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Schnider TW, Nieuwenhuijs-Moeke GJ, Beck-Schimmer B, Hemmerling TM. Pro-Con Debate: Should All General Anesthesia Be Done Using Target-Controlled Propofol Infusion Guided by Objective Monitoring of Depth of Anesthesia? Anesth Analg 2023; 137:565-575. [PMID: 37590801 DOI: 10.1213/ane.0000000000006293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
In this Pro-Con commentary article, we discuss whether all general anesthesia should be done using target-controlled propofol anesthesia guided by monitoring of depth of anesthesia. This is an ongoing debate since more than 25 years, representing a scientific, cultural as well as geographical divide in the anesthesia community. The Pro side argues that total intravenous anesthesia causes less postoperative nausea and higher patient satisfaction than anesthesia using volatile anesthetics. Target-controlled infusion (TCI) of anesthetic agents allows for better titration of intravenous anesthesia using pharmacokinetic models. Processed EEG monitors, such as bispectral index monitoring, allows for better assessing the effect of TCI anesthesia than solely assessment of clinical parameters, such as ECG or blood pressure. The combination of TCI propofol and objective depth of anesthesia monitoring allows creating a pharmacokinetic-pharmacodynamic profile for each patient. Finally, anesthesia using volatile anesthetics poses health risks for healthcare professionals and contributes to greenhouse effect. The Con side argues that for procedures accompanied with ischemia and reperfusion injury of an organ or tissue and for patients suffering from a severe inflammation' the use of volatile anesthetics might well have its advantages above propofol. In times of sudden shortage of drugs, volatile anesthetics can overcome the restriction in the operating theater or even on the intensive care unit, which is another advantage. Volatile anesthetics can be used for induction of anesthesia when IV access is impossible, end-tidal measurements of volatile anesthetic concentration allows confirmation that patients receive anesthetics. Taking environmental considerations into account, both propofol and volatile anesthetics bear certain harm to the environment, be it as waste product or as greenhouse gases. The authors therefore suggest to carefully considering advantages and disadvantages for each patient in its according environment. A well-balanced choice based on the available literature is recommended. The authors recommend careful consideration of advantages and disadvantages of each technique when tailoring an anesthetic to meet patient needs. Where appropriate, anesthesia providers are encouraged to account for unique features of anesthetic drug behavior, patient-reported and observed postoperative outcomes, and economic and environmental considerations when choosing any of the 2 described techniques.
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Affiliation(s)
- Thomas W Schnider
- From the Department for Anesthesiology, Intensive, Rescue and Pain medicine, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Gertrude J Nieuwenhuijs-Moeke
- Department of Anesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Ishikawa E, Iwamoto R, Hojo T, Teshirogi T, Hashimoto K, Shibuya M, Kimura Y, Fujisawa T. Cross-sectional Study of PONV Risk Factors for Oral Surgery After Intubated General Anesthesia With Total Intravenous Anesthesia. Anesth Prog 2022; 69:18-23. [PMID: 35377932 DOI: 10.2344/anpr-68-03-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The incidence of postoperative nausea and vomiting (PONV) after general anesthesia with total intravenous anesthesia (TIVA) was reported to be significantly lower than with volatile inhalational agents (13.3% vs 25%). However, no investigation of PONV risk factors associated with TIVA has ever been reported. This cross-sectional retrospective study aimed to investigate whether known risk factors influenced PONV in intubated general anesthetics utilizing TIVA for dental or oral and maxillofacial surgery. METHODS Subjects were 761 patients who underwent dental or oral and maxillofacial surgery under TIVA with propofol, fentanyl, and remifentanil. Univariate and multivariable logistic regression analyses were performed using PONV (within 24 hours) as the dependent variable and previously reported risk factors as independent variables. RESULTS Age (odds ratio [OR]: 1.020 per year decrease; 95% confidence interval [CI]: 1.0002-1.0418; P = .047) and female sex (OR: 2.73; 95% CI: 1.60-4.84; P < .001) were positively associated with PONV. Sagittal split ramus osteotomy (SSRO) (OR: 2.28; 95% CI: 1.21-4.33; P = .011) and bimaxillary osteotomy (OR: 5.69; 95% CI: 2.09-15.99; P < .001) were more likely to be associated with PONV than operations that were neither bimaxillary osteotomy nor SSRO. Late PONV (2-24 hours) had an ∼2.7 times higher incidence than early PONV (0-2 hours). CONCLUSION These findings suggest further PONV countermeasures, aside from TIVA with propofol and prophylactic antiemetics for orthognathic surgeries especially bimaxillary osteotomy, are needed.
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Affiliation(s)
- Emi Ishikawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Rie Iwamoto
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hojo
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takahito Teshirogi
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Keiji Hashimoto
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Makiko Shibuya
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yukifumi Kimura
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Fujisawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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González Moral ML, Selva Sevilla C, Romero Rodenas P, Tolosa Pérez MT, Lucas Pérez-Romero M, Domato Lluch M, Gerónimo Pardo M. Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 30143318 PMCID: PMC9391781 DOI: 10.1016/j.bjane.2018.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background and objectives Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. Methods After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. Results 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081 s for every mg.kg−1 of propofol; CI95%: −7906 to −0.255, p = 0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. Conclusions Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.
