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Paramsothy J, Gutlapalli SD, Ganipineni VDP, Mulango I, Okorie IJ, Arrey Agbor DB, Delp C, Apple H, Kheyson B, Nfonoyim J, Isber N, Yalamanchili M. Propofol in ICU Settings: Understanding and Managing Anti-Arrhythmic, Pro-Arrhythmic Effects, and Propofol Infusion Syndrome. Cureus 2023; 15:e40456. [PMID: 37456460 PMCID: PMC10349530 DOI: 10.7759/cureus.40456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Propofol has revolutionized anesthesia and intensive care medicine owing to its favorable pharmacokinetic characteristics, fast onset, and short duration of action. This drug has been shown to be remarkably effective in numerous clinical scenarios. In addition, propofol has maintained an overwhelmingly favorable safety profile; however, it has been associated with both antiarrhythmic and proarrhythmic effects. This review concisely summarizes the dual arrhythmic cardiovascular effects of propofol and a rare but serious complication, propofol infusion syndrome (PRIS). We also discuss the need for careful patient evaluation, compliance with recommended infusion rates, and vigilant monitoring.
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Affiliation(s)
- Jananthan Paramsothy
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Sai Dheeraj Gutlapalli
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
- Internal Medicine Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vijay Durga Pradeep Ganipineni
- Internal Medicine, Thomas Hospital Infirmary Health, Fairhope, USA
- General Medicine, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Center, Chennai, IND
- General Medicine, Andhra Medical College/King George Hospital, Visakhapatnam, IND
| | - Isabelle Mulango
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Ikpechukwu J Okorie
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Divine Besong Arrey Agbor
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Crystal Delp
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Hanim Apple
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Borislav Kheyson
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Jay Nfonoyim
- Pulmonary and Critical Care, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Nidal Isber
- Electrophysiology, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Mallikarjuna Yalamanchili
- Anesthesiology, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
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Trolese L, Dall'Aglio PB, Steinfurt J, Gressler A, Faber T, Cipriani A, Migliore F, Westermann D, Hilgendorf I, Jäckel M. Propofol dose and efficacy of defibrillation testing during implantation of subcutaneous implantable cardioverter-defibrillators: A retrospective, single center cohort study. J Cardiovasc Electrophysiol 2023; 34:420-428. [PMID: 36444777 DOI: 10.1111/jce.15762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Defibrillation testing (DFT) is recommended during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. Previous studies analyzing the potential interference of propofol with defibrillation threshold are inconsistent. The purpose of this study was to analyze whether propofol affects DFT post S-ICD placement. METHODS All patients with S-ICD implantation between 01/2017 and 11/2020 at the University Heart Center Freiburg were retrospectively analyzed. Two groups were generated depending on the success of the first shock during DFT. Implantation characteristics and dose of anesthetics were analyzed. RESULTS In 12 of the included 80 (15%) patients, first shock during DFT failed. The absolute dose of propofol was significantly higher in patients with first shock failure (median 653 mg [IQR 503-855]) compared to patients with first shock termination (376 mg [200-600]; p = 0.027). Doses of opioids and midazolam as well as type of anesthesia did not differ between the groups. A multivariable binary logistic regression analysis confirmed an independent association of first shock termination and propofol dose (per 100 mg: OR 0.73 (95% CI: 0.56-0.95); p = 0.021). CONCLUSION There is an independent association of propofol dose and first shock failure in routine S-ICD defibrillation testing.
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Affiliation(s)
- Luca Trolese
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany.,Department of Rhythmology, Ortenau Klinikum Offenburg-Lahr, Lahr, Germany
| | - Pietro Bernardo Dall'Aglio
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany.,Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Johannes Steinfurt
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Alexander Gressler
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Thomas Faber
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Dirk Westermann
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Ingo Hilgendorf
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Markus Jäckel
- Department of Cardiology and Angiology, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
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Shannon K, Saltzman D, Li I, Mokszycki R, Galletta G. Ventricular tachycardia converts to sinus rhythm after administration of propofol. Am J Emerg Med 2021; 48:377.e1-377.e3. [PMID: 33875319 DOI: 10.1016/j.ajem.2021.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/06/2021] [Accepted: 04/10/2021] [Indexed: 11/26/2022] Open
Abstract
Ventricular tachycardia (VT) is a major contributor to sudden cardiac death, and pharmacologic treatment options beyond antiarrhythmics are limited. Emerging data suggest sympathetic blocking agents such as propofol are a potential management option for VT refractory to first line antiarrhythmics. Previous literature has described fixed-dose propofol boluses and continuous infusions to convert ventricular arrhythmias; however, to our knowledge, there are no reports of a weight-based dosing strategy for VT. We present the case of a patient with amiodarone-refractory VT who received a 1 mg/kg propofol bolus in preparation for cardioversion and subsequently converted to normal sinus rhythm. The patient stabilized following these interventions, transferred to a tertiary care facility, and was discharged home with an implantable cardioverter defibrillator.
