L, Yu S, Thiele CM, Koyyalamudi V. Anesthetic Considerations for Patients on Psychotropic Drug Therapies. Neurol Int 2021; 13:640-658. [PMID: 34940748 PMCID: PMC8708655 DOI: 10.3390/neurolint13040062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/08/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Psychotropic drugs are used in the treatment of psychiatric and non-psychiatric conditions. Many patients who are on psychotropic medications may present for procedures requiring anesthesia. Psychotropic medications can have dangerous interactions with drugs commonly used in anesthesia, some of which can be life-threatening. In this review, we describe the current anesthetic considerations for patients on psychotropic drug therapies, including antidepressants, antipsychotics, mood stabilizers, anxiolytics, and stimulants. The pharmacology, side effects, and potential drug interactions of the commonly prescribed psychotropic drug therapies with anesthetic agents are described. Further, we highlight the current recommendations regarding the cessation and continuation of these medications during the perioperative period.
Collapse
Affiliation(s)
- Monica W. Harbell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; (C.D.); (L.B.); (S.Y.); (V.K.)
- Correspondence:
| | - Catalina Dumitrascu
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; (C.D.); (L.B.); (S.Y.); (V.K.)
| | - Layne Bettini
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; (C.D.); (L.B.); (S.Y.); (V.K.)
| | - Soojie Yu
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; (C.D.); (L.B.); (S.Y.); (V.K.)
| | | | - Veerandra Koyyalamudi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; (C.D.); (L.B.); (S.Y.); (V.K.)
| |
Collapse
|
4
|
Wong BJ, Agarwal R, Chen MI. Anesthesia for the Pediatric Patient With Epilepsy and Minimally Invasive Surgery for Epilepsy. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
5
|
Calcium channel blockers, angiotensin II receptor antagonists and alpha-blockers accentuate blood pressure reducing caused by dental local anesthesia. Clin Oral Investig 2021; 25:4879-4886. [PMID: 33506427 DOI: 10.1007/s00784-021-03795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The primary aim of this study was to investigate the effect associated with patients' factor such as systemic disease on the blood pressure of patients in dental procedure. The secondary aim of this study was to investigate the effect associated with systemic disease and antihypertensive on the blood pressure changes with local anesthesia. METHODS The blood pressure was measured before and after local anesthesia injection for dental treatment. The effect associated with patients' factor such as systemic disease on the blood pressure and the effect on blood pressure changes of the type of antihypertensive drugs and the systemic disease were analyzed using a multivariate analysis of variance test. RESULTS We analyzed 1306 patients scheduled for the dental procedure. Age and some systemic diseases such as hypertension and angina pectoris affected blood pressure before local anesthesia. On the other hand, age and systemic diseases did not affect blood pressure changes. And, some antihypertensive affected systolic blood pressure changes. CONCLUSIONS The blood pressure change with local anesthesia was not associated with systemic diseases and age but was associated with antihypertensive agents. In particular, calcium channel blockers, angiotensin II receptor antagonists and alpha-blockers accentuate blood pressure reducing caused by local anesthesia. CLINICAL RELEVANCE The blood pressure change with local anesthesia was associated with antihypertensive agents. This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (number UMIN000030695).
Collapse
|
6
|
Mariappan R, Raju K. Response to the comments raised by the readers to our published article “An observational case-control study comparing the recovery profile in patients receiving additional dose of anticonvulsant vs. regular dose during supratentorial craniotomy.”. Indian J Anaesth 2020; 64:546-547. [PMID: 32792731 PMCID: PMC7398027 DOI: 10.4103/ija.ija_442_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022] Open
|