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Zheng G, Qu H, Li F, Ma W, Yang H. Propofol attenuates sepsis-induced acute kidney injury by regulating miR-290-5p/CCL-2 signaling pathway. ACTA ACUST UNITED AC 2018; 51:e7655. [PMID: 30328934 PMCID: PMC6190213 DOI: 10.1590/1414-431x20187655] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/13/2018] [Indexed: 11/22/2022]
Abstract
Previous studies have indicated that propofol has immunomodulatory and antioxidative properties. However, the renoprotection effect and the precise mechanisms of propofol in sepsis-induced renal injury remain unclear. The purpose of the present study was to investigate the role of miR-290-5p/CCL-2 signaling in septic mice treatment with propofol. Mice were treated with propofol (50 mg/kg) twice within 24 h. Survival outcome was monitored within 48 h. The mRNA and protein levels were assayed by qRT-PCR and western blotting, respectively. Mouse podocytes (MPC5) were treated with lipopolysaccharide (LPS) to establish the cell model in vitro. The proliferation of MPC5 was monitored using the MTS assay. Cell apoptosis was analyzed by flow cytometry. Propofol improved survival outcome and alleviated acute kidney injury in cecal ligation and puncture-operated mice. Propofol increased miR-290-5p expression and decreased CCL-2 and inflammatory cytokines levels in the kidney for septic mice. We found that miR-290-5p was a direct regulator of CCL-2 in MPC5. Propofol could abrogate LPS-induced growth inhibition and apoptosis in MPC5. Meanwhile, propofol inhibited CCL-2 expression in LPS-treated MPC5, however, knockdown of miR-290-5p abrogated the inhibitory effect propofol on the mRNA and protein expressions of CCL-2. Propofol could serve as an effective therapeutic medication to suppress sepsis-induced renal injury in vivo and in vitro by regulating the miR-290-5p/CCL-2 signaling pathway.
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Affiliation(s)
- Guodong Zheng
- Department of Critical Care Medicine, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hong Qu
- Department of Hematology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Fen Li
- Department of Critical Care Medicine, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Weiquan Ma
- Department of Critical Care Medicine, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hong Yang
- Department of Critical Care Medicine, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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González Moral ML, Selva Sevilla C, Romero Rodenas P, Tolosa Pérez MT, Lucas Pérez-Romero M, Domato Lluch M, Gerónimo Pardo M. [Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy]. Rev Bras Anestesiol 2018; 68:564-570. [PMID: 30143318 DOI: 10.1016/j.bjan.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/19/2018] [Accepted: 03/30/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. METHODS After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. RESULTS 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081s for every mg.kg-1 of propofol; CI95%: -7906 to -0.255, p=0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. CONCLUSIONS Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.
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Affiliation(s)
| | | | - Patricia Romero Rodenas
- Complejo Hospitalario Universitario de Albacete, Departamento de Salud Mental, Albacete, Espanha
| | | | - Marta Lucas Pérez-Romero
- Complejo Hospitalario Universitario de Albacete, Departamento de Salud Mental, Albacete, Espanha
| | - Mar Domato Lluch
- Complejo Hospitalario Universitario de Albacete, Departamento de Salud Mental, Albacete, Espanha
| | - Manuel Gerónimo Pardo
- Complejo Hospitalario Universitario de Albacete, Departamento de Anestesiología, Albacete, Espanha.
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Ridge Y, Landini P, Thompson A. High-throughput screening of a collection of known pharmacologically active small compounds for inhibitors of Salmonella invasion and intracellular replication. J Appl Microbiol 2018; 125:724-730. [PMID: 29693760 DOI: 10.1111/jam.13890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 01/12/2023]
Abstract
AIMS The aim of this study was to screen a chemical library consisting of over 1200 pharmacologically active, already approved off-patent compounds, to determine whether any of the compounds reduced or eliminated the invasion or intracellular replication phenotypes of Salmonella enterica serovar Typhimurium (S. Typhimurium). METHODS AND RESULTS LacZ reporter and tissue culture-based infection assays were used to screen for compounds that significantly reduced expression of key virulence genes, and were required for the invasion or intracellular replication phenotypes of S. Typhimurium in host cells. The search lead to the discovery of four compounds that reduced invasion by between 90-100%, and two compounds that reduced intracellular replication by between 65-93% at concentrations of either 2, 10 or 50 μg ml-1 , relative to an untreated control strain. CONCLUSIONS We identified six compounds that significantly reduced expression of S. Typhimurium virulence genes resulting in decreased in vitro virulence. SIGNIFICANCE AND IMPACT OF THE STUDY The emergence of multidrug-resistant strains of Salmonella poses a considerable and growing worldwide threat to human and animal health. The screening of off-patent chemical libraries represents a potential discovery route for novel antimicrobials.