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Affiliation(s)
- Krysta Shannon
- UMass Memorial Medical Center, Department of Pharmacy, 55 Lake Avenue North, Worcester, MA, United States.
| | - Daniel Saltzman
- UMass Memorial Medical Center, Department of Emergency Medicine, 55 Lake Avenue North, Worcester, MA, United States.
| | - Irene Li
- UMass Memorial Medical Center, Department of Pharmacy, 55 Lake Avenue North, Worcester, MA, United States.
| | - Robert Mokszycki
- UMass Memorial Medical Center, Department of Pharmacy, 55 Lake Avenue North, Worcester, MA, United States.
| | - Gayle Galletta
- UMass Memorial Medical Center, Department of Emergency Medicine, 55 Lake Avenue North, Worcester, MA, United States.
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Al Ali MS, Musa A, Hamadeh W, Seddik E. Etomidate Shows Prospect as an Anti-Arrhythmic Drug Conferring Safe Sedation and Sinus Conversion Simultaneously. DUBAI MEDICAL JOURNAL 2020. [DOI: 10.1159/000510598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This case is of a 76-year-old man with a known history of hypertension, type 2 diabetes mellitus, and ischemic heart disease, who presented to our department with chest pain and palpitations. His electrocardiogram showed a ventricular tachycardia (VT), but fortunately our patient was hemodynamically stable. A trial of adenosine was given to convert the patient’s heart back to sinus rhythm, but was unsuccessful and the rhythm remained as VT. Soon after, the patient suddenly became hemodynamically unstable as his blood pressure acutely declined; thus, the decision to perform a direct current cardioversion was taken. Bearing in mind that the patient was still awake, he was given 10 mg of intravenous etomidate as a pre-procedural sedative. During the time it took to prepare for the procedure, the patient’s rhythm reverted from VT to a regular sinus rhythm, raising his blood pressure back to normal and achieving hemodynamic stablility, negating the need of any electrical or chemical cardioversion. Our patient was then handed over to the cardiology team for an emergency percutaneous coronary intervention procedure and an implantable cardioverter-defibrillator procedure, both of which were successful. Etomidate was used in this case for the purpose of sedation, and as luck would have it, it seems that it had also incidentally reverted the arrhythmia back to normal.
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Bundgaard JS, Jacobsen PK, Grand J, Lindholm MG, Hassager C, Pehrson S, Kjaergaard J, Bundgaard H. Deep sedation as temporary bridge to definitive treatment of ventricular arrhythmia storm. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:657-664. [DOI: 10.1177/2048872620903453] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background:
Electrical storm and incessant ventricular tachycardia (VT) are characterized by the clustering of episodes of VT or ventricular fibrillation (VF) and are associated with a poor prognosis. Autonomic nervous system activity influences VT threshold, and deep sedation may be useful for the treatment of VT emergencies.
Methods:
We reviewed data from conscious patients admitted to our intensive care unit (ICU) due to monomorphic VT, polymorphic VT or VF at our tertiary center between 2010 and 2018.
Results:
A total of 46 conscious patients with recurrent ventricular arrhythmia, refractory to initial treatment, were referred to the ICU. The majority (n = 31) were stabilized on usual care. The remaining treatment-refractory 15 patients (57 years (range 9–74), 80% males, seven with implantable cardioverter-defibrillators) with VT/VF storm (n = 11) or incessant VT (n = 4) due to ischemic heart disease (n = 10), cardiomyopathy (n = 2), primary arrhythmia (n = 2) and one patient post valve surgery, were deeply sedated and intubated. A complete resolution of VT/VF within minutes to hours was achieved in 12 patients (80%), partial resolution in two (13%) and one (7%) patient died due to ventricular free-wall rupture. One patient with recurrent VT episodes needing repeated deep sedation developed necrotic caecum. No other major complications were seen. Thirteen (87%) patients were alive after a mean follow-up of 3.7 years.
Conclusion:
Deep sedation was effective and safe for the temporary management of malignant VT/VF refractory to usual treatment. In emergencies, deep sedation may be widely accessible at both secondary and tertiary centers and a clinically useful bridge to definitive treatment of VT.