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Affiliation(s)
- Y Ridge
- Institute of Food Research, Norwich, UK
| | - P Landini
- Department of Biosciences, University of Milan, Milan, Italy
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Ren L, Hao X, Min S, Deng J, Chen Q, Chen H, Liu D. Anesthetics alleviate learning and memory impairment induced by electroconvulsive shock by regulation of NMDA receptor-mediated metaplasticity in depressive rats. Neurobiol Learn Mem 2018; 155:65-77. [PMID: 29953948 DOI: 10.1016/j.nlm.2018.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/14/2018] [Accepted: 06/23/2018] [Indexed: 02/05/2023]
Abstract
Along with its outstanding antidepressant effect, electroconvulsive shock (ECS) can induce learning and memory impairment. Propofol and ketamine have shown to be useful in alleviating the learning and memory impairment. Nevertheless, the mechanism still remains unclear. This study investigated the role of NMDA receptor (NMDAR)-mediated metaplasticity in the learning and memory impairment induced by ECS, as well as the neuroprotective effect of propofol and ketamine in depressive rats. Rats received ECS or ECS under anesthetics after chronic unpredictable mild stress procedure. Long-term potentiation (LTP) was tested by extracellular recording. LTD/LTP threshold was assessed by stimulation of different frequencies. Additionally, NMDAR-mediated field excitatory postsynaptic potential (fEPSP) and NMDAR input/output relationship were detected under hippocampal slice perfusion. Results showed that propofol or low-dose ketamine could partially alleviate ECS-induced LTP impairment, while propofol combined with low-dose ketamine almost reversed the LTP impairment. LTP under ECS was increased by stronger stimulation. ECS could up-regulated LTD/LTP threshold, while propofol or ketamine could down-regulate it. Moreover, ECS activated NMDAR, while propofol and ketamine could inhibit the activation of NMDAR. NMDAR input/output relationship decrease was induced by preconditioning (an analog of ECS in hippocampal slice), however, NMDAR input/output relationship increased by propofol or ketamine. In conclusion, ECS-induced cognitive impairment is caused by NMDAR-mediated metaplasticity via up-regulation of LTD/LTP threshold. Propofol or ketamine alleviates the cognitive impairment, possibly by down-regulating the threshold via inhibition of NMDAR activation induced by ECS.
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Affiliation(s)
- Li Ren
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuechao Hao
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Su Min
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Jie Deng
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qibin Chen
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hengsheng Chen
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Dawei Liu
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Schnider TW. Pharmacokinetic and pharmacodynamic concepts underpinning total intravenous anesthesia. J Cardiothorac Vasc Anesth 2015; 29 Suppl 1:S7-S10. [PMID: 26025045 DOI: 10.1053/j.jvca.2015.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas W Schnider
- Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
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Wozniak KM, Vornov JJ, Mistry BM, Wu Y, Rais R, Slusher BS. Gastrointestinal delivery of propofol from fospropofol: its bioavailability and activity in rodents and human volunteers. J Transl Med 2015; 13:170. [PMID: 26021605 PMCID: PMC4448313 DOI: 10.1186/s12967-015-0526-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/08/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Propofol is a safe and widely used intravenous anesthetic agent, for which additional clinical uses including treatment of migraine, nausea, pain and anxiety have been proposed (Vasileiou et al. Eur J Pharmacol 605:1-8, 2009). However, propofol suffers from several disadvantages as a therapeutic outside anesthesia including its limited aqueous solubility and negligible oral bioavailability. The purpose of the studies described here was to evaluate, in both animals and human volunteers, whether fospropofol (a water soluble phosphate ester prodrug of propofol) would provide higher propofol bioavailability through non-intravenous routes. METHODS Fospropofol was administered via intravenous, oral and intraduodenal routes to rats. Pharmacokinetic and pharmacodynamic parameters were then evaluated. Based on the promising animal data we subsequently conducted an oral and intraduodenal pharmacokinetic/pharmacodynamic study in human volunteers. RESULTS In rats, bioavailability of propofol from fospropofol delivered orally was found to be appreciable, in the order of around 20-70%, depending on dose. Availability was especially marked following fospropofol administration via the intraduodenal route, where bioavailability approximated 100%. Fospropofol itself was not appreciably bioavailable when administered by any route except for intravenous. Pharmacologic effect following oral fospropofol was confirmed by observation of sedation and alleviation of thermal hyperalgesia in the rat chronic constrictive injury model of neuropathic pain. The human data also showed systemic availability of propofol from fospropofol administration via oral routes, a hereto novel finding. Assessment of sedation in human volunteers was correlated with pharmacokinetic measurements. CONCLUSIONS These data suggest potential utility of oral administration of fospropofol for various therapeutic indications previously considered for propofol.
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Affiliation(s)
- Krystyna M Wozniak
- Eisai Inc., Baltimore, MD, USA. .,Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, The John G. Rangos, Sr. Building, 855 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - James J Vornov
- Eisai Inc., Baltimore, MD, USA. .,Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, The John G. Rangos, Sr. Building, 855 N. Wolfe Street, Baltimore, MD, 21205, USA. .,Medpace, Cincinnati, OH, USA.
| | - Bipin M Mistry
- Eisai Inc., Baltimore, MD, USA. .,Center for Veterinary Medicine, FDA, Derwood, MD, USA.
| | - Ying Wu
- Eisai Inc., Baltimore, MD, USA. .,Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, The John G. Rangos, Sr. Building, 855 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Rana Rais
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, The John G. Rangos, Sr. Building, 855 N. Wolfe Street, Baltimore, MD, 21205, USA. .,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Barbara S Slusher
- Eisai Inc., Baltimore, MD, USA. .,Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, The John G. Rangos, Sr. Building, 855 N. Wolfe Street, Baltimore, MD, 21205, USA. .,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of Psychiatry, and Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Hirmanpour A, Safavi M, Honarmand A, Hosseini AZ, Sepehrian M. The comparative study of intravenous Ondansetron and sub-hypnotic Propofol dose in control and treatment of intrathecal Sufentanil-induced pruritus in elective caesarean surgery. J Res Pharm Pract 2015; 4:57-63. [PMID: 25984542 PMCID: PMC4418137 DOI: 10.4103/2279-042x.155751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Pruritus is a common and disturbing side effect of neuraxial opioids after cesarean section. The purpose of this study was to compare the efficacy of intravenous ondansetron and sub-hypnotic dose of propofol in control and treatment of intrathecal sufentanil induced pruritus in cesarean surgery. Methods: Totally, 90 parturient with American Society of Anesthesiology physical status grade I-II, undergoing spinal anesthesia with 2.5 μg sufentanil and 10 mg bupivacaine 0.5% were enrolled to this randomized, prospective, double-blind study. The women were randomly assigned to two groups who received 8 mg ondansetron or 10 mg propofol to treat pruritus grade ≥3. The patient was evaluated after 5 min and in the lack of successful treatment, the doses of two drugs repeated and if the pruritus is on-going, the exact treatment with naloxone was done. Findings: The incidence of pruritus was 69.3%. Both groups were well-matched. The peak time pruritus was 30–75 min after injection. The percentage of individuals consumed naloxone were 6.8% and 15.9% in ondansetron and propofol groups, respectively (P = 0.18). The mean score of satisfaction (according to visual analog scale criteria) was 9.09 ± 1.1 in ondansetron group and 9.3 ± 1.07 in the propofol group (P = 0.39). Conclusion: Ondansetrone and sub-hypnotic dose of propofol are both safe and well-tolerated. Due to their same efficacy in the treatment of intrathecal sufentanil-induced pruritus, they can be widely used in clinical practice.
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Affiliation(s)
- Anahita Hirmanpour
- Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Safavi
- Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Honarmand
- Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akram Zavaran Hosseini
- Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Sepehrian
- Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Ahuja H, Abraham V, Abraham J, Liddle D. Ideal anesthetic agents for day-care gynecological procedures: A clinical trial comparing thiopentone with ketamine as adjuncts to propofol. Adv Biomed Res 2015; 4:81. [PMID: 26015907 PMCID: PMC4434485 DOI: 10.4103/2277-9175.156639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/13/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Day-care gynecological procedures require the use of anesthetic agents, which ensure rapid induction and recovery. Although propofol is the gold standard drug in day-care procedures, it has its own side effects like apnea, cardiovascular instability, pain on injection, as well as its cost. The ideal drug combination to achieve this end remains elusive. Therefore, a combination of propofol, thiopentone, and ketamine may be a better alternative. MATERIALS AND METHODS This prospective, double-blind, randomized study was conducted on 60 women, aged 18-50 years, American Society of Anesthesiologists (ASA) physical status 1 and 2, undergoing day-care gynecological surgeries. The patients were allocated to two groups. Group T received an admixture containing 10 ml of 1% propofol and 10 ml of 1.25% thiopentone. Group K received an admixture containing 10 ml of 1% propofol and 10 ml of 0.5% ketamine. RESULTS There was less variation in the mean systolic blood pressure of patients in Group K as compared to patients in Group T. The mean total dose of propofol required in Group K (0.85 mg/kg) was significantly less than that required in Group T (1.12 mg/kg) (P = 0.0004). The mean recovery time in Group T (3.67 minutes) was significantly less than in Group K (6.27 minutes; P = 0.0001). However, the mean discharge time in both the groups was similar. (P = 0.7392). The results were analyzed statistically using the Student's t-test and the Fisher's exact test. CONCLUSIONS Both the propofol-thiopentone and propofol-ketamine admixtures provided adequate anesthesia. Propofol-ketamine proved superior to propofol-thiopentone in terms of hemodynamic stability and requirement of a lesser total dose of propofol. However, the patients in the propofol-thiopentone group had faster recovery.