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Li KHC, Sang T, Chan C, Gong M, Liu Y, Jesuthasan A, Li G, Liu T, Lam MHS, Wu WK, Chan MTV, Liu FZ, Chen C, Ho J, Xia Y, Tse G. Anaesthesia use in catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies. HEART ASIA 2019; 11:e011155. [PMID: 31565074 DOI: 10.1136/heartasia-2018-011155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 12/20/2022]
Abstract
Objectives This meta-analysis and systematic review seeks to compare both characteristic parameters and procedural outcomes of atrial fibrillation (AF) catheter ablation in patients under general anaesthesia (GA)/deep sedation and mild/moderate sedation. Background Catheter ablation has become a widely applied intervention for treating symptomatic AF and arrhythmias that are refractory to medical therapy. It can be conducted through from mild sedation to GA. Methods PubMed and Embase were searched up to July 2018 for randomised controlled trials, cohort and observational studies that assessed the outcomes of catheter ablation under GA/deep sedation or mild/moderate sedation. Nine studies were included in this meta-analysis after screening with the inclusion and exclusion criteria. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger's regression, respectively. Results Our meta-analysis found catheter AF ablation with GA/deep sedation to be associated with reduced risk of recurrence (RR: 0.79, 95% CI 0.56 to 1.13, p=0.20) and complications (RR: 0.95, 95% CI 0.64 to 1.42, p=0.82), though statistically insignificant. In terms of procedural parameters, there was no significant difference between the two groups for both procedural time (SMD: -0.13, 95% CI -0.90 to 0.63, p=0.74) and fluoroscopy time (SMD: -0.41, 95% CI -1.40 to 0.58, p=0.41). Univariate meta-regression did not reveal any covariates as a moderating factor for complication and recurrence risk. Conclusion Apart from an increased likelihood of procedural success, ablation by GA/deep sedation was found to be non-significantly different from the mild/moderate sedation approach in both procedural parameters and outcome measures.
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Affiliation(s)
| | - Tian Sang
- Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Cheng Chan
- Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Mengqi Gong
- Atrial fibriallation cente, Tianjin Institute of Cardiology, Tianijin, China
| | - Yingzhi Liu
- Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Aaron Jesuthasan
- Cardiovascular research center, Newcastle University, Newcastle, UK
| | - Guangping Li
- Atrial fibriallation cente, Tianjin Institute of Cardiology, Tianijin, China
| | - Tong Liu
- Atrial fibriallation cente, Tianjin Institute of Cardiology, Tianijin, China
| | - Michael H S Lam
- Department of Cardiology, Sheffield Hallam University, Sheffield, UK
| | | | - Matthew T V Chan
- Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Fang-Zhou Liu
- Atrial fibriallation cente, Tianjin Institute of Cardiology, Tianijin, China
| | - Cheng Chen
- Department of Cardiology, Dalian University, Dalian, China
| | - Jeffery Ho
- Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Yunlong Xia
- First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gary Tse
- Chinese University of Hong Kong, Shatin, Hong Kong
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Schenone AL, Chen K, Andress K, Militello M, Cho L. Editor’s Choice- Sedation in the coronary intensive care unit: An adapted algorithm for critically ill cardiovascular patient. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:167-175. [DOI: 10.1177/2048872617753797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the current era, cardiovascular intensive care units care for more complex patients who are far sicker than historical post-myocardial infarction patients, and sedation has become a common intervention in these units. Current sedation best practices derive mainly from non-cardiac units which limits their generalization to the critically ill cardiac patient. Thus, a great variability in sedation protocols, especially the selection of sedative agents, is commonly seen in daily practice across cardiac units. We present an updated review on sedation in cardiovascular critical care medicine with emphasis on the hemodynamic impact. The goal of this review is to generate a general sedation algorithm specific for the cardiac patient.
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Affiliation(s)
- AL Schenone
- Department of Cardiovascular Medicine, Cleveland Clinic, USA
| | - K Chen
- Internal Medicine Department, Cleveland Clinic, USA
| | - K Andress
- Internal Medicine Department, Cleveland Clinic, USA
| | | | - L Cho
- Department of Cardiovascular Medicine, Cleveland Clinic, USA
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Abstract
INTRODUCTION Procedural sedation is of paramount importance for a plethora of electrophysiological procedures. From electrical cardioversion to electrophysiology studies, device implantations, and catheter ablations, intraprocedural sedation and anesthesia have a pivotal role in allowing procedural success while ensuring patient safety and avoiding discomfort. Areas covered: The present review will discuss the current state-of-the-art in sedation and anesthesia during electrical cardioversion, cardiac implantable electronic device implantation, catheter ablation and electrophysiology studies. Specific information will be provided for each procedure in order to reach the core of this important clinical issue, and specific protocols will be compared. The main pro-arrhythmic and anti-arrhythmic effects of the most commonly used sedatives will also be discussed. Expert commentary: According to much recent evidence, the cardiologist can be the only person responsible for sedation administration in many settings, highlighting few safety issues associated with the absence of a dedicated anesthesiologist thus a concomitant reduction in costs. However, many concerns have been raised in allowing non-anesthesiologists to manage sedatives, as adverse events, while rare, could have catastrophic consequences. The present paper will highlight when a cardiologist-directed sedation is considered safe, how it should be performed, and the pros and cons related to this strategy.