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Affiliation(s)
- Hemani Ahuja
- Department of Anesthesia and Critical Care, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Valsamma Abraham
- Department of Anesthesia and Critical Care, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - John Abraham
- Department of Anesthesia and Critical Care, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Dootika Liddle
- Department of Anesthesia and Critical Care, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Locomotor stimulation by acute propofol administration in rats: Role of the nitrergic system. Pharmacol Rep 2015; 67:980-5. [PMID: 26398394 DOI: 10.1016/j.pharep.2015.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 02/21/2015] [Accepted: 03/05/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The addictive potential of propofol has been scientifically discussed. Drugs' psychostimulant properties that can be assessed via measurements of locomotor activity are linked to their addictive properties. No studies that have investigated the effects of propofol on locomotor activity have been reported to date. The present study sought to investigate the effects and possible mechanisms of action of propofol on locomotor activity in rats. METHODS Adult male albino Wistar rats (250-330g) were used as subjects. The locomotor activities of the rats were recorded for 30min immediately following intraperitoneal administration of propofol (20 and 40mg/kg), saline or vehicle (n=8 for each group). NG-nitro arginine methyl ester (l-NAME, 15-60mg/kg), a nitric oxide (NO) synthase inhibitor, and haloperidol (0.125-5mg/kg), a non-specific dopamine receptor antagonist, were also administered to other groups of rats 30min prior to the propofol (40mg/kg) injections, and locomotor activity was recorded for 30min immediately after propofol administration (n=8 for each group). RESULTS Propofol produced significant increases in the locomotor activities of the rats in the first 5min of the observation period [F(2,21)=9.052; p<0.001]. l-NAME [F(4,35)=3.112; p=0.02] but not haloperidol [F(4,35)=2.440; p=0.067] pretreatment blocked the propofol-induced locomotor hyperactivity. l-NAME did not cause any significant change in locomotor activity in naïve rats [F(2,21)=0.569; p=0.57]. CONCLUSIONS Our results suggest that propofol might cause a short-term induction of locomotor activity in rats and that this effect might be related to nitrergic but not dopaminergic mechanisms.
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Effect of propofol and remifentanil on a somatosensory evoked potential indicator of pain perception intensity in volunteers. J Clin Monit Comput 2014; 29:561-7. [DOI: 10.1007/s10877-014-9632-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
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Jaggi N, Kalra A, Baghla GK, Medsinge SV, Purohit N. Evaluation of propofol as a general anesthetic agent for minor oral surgical procedure. J Contemp Dent Pract 2013; 14:605-9. [PMID: 24309336 DOI: 10.5005/jp-journals-10024-1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nausea and vomiting following anesthesia is a distressing problem for the patient as it increases the recovery time, intensity of nursing care and delays discharge. The aim of randomized controlled single blind study is to evaluate the efficacy and safety of subhypnotic doses of propofol for the prevention of postoperative nausea and vomiting (PONV) in day care management of cases in oral and maxillofacial surgeries. Twenty-five patient of ASA-1 with age ranging from 12 to 40 years were scheduled for various maxillofacial surgical cases like fracture, cyst enucleation, surgical removal of 3rd molar, etc. were given propofol at the dose of 2 to 2.5 mg/kg as induction dose and sedation was maintained with the dose 5 to 10 mg/min. There was no significant effect on heart rate, systolic and diastolic blood pressure, respiratory rate and oxygen saturation intraoperatively. In conclusion, a subhypnotic dose of propofol is fast acting, safe and easily controllable, short acting general anesthetic agent with rapid recovery. The study found that the PONV was significantly reduced in the patient with propofol, no hemodynamic derangements were noted in the postoperative period.
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Affiliation(s)
- Nitin Jaggi
- Professor and Head, Department of Oral and Maxillofacial Surgery, MPCD and RC, Gwalior, Madhya Pradesh, India, e-mail:
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Dhir A, Lossin C, Rogawski MA. Propofol hemisuccinate suppresses cortical spreading depression. Neurosci Lett 2012; 514:67-70. [DOI: 10.1016/j.neulet.2012.02.058] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 02/14/2012] [Accepted: 02/16/2012] [Indexed: 11/28/2022]
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Viljoen A, Byth K, Coombs M, Mahoney G, Stewart D. Analysis of oxygen saturations recorded during dental intravenous sedations: a retrospective quality assurance of 3500 cases. Anesth Prog 2011; 58:113-20. [PMID: 21882986 PMCID: PMC3167154 DOI: 10.2344/09-00001.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 03/10/2011] [Indexed: 12/22/2022] Open
Abstract
The death of a patient under sedation in New South Wales, Australia, in 2002 has again raised the question of the safety of dental sedation. This study sought answers to 2 questions: Can safe oxygen saturation levels (≥ 94%) be consistently maintained by a single operator/sedationist? Does the additional use of propofol, in subanesthetic doses, increase the risk of exposure to hypoxemia? Three thousand five hundred cases generated between 1996 and 2006 were randomly examined and divided into 2 subcohorts: 1750 patients were sedated with midazolam and fentanyl, and 1750 patients received propofol, in subanesthetic increments, in addition to midazolam and fentanyl. Initial sedation was established using midazolam and fentanyl in both subcohorts. The second subcohort received propofol during times of noxious stimulation. Patient exposure to 2 or more oxygen desaturations below 94% was uncommon. The variables that were significantly associated with low saturations were age, gender, and weight. Neither the dose of midazolam nor the additional use of propofol was a significant risk factor. ASA classification (I or II) was not a determinant of risk. The data, within the limitations of the study, showed that a single operator/sedationist, supported by a well-trained team of nurses, can consistently maintain safe oxygen saturation levels. The additional use of propofol did not increase exposure to hypoxemia.