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Affiliation(s)
- Federico Guerra
- a Cardiology and Arrhythmology Clinic , Marche Polytechnic University, University Hospital "Ospedali Riuniti" , Ancona , Italy
| | | | - Alessandro Capucci
- a Cardiology and Arrhythmology Clinic , Marche Polytechnic University, University Hospital "Ospedali Riuniti" , Ancona , Italy
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Abstract
The electrophysiology suite is a foreign location to many anesthesiologists. The initial experience was with shorter procedures under conscious sedation, and the value of greater tailoring of the sedation/anesthesia by anesthesiologists was not perceived until practice patterns had already been established. Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen. We review a range of electrophysiology procedures and discuss anesthetic approaches that balance patient safety and favorable outcomes.
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Affiliation(s)
- Jeff E Mandel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - William G Stevenson
- Electrophysiology Section, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - David S Frankel
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Narui R, Matsuo S, Isogai R, Tokutake K, Yokoyama K, Kato M, Ito K, Tanigawa SI, Yamashita S, Tokuda M, Inada K, Shibayama K, Miyanaga S, Sugimoto K, Yoshimura M, Yamane T. Impact of deep sedation on the electrophysiological behavior of pulmonary vein and non-PV firing during catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2017; 49:51-57. [PMID: 28285382 DOI: 10.1007/s10840-017-0238-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 02/23/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Catheter ablation for atrial fibrillation is performed with and without deep sedation, which could affect the arrhythmogenic activity during the procedure. We investigated the impact of sedation on electrophysiological properties in patients with AF who underwent catheter ablation. METHODS This study consisted of 255 consecutive patients with atrial fibrillation (229 males, persistent: 105 patients) who underwent a single-catheter ablation procedure. The patients were divided into the following two groups according to the depth of sedation during the procedure: group M (mild sedation with flunitrazepam in 138 patients) and group D (deep sedation with propofol in 117 patients). Peripheral oxygen saturation was continuously monitored via pulse oximetry throughout the procedure. RESULTS A spontaneous dissociated pulmonary vein activity after pulmonary vein isolation occurred more frequently in group M than in group D (29.1 vs 15.7%, P < 0.01). Adenosine-induced dormant pulmonary vein conduction was more frequently observed in group M than in group D (19.2 vs 13.0% P = 0.01). There were no significant differences in the incidence of non-pulmonary vein triggers between groups M and D (15.2 vs 11.1%, P = 0.53). The atrial fibrillation recurrence rate following the single procedure did not differ between the two groups (29.0 vs 26.5%, in groups M and D, P = 0.85). CONCLUSIONS Although deep sedation reduced the incidence of a dissociated pulmonary vein activity and dormant pulmonary vein conduction following pulmonary vein isolation, it did not affect the recurrence rate for atrial fibrillation after the procedure.
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Affiliation(s)
- Ryohsuke Narui
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Seiichiro Matsuo
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Ryota Isogai
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Yokoyama
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Mika Kato
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keiichi Ito
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shin-Ichi Tanigawa
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Michifumi Tokuda
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keiichi Inada
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenri Shibayama
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Satoru Miyanaga
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Sugimoto
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Michihiro Yoshimura
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Montero-Tinnirello J, Magaldi M, Fontanals J, Masgoret P, Bravo JC. Sinusal reversion of supraventricular tachyarrhythmias after propofol administration. A case series. Med Intensiva 2016; 41:499-501. [PMID: 28027785 DOI: 10.1016/j.medin.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 11/19/2022]
Affiliation(s)
- J Montero-Tinnirello
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic, Barcelona, España.