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Iturri Clavero F, González Uriarte A, Tamayo Medel G, Pomposo Gaztelu IC, Cano Dorronsoro M, Martínez Ruiz A. [Perioperative considerations in vagal nerve stimulator implantation]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:431-438. [PMID: 20857639 DOI: 10.1016/s0034-9356(10)70270-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Vagal nerve stimulation has become an a important tool in the treatment of refractory epilepsy, which continues to be the main indication for this technique. Other therapeutic indications are emerging, however, and vagal nerve stimulation has now been approved for major depression. Additional possible uses under study include morbid obesity, Alzheimer disease, chronic pain syndromes, and certain neuropsychologic disorders. This review considers perioperative aspects relevant to using this therapeutic procedure with a view to facilitating better and more integrated management of its application.
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Affiliation(s)
- F Iturri Clavero
- Servicio de Anestesiología y Reanimación, Hospital de Cruces, Baracaldo,. Bizkaia.
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Vari A, Gazzanelli S, Cavallaro G, De Toma G, Tarquini S, Guerra C, Stramaccioni E, Pietropaoli P. Post-Operative Nausea and Vomiting (PONV) after Thyroid Surgery: A Prospective, Randomized Study Comparing Totally Intravenous versus Inhalational Anesthetics. Am Surg 2010. [DOI: 10.1177/000313481007600317] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The incidence of postoperative nausea and vomiting (PONV) after thyroidectomy and the association of Propofol versus Sevoflurane use for anesthesia maintenance were investigated during a randomized, prospective study. One hundred and ninety-eight patients underwent thyroidectomy receiving either Sevoflurane (0.5-1.3% end-tidal) or Propofol (50-200 mg/kg/min) for anesthesia maintenance. All patients received Propofol for induction of anesthesia, Succinylcholine or Vecuronium, Nitrous Oxide, and Fentanyl. Prophylactic antiemetics were not administered. The combined incidence of PONV was 54.4 per cent over the 24-hour postoperative evaluation period. PONV was more common in patients receiving Sevoflurane than Propofol for maintenance of anesthesia (64.6% vs 43.8%). In women (n = 117), the incidence of PONV resulted higher when receiving inhalational Sevoflurane than Propofol for maintenance (70.6% vs 42.4%). However, in men (n = 81), there was no significant difference in PONV between anesthetic regimens (47.4% with Sevoflurane vs 49.6% with Propofol). Patients undergoing thyroid surgery are at high risk for the development of PONV. Propofol for maintenance of anesthesia, although more expensive than Sevoflurane, may reduce the rate of PONV.
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Affiliation(s)
- Alessandra Vari
- Departments of Anesthesiology, Intensive Care and Pain Therapy and University School of Medicine, Rome, Italy
| | - Sergio Gazzanelli
- Departments of Anesthesiology, Intensive Care and Pain Therapy and University School of Medicine, Rome, Italy
| | - Giuseppe Cavallaro
- Departments of Surgery “Pietro Valdoni”, “Sapienza” University School of Medicine, Rome, Italy
| | - Giorgio De Toma
- Departments of Surgery “Pietro Valdoni”, “Sapienza” University School of Medicine, Rome, Italy
| | - Sergio Tarquini
- Departments of Anesthesiology, Intensive Care and Pain Therapy and University School of Medicine, Rome, Italy
| | - Carolina Guerra
- Departments of Anesthesiology, Intensive Care and Pain Therapy and University School of Medicine, Rome, Italy
| | - Elisa Stramaccioni
- Departments of Anesthesiology, Intensive Care and Pain Therapy and University School of Medicine, Rome, Italy
| | - Paolo Pietropaoli
- Departments of Anesthesiology, Intensive Care and Pain Therapy and University School of Medicine, Rome, Italy
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Anaesthetic and cardiorespiratory effects of propofol at 10% for induction and 1% for maintenance of anaesthesia in horses. Equine Vet J 2010; 41:578-85. [DOI: 10.2746/042516409x407620] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
The number of pediatric patients requiring sedation for procedures performed outside the operating room environment continues to grow yearly, as does the number of patients surviving to adulthood with the residua and sequelae of congenital heart disease. Ongoing efforts to develop guidelines to enhance the safety of these pediatric sedative encounters have resulted in great strides in the prevention of adverse events. In addition, the Society for Pediatric Sedation, associated with the Pediatric Sedation Research Consortium, provides an important forum for practitioner education and the promotion of safe care for infants and children undergoing sedative experiences. Care of the subset of patients with congenital heart disease or pulmonary hypertension remains especially demanding. The additional safety challenges posed by remote locations make the highest level of vigilance essential when planning and performing sedation for these children.