| | - M Magaldi
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic, Barcelona, España
| | - J Fontanals
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic, Barcelona, España
| | - P Masgoret
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic, Barcelona, España
| | - J C Bravo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic, Barcelona, España
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Inhibition of the cardiac Na⁺ channel α-subunit Nav1.5 by propofol and dexmedetomidine. Naunyn Schmiedebergs Arch Pharmacol 2015; 389:315-25. [PMID: 26667357 DOI: 10.1007/s00210-015-1195-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/26/2015] [Indexed: 12/19/2022]
Abstract
Propofol and dexmedetomidine are very commonly used sedative agents. However, several case reports demonstrated cardiovascular adverse effects of these two sedatives. Both substances were previously demonstrated to quite potently inhibit neuronal voltage-gated Na(+) channels. Thus, a possible molecular mechanism for some of their cardiac side effects is an inhibition of cardiac voltage gated Na(+) channels. In this study, we therefore explored the effects of propofol and dexmedetomidine on the cardiac predominant Na(+) channel α-subunit Nav1.5. Effects of propofol and dexmedetomidine were investigated on constructs of the human α-subunit Nav1.5 stably expressed in HEK-293 cells by means of whole-cell patch clamp recordings. Both agents induced a concentration-dependent tonic inhibition of Nav1.5. The calculated IC50 value for propofol was 228 ± 10 μM, and for dexmedetomidine 170 ± 20 μM. Tonic block only marginally increased on inactivated channels, and a weak use-dependent block at 10 Hz was observed for dexmedetomidine (16 ± 2 % by 100 μM). The voltage dependencies of fast and slow inactivation as well as the time course of recovery from inactivation were shifted by both propofol and dexmedetomidine. Propofol (IC50 126 ± 47 μM) and dexmedetomidine (IC50 182 ± 27 μM) blocked the persistent sodium current induced by veratradine. Finally, the local-anesthetic (LA)-insensitive mutant Nav1.5-F1760A exhibited reduced tonic and use-dependent block by both substances. Dexmedetomidine was generally more potent as compared to propofol. Propofol and dexmedetomidine seem to interact with the LA-binding site to inhibit the cardiac Na(+) channel Nav1.5 in a state-dependent manner. These data suggest that Nav1.5 is a hitherto unrecognized molecular component of some cardiovascular side effects of these sedative agents.
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13
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Abstract
Abstract
Background:
Propofol is widely used clinically for the induction and maintenance of anesthesia. Clinical case reports have shown that propofol has an antiatrial tachycardia/fibrillation effect; however, the related ionic mechanisms are not fully understood. The current study investigates the effects of propofol on human cardiac potassium channels.
Methods:
The whole cell patch voltage clamp technique was used to record transient outward potassium current (Ito) and ultrarapidly activating delayed rectifier potassium current (IKur) in human atrial myocytes and hKv1.5, human ether-à-go-go-related gene (hERG), and hKCNQ1/hKCNE1 channels stably expressed in HEK 293 cells. Current clamp mode was used to record action potentials in human atrial myocytes.
Results:
In human atrial myocytes, propofol inhibited Ito in a concentration-dependent manner (IC50 = 33.5 ± 2.0 μM for peak current, n = 6) by blocking open channels without affecting the voltage-dependent kinetics or the recovery time constant; propofol decreased IKur (IC50 = 35.3 ± 1.9 μM, n = 6) in human atrial myocytes and inhibited hKv1.5 current expressed in HEK 293 cells by preferentially binding to the open channels. Action potential duration at 90% repolarization was slightly prolonged by 30 μM propofol in human atrial myocytes. In addition, propofol also suppressed hERG and hKCNQ1/hKCNE1 channels expressed in HEK 293 cells.
Conclusion:
Propofol inhibits multiple human cardiac potassium channels, including human atrial Ito and IKur, as well as hKv1.5, hERG, and hKCNQ1/hKCNE1 channels stably expressed in HEK 293 cells, and slightly prolongs human atrial action potential duration, which may contribute to the antiatrial tachycardia/fibrillation effects observed in patients who receive propofol.
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MOUNTANTONAKIS STAVROSE, ELKASSABANY NABIL, KONDAPALLI LAVANYA, MARCHLINSKI FRANCISE, MANDEL JEFFE, HUTCHINSON MATHEWD. Provocation of Atrial Fibrillation Triggers During Ablation: Does the Use of General Anesthesia Affect Inducibility? J Cardiovasc Electrophysiol 2014; 26:16-20. [DOI: 10.1111/jce.12512] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/28/2014] [Accepted: 07/31/2014] [Indexed: 12/18/2022]
Affiliation(s)
| | - NABIL ELKASSABANY
- Department of Anesthesiology and Critical Care; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - LAVANYA KONDAPALLI
- Cardiovascular Division; Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - FRANCIS E. MARCHLINSKI
- Cardiovascular Division; Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - JEFF E. MANDEL
- Department of Anesthesiology and Critical Care; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - MATHEW D. HUTCHINSON
- Cardiovascular Division; Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
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Wutzler A, Huemer M, Boldt LH, Parwani AS, Attanasio P, Tscholl V, Haverkamp W. Effects of deep sedation on cardiac electrophysiology in patients undergoing radiofrequency ablation of supraventricular tachycardia: impact of propofol and ketamine. ACTA ACUST UNITED AC 2013; 15:1019-24. [DOI: 10.1093/europace/eut025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Cong M, Hu CM, Cao YF, Fang ZZ, Tang SH, Wang JR, Luo JS. Cryptotanshinone and dihydrotanshinone I exhibit strong inhibition towards human liver microsome (HLM)-catalyzed propofol glucuronidation. Fitoterapia 2013; 85:109-13. [PMID: 23333907 DOI: 10.1016/j.fitote.2013.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 12/31/2012] [Accepted: 01/06/2013] [Indexed: 10/27/2022]
Abstract
Danshen is one of the most famous herbs in the world, and more and more danshen-prescribed drugs interactions have been reported in recent years. Evaluation of inhibition potential of danshen's major ingredients towards UDP-glucuronosyltransferases (UGTs) will be helpful for understanding detailed mechanisms for danshen-drugs interaction. Therefore, the aim of the present study is to investigate the inhibitory situation of cryptotanshinone and dihydrotanshinone I towards UGT enzyme-catalyzed propofol glucuronidation. In vitro the human liver microsome (HLM) incubation system was used, and the results showed that cryptotanshinone and dihydrotanshinone I exhibited dose-dependent inhibition towards HLM-catalyzed propofol glucuronidation. Dixon plot and Lineweaver-Burk plot showed that the inhibition type was best fit to competitive inhibition type for both cryptotanshinone and dihydrotanshinone I. The second plot using the slopes from the Lineweaver-Burk plot versus the concentrations of cryptotanshinone or dihydrotanshinone I was employed to calculate the inhibition parameters (Ki) to be 0.4 and 1.7μM, respectively. Using the reported maximum plasma concentration (Cmax), the altered in vivo exposure of propofol increased by 10% and 8.2% for the co-administration of dihydrotanshinone I and cryptotanshinone, respectively. All these results indicated the possible danshen-propofol interaction due to the inhibition of dihydrotanshinone I and cryptotanshinone towards the glucuronidation reaction of propofol.
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Affiliation(s)
- Ming Cong
- First Affiliated Hospital of Liaoning Medical University, Jinzhou 121001, China
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Liu Q, Yao JY, Qian C, Chen R, Li XY, Liu SW, Sun BG, Song LS, Hong J. Effects of propofol on ischemia-induced ventricular arrhythmias and mitochondrial ATP-sensitive potassium channels. Acta Pharmacol Sin 2012; 33:1495-501. [PMID: 22983391 DOI: 10.1038/aps.2012.86] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIM To investigate the potential of propofol in suppressing ventricular arrhythmias and to examine whether mitochondrial ATP-sensitive potassium channels are involved. METHODS Male Sprague-Dawley rats were pretreated with intravenous infusion of propofol (Prop), a selective mitochondrial KATP channel inhibitor 5-hydroxydecanoate (5-HD), propofol plus 5-HD (Prop+5-HD), a potent mitochondrial K(ATP) channel opener diazoxide (DZ) or NS, respectively. The dosage of each drug was 10 mg/kg. The animals then underwent a 30 min-ligation of the left anterior descending artery. The severity of arrhythmias, the incidence of ventricular fibrillation (VF), and the time of the first run of ventricular arrhythmias were documented using an arrhythmia scoring system. Mitochondrial membrane potential (ΔΨm) was measured in freshly isolated rat cardiomyocytes with a fluorescence microscope. RESULTS The arrhythmia scores in the Prop and DZ group were 2.6(0-5) and 2.4(0-5), respectively, which were significantly lower than that in the control group [4.9(2-8)]. VF was not observed in both Prop and DZ groups. The first run of ventricular arrhythmias was significantly postponed in the Prop group (10.5±2.2 vs 7.3±1.9 min). Bracketing of propofol with 5-HD eliminated the anti-arrhythmic effect of propofol. In isolated rat cardiomyocytes, propofol (50 μmol/L) significantly decreased ΔΨm, but when propofol was co-administered with 5-HD, the effect on ΔΨm was reversed. CONCLUSION Propofol preconditioning suppresses ischemia-induced ventricular arrhythmias in the rat heart, which are proposed to be caused by opening of mitochondrial K(ATP) channels.
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Sharma MK, Misra S. Anaesthetic management of a patient with Lown Ganong Levine syndrome-a case report. Med J Armed Forces India 2011; 67:285-7. [PMID: 27365828 DOI: 10.1016/s0377-1237(11)60064-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 02/02/2011] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - S Misra
- Senior Advisor (Anaesthesiology), MH, Meerut Cantt
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Liu Q, Kong AL, Chen R, Qian C, Liu SW, Sun BG, Wang LX, Song LS, Hong J. Propofol and arrhythmias: two sides of the coin. Acta Pharmacol Sin 2011; 32:817-23. [PMID: 21642950 DOI: 10.1038/aps.2011.42] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The hypnotic agent propofol is effective for the induction and maintenance of anesthesia. However, recent studies have shown that propofol administration is related to arrhythmias. Propofol displays both pro- and anti-arrhythmic effects in a concentration-dependent manner. Data indicate that propofol can convert supraventricular tachycardia and ventricular tachycardia and may inhibit the conduction system of the heart. The mechanism of the cardiac effects remains poorly defined and may involve ion channels, the autonomic nervous system and cardiac gap junctions. Specifically, sodium, calcium and potassium currents in cardiac cells are suppressed by clinically relevant concentrations of propofol. Propofol shortens the action potential duration (APD) but lessens the ischemia-induced decrease in the APD. Furthermore, propofol suppresses both sympathetic and parasympathetic tone and preserves gap junctions during ischemia. All of these effects cumulatively contribute to the antiarrhythmic and proarrhythmic properties of propofol.