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Affiliation(s)
- Laura K Diaz
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Vasileiou I, Xanthos T, Koudouna E, Perrea D, Klonaris C, Katsargyris A, Papadimitriou L. Propofol: A review of its non-anaesthetic effects. Eur J Pharmacol 2009; 605:1-8. [DOI: 10.1016/j.ejphar.2009.01.007] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Dawidowicz AL, Kobielski M, Pieniadz J. Anomalous relationship between free drug fraction and its total concentration in drug–protein systems. Eur J Pharm Sci 2008; 34:30-6. [DOI: 10.1016/j.ejps.2008.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 01/03/2008] [Accepted: 02/10/2008] [Indexed: 10/22/2022]
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Singler B, Tröster A, Manering N, Schüttler J, Koppert W. Modulation of Remifentanil-Induced Postinfusion Hyperalgesia by Propofol. Anesth Analg 2007; 104:1397-403, table of contents. [PMID: 17513631 DOI: 10.1213/01.ane.0000261305.22324.f3] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Experimental and clinical studies suggest that brief opioid exposure can enhance pain sensitivity. During anesthesia, however, opioids are commonly administered in combination with either IV or inhaled hypnotic drugs. In this investigation we sought to determine the analgesic and antihyperalgesic properties of propofol in subhypnotic concentrations on remifentanil-induced postinfusion hypersensitivity in an experimental human pain model. METHODS Fifteen healthy volunteers were included in this randomized, double-blind, and placebo-controlled study in a cross-over design. Transcutaneous electrical stimulation at high current densities (41.7 +/- 14.3 mA) induced spontaneous acute pain (numerical rating scale = 6 of 10) and stable areas of hyperalgesia. Pain intensities and areas of hyperalgesia were assessed before, during and after a 30 min target-controlled infusion of propofol (1.5 microg/mL) and remifentanil (0.05 microg x kg(-1) x min(-1)), either alone or in combination (propofol 1.5 microg/mL with remifentanil 0.025 or 0.05 microg x kg(-1) x min(-1)). RESULTS During infusion, propofol significantly reduced the electrically evoked pain to 72% +/- 21% of control. Subhypnotic concentrations of propofol did not lead to any hyperalgesic effects. Coadministration of remifentanil led to synergistic analgesic effects (to 62% +/- 26% and 58% +/- 25% of control, for 0.025 or 0.05 microg x kg(-1) x min(-1), respectively), but upon withdrawal, pain and hyperalgesia increased above control level. CONCLUSIONS The results suggest clinically relevant interactions of propofol and remifentanil in humans, since propofol led to a delay and a weakening of remifentanil-induced postinfusion anti-analgesia in humans. Nevertheless, pronociceptive effects were not completely antagonized by propofol, which may account for the increased demand for analgesics after remifentanil-based anesthesia in clinical practice.
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Affiliation(s)
- Boris Singler
- Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany
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Kalitynski R, Dawidowicz AL, Poszytek J. Influence of intralipid on free propofol fraction assayed in human serum albumin solutions and human plasma. Acta Pharmacol Sin 2006; 27:1637-41. [PMID: 17112420 DOI: 10.1111/j.1745-7254.2006.00454.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM It is generally assumed that only unbound drugs can reach the site of action by diffusing across the membranes and exerting pharmacological effects by interacting with receptors. Recent research has shown that the percentage of free drugs may depend on the total drug concentration. The aim of the paper is to verify whether the mentioned dependence reported for propofol also takes place in plasma and human serum albumin samples in the presence of intralipid-the medium used as a vehicle for propofol infusions and a parenteral nutrition agent. METHODS Artificial plasma samples and human plasma were spiked with intralipid or ethanolic solutions of propofol. The samples were then assayed for free propofol concentration using ultrafiltration and high performance liquid chromatography with fluorimetric detection. RESULTS The decrease of the total drug concentration results in free propofol fraction increase, irrespectively of the used type of propofol solvent and sample type. The addition of intralipid causes the lowering of the overall free drug fraction with respect to the samples spiked with ethanolic solutions of the drug. CONCLUSION The presence of intralipid does not influence the phenomenon of free propofol fraction rise at low total drug concentration. Such a rise cannot be ignored in clinical conditions when the drug is applied for sedative, antiemetic or other low-dosage purposes.
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Affiliation(s)
- Rafal Kalitynski
- Department of Chromatographic Methods, Maria Curie-Sklodowska University, Lublin PL 20 031, Poland
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Meyer S, Shamdeen MG, Kegel B, Mencke T, Gottschling S, Gortner L, Grundmann U. Effect of propofol on seizure-like phenomena and electroencephalographic activity in children with epilepsy vs children with learning difficulties. Anaesthesia 2006; 61:1040-7. [PMID: 17042840 DOI: 10.1111/j.1365-2044.2006.04782.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There is an ongoing debate as to whether propofol exhibits pro- or anticonvulsant effects, and whether it should be used in patients with epilepsy. We prospectively assessed the occurrence of seizure-like phenomena and the effects of intravenous propofol on the electroencephalogram (EEG) in 25 children with epilepsy (mean (SD) age: 101 (49) months) and 25 children with learning difficulties (mean (SD) age: 52 (40) months) undergoing elective sedation for MRI studies of the brain. No child demonstrated seizure-like phenomena of epileptic origin during and after propofol sedation. Immediately after stopping propofol, characteristic EEG changes in the epilepsy group consisted of increased beta wave activity (23/25 children), and suppression of pre-existing theta rhythms (11/16 children). In addition, 16 of 18 children with epilepsy and documented EEG seizure activity demonstrated suppression of spike-wave patterns after propofol sedation. In all 25 children with learning difficulties an increase in beta wave activity was seen. Suppression of theta rhythms occurred in 11 of 12 children at the end of the MRI study. In no child of either group was a primary occurrence or an increase in spike-wave patterns seen following propofol administration. The occurrence of beta wave activity (children with learning difficulties and epilepsy group) and suppression of spike-wave patterns (epilepsy group) were transient, and disappeared after 4 h. This study demonstrates characteristic, time-dependent EEG patterns induced by propofol in children with epilepsy and learning difficulties. Our data support the concept of propofol being a sedative-hypnotic agent with anticonvulsant properties as shown by depression of spike-wave patterns in children with epilepsy and by the absence of seizure-like phenomena of epileptic origin.