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Hanci V, Aydin M, Yurtlu BS, Ayoğlu H, Okyay RD, Taş E, Erdoğan G, Aydoğan K, Turan IO. Anesthesia induction with sevoflurane and propofol: evaluation of P-wave dispersion, QT and corrected QT intervals. Kaohsiung J Med Sci 2011; 26:470-7. [PMID: 20837343 DOI: 10.1016/s1607-551x(10)70074-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 03/25/2010] [Indexed: 12/24/2022] Open
Abstract
The present study compared the effects of anesthesia induction with sevoflurane and propofol on hemodynamics, P-wave dispersion (Pwd), QT interval and corrected QT (QTc) interval. A total of 72 adult patients were included in this prospective study. All patients had control electrocardiograms (ECGs) before anesthesia induction. Anesthesia was induced with sevoflurane inhalation or intravenous propofol. Electrocardiography for all patients was performed during the 1(st) and 3(rd) minutes of induction, 3 minutes after administration of muscle relaxant, and at 5 minutes and 10 minutes after intubation. Pwd and QT intervals were measured on all ECGs. QTc intervals were determined using the Bazett formula. There was no significant difference in Pwd and QT and QTc intervals on control ECGs. In the sevoflurane group, except for control ECGs, Pwd and QTc interval on all ECGs were significantly longer than those in the propofol group (p < 0.05). We conclude that propofol should be used for anesthesia induction in patients with a predisposition to preoperative arrhythmias, and in those whose Pwd and QTc durations are prolonged on preoperative ECGs.
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Affiliation(s)
- Volkan Hanci
- Department of Anesthesiology and Reanimation, School of Medicine, Zonguldak Karaelmas University, Turkey.
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Warpechowski P, dos Santos ATL, Pereira PJI, de Lima GG. Effects of Propofol on the Cardiac Conduction System. Braz J Anesthesiol 2010; 60:438-44. [DOI: 10.1016/s0034-7094(10)70054-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 04/04/2010] [Indexed: 10/26/2022] Open
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Atrial fibrillation organization: quantification of propofol effects. Med Biol Eng Comput 2008; 47:333-41. [DOI: 10.1007/s11517-008-0421-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 10/21/2008] [Indexed: 11/26/2022]
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Atiyeh RH, Arthur ME, Berman AE, Castresana MR. The utility of ketamine in facilitating the induction of isoproterenol-refractory idiopathic ventricular tachyarrhythmias. J Cardiothorac Vasc Anesth 2008; 23:373-8. [PMID: 18834838 DOI: 10.1053/j.jvca.2008.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Rony H Atiyeh
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic and Critical Care Anesthesiology, Medical College of Georgia, Augusta, GA 30912, USA.
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Warpechowski P, Lima GG, Medeiros CM, Santos ATL, Kruse M, Migloransa MH, Kalil RAK. Randomized Study of Propofol Effect On Electrophysiological Properties of the Atrioventricular Node in Patients with Nodal Reentrant Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1375-82. [PMID: 17201845 DOI: 10.1111/j.1540-8159.2006.00550.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrioventricular nodal reentrant tachycardia (AVNRT) is probably the most common form of paroxysmal supraventricular tachycardia. Percutaneous catheter ablation is a technique to interrupt cardiac conduction pathways selectively. The anesthetist is challenged to provide a safe anesthetic which takes into account the electrophysiologist's requirements for minimal cardiac conduction interference. Propofol is an ideal drug. However, previous studies have shown that the infusion of propofol has sometimes been associated with bradyarrhythmias or conversion of arrhythmias to sinusal rhythm. The purpose of this report is to verify the interferences of propofol in the electrophysiological properties of the atrioventricular (AV) node conduction system in patients with AVNRT. METHODS Patients were randomly assigned to receive either a placebo or propofol at sedative doses. An electrophysiological study was performed consisting of measuring the anterograde (AERPFP) and retrograde effective refractory period of the fast (RERPFP) and the anterograde effective refractory period of the slow (AERPSP) AV nodal pathway. Reciprocating tachycardia was induced and the cycle length (CL) and atrial-His (AH), His-ventricular (HV), and ventriculoatrial (VA) intervals were measured. RESULTS Propofol did not cause alteration (P > 0.05) in the AERPFP or RERPFP and the AERPSP AV nodal pathway. The AH, HV, and VA intervals were not affected. Sustained reciprocating tachycardia could be induced in the all patients. All slow pathways were successfully identified and ablated. CONCLUSION Propofol has no effect on the electrophysiological properties of the AV node conduction system. It is thus a suitable anesthetic agent for use in patients undergoing ablative procedures.
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Affiliation(s)
- Paulo Warpechowski
- Institute of Cardiology of Rio Grande Do SUL/FUC, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Brazil.
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Gangi S, Saidi F, Patel K, Johnstone B, Jaeger J, Shine D. Cardiovascular complications after GI endoscopy: occurrence and risks in a large hospital system. Gastrointest Endosc 2004; 60:679-85. [PMID: 15557942 DOI: 10.1016/s0016-5107(04)02016-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is limited information concerning the risks for, and occurrence of, cardiovascular complications because of GI endoscopy. Published data are based on questionnaire surveys, which have a potential for bias. Moreover, available studies pertain exclusively to out-patients. METHODS In-patients and day-stay patients who incurred charges for endoscopy with endoscopic procedure coding from 1999 through 2001 were identified from a financial database for all 9 hospitals in a large health care system. From these patients, those considered "at risk" for cardiovascular complications were selected based on charges for cardioactive medications, cardiac enzyme determinations, or intensive care services on the day of or the day after endoscopy. Medical records were reviewed for 25% of these patients, selected at random, noting demographics, history, and a modified Goldman score in patients with cardiovascular complications (defined as arrhythmia, chest pain or anginal equivalent, hypotension or myocardial infarction occurring within 24 hours after endoscopy). Identical information was obtained from a random sample of 0.5% of the chart records for all patients undergoing endoscopy. RESULTS Patients who underwent endoscopy were not reliably identified for one hospital. This hospital was omitted from the calculation of the extrapolated rate of complication occurrence, but patients identified through chart review as having or not having a complication after endoscopy were included in the risk analysis. The extrapolated rate of occurrence of cardiovascular complications was 308: 95% CI [197, 457] per 100,000 procedures. Independent risk factors were: male gender, modified Goldman score, and use of propofol. CONCLUSIONS In this study of patients undergoing hospital-based GI endoscopy, the risk of procedure-related cardiovascular complications was 2 to 70 times higher than previously reported. This finding may be ascribed to differences in the populations sampled and to a case-finding method that minimized reporting and ascertainment biases.
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Affiliation(s)
- Sumana Gangi
- Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey 07740, USA
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Zaballos M, Almendral J, Anadón MJ, González P, Navia J. Comparative effects of thiopental and propofol on atrial vulnerability: electrophysiological study in a porcine model including acute alcoholic intoxication †. Br J Anaesth 2004; 93:414-21. [PMID: 15247108 DOI: 10.1093/bja/aeh215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atrial tachyarrhythmias (AT) frequently complicate the perioperative period. Alcohol intoxication is a recognized causative factor for dysrrhythmias. We studied the effects of propofol and thiopental on atrial electrophysiology and vulnerability to AT in a closed-chest porcine model in which AT are facilitated by ethanol. METHODS Thirty-eight pigs were randomly assigned to thiopental (T-group, n=19) or propofol (P-group n=19). All animals were assigned to undergo a right atrial electrical stimulation protocol (RASP) at baseline. Thirty pigs were assigned to undergo additional RASP during ethanol infusion, while the remaining eight were assigned to undergo additional RASP during saline infusion (control group). We analysed effective refractory period (ERP), and intra-atrial conduction interval (ICI) (between atrial sites 4 cm apart), at several cycle lengths (CL). RESULTS There were no significant differences at baseline. During ethanol infusion, propofol produced a greater rate-dependent decrease in excitability, manifested by a longer minimum paced CL with 1:1 atrial capture: 145 (11) vs 164 (27) ms in the T- and P-group, respectively (P=0.01). Propofol was associated with a greater rate-related slowing in conduction: difference between ICI at CL of 300 ms and ICI at minimum CL: 30 ms in P-group and 22 ms in T-group (P<0.03). In the P-group we observed a longer duration of induced arrhythmias (145 (131) vs 74 (91) s, P<0.03) and a higher proportion with atrial flutter (AFl) (76 vs 19%, P<0.001). CONCLUSIONS Propofol in this model was more arrhythmogenic than thiopental, as manifested by a longer duration of induced arrhythmias, particularly AFI.
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Affiliation(s)
- M Zaballos
- Department of Anesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
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Bibliography Current World Literature. Curr Opin Anaesthesiol 2003. [DOI: 10.1097/01.aco.0000084472.59960.ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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