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Affiliation(s)
- S Meyer
- Department of Paediatrics and Paediatric Intensive Care Medicine, University Hospital of Saarland, Homburg, Germany
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Kostopanagiotou G, Pandazi A, Matiatou S, Kontogiannopoulou S, Matsota P, Niokou D, Kitsou M, Crepi E, Christodoulaki K, Grigoropoulou I. The impact of intraoperative propofol administration in the prevention of postoperative pruritus induced by epidural morphine. Eur J Anaesthesiol 2006; 23:418-21. [PMID: 16469206 DOI: 10.1017/s0265021505001912] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2005] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE We examined the efficacy of intraoperative propofol administration to prevent pruritus induced by epidural morphine. METHODS Seventy patients ASA I-II undergoing combined epidural and general anaesthesia for hysterectomy were randomly assigned to two groups, Group P where anaesthesia was induced with propofol and fentanyl and maintained with propofol-nitrous oxide and Group S in which anaesthesia was induced with thiopental and fentanyl and maintained with sevoflurane-nitrous oxide. All patients received a ropivacaine epidural bolus with 3 mg morphine 1 h before the end of surgery. The incidence and severity of pruritus were evaluated every 4 h for the first 12 h postoperatively by blinded observers. RESULTS The total incidence of pruritus was significantly higher (P = 0.024) in Group S (65.6%) compared to Group P (29%) between 4 and 8 h postoperatively. There were also significantly more patients (P = 0.03) reporting severe pruritus in Group S (22%) compared to Group P (0). CONCLUSION Propofol-based general anaesthesia compared to thiopental-sevoflurane-based anaesthesia reduces the incidence and severity of pruritus induced by a single injection of 3 mg epidural morphine with ropivacaine.
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Affiliation(s)
- G Kostopanagiotou
- University of Athens, Attikon Hospital, School of Medicine, Athens, Greece
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Dawidowicz AL, Kalitynski R, Kobielski M, Pieniadz J. Influence of propofol concentration in human plasma on free fraction of the drug. Chem Biol Interact 2006; 159:149-55. [PMID: 16318847 DOI: 10.1016/j.cbi.2005.10.108] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Revised: 10/21/2005] [Accepted: 10/24/2005] [Indexed: 11/19/2022]
Abstract
Drugs exist in blood in two forms: free and bound to proteins and blood cells. It is generally assumed that only the unbound form of a drug exerts pharmacological activity as it is able to diffuse across the membranes and reach the site of action. Since for the majority of drugs their free fraction is usually constant, the therapeutic effect of the drug is most often correlated with its total concentration. However, in case of some disease states (e.g. renal or hepatic disorders) the protein concentration may change dramatically, resulting in clinically significant change of free drug fraction. The results presented in the paper prove that, in case of propofol, an increase of free fraction occurs with a decrease of total drug concentration. This dependence is observed both in vitro (in artificial and native human plasma) and in vivo. Free propofol fraction, which in clinical conditions ranges from 1 to 3%, at very low total propofol concentrations (below 0.01 microgml(-1)) tends to reach 100%. This increase of free drug percentage is discussed in terms of its possible reasons as well as its potential clinical relevance.
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Affiliation(s)
- Andrzej L Dawidowicz
- Department of Chromatographic Methods, Faculty of Chemistry, Maria Curie-Sklodowska University, pl. Marii Curie-Sklodowskiej 3, PL 20-031 Lublin, Poland.
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Golembiewski J, Chernin E, Chopra T. Prevention and treatment of postoperative nausea and vomiting. Am J Health Syst Pharm 2005; 62:1247-60; quiz 1261-2. [PMID: 15947124 DOI: 10.1093/ajhp/62.12.1247] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The physiology, risk factors, and prevention and treatment of postoperative nausea and vomiting (PONV) are discussed. SUMMARY Factors to consider when determining a patient's risk for PONV include sex, history of PONV, history of motion sickness, smoking status, duration of anesthesia, use of opioids, and type of surgery. Receptors that, when activated, can cause nausea or vomiting or both include dopamine type 2, serotonin type 3, histamine type 1, and muscarinic cholinergic type 1 receptors. Patients at moderate to high risk for PONV benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, and dexamethasone. In high-risk patients, combining two or more antiemetics with different mechanisms of action has been shown to be more effective than using a single agent. In addition to administering a prophylactic antiemetic, it is important to reduce the patient's risk by considering regional anesthesia, considering inducing and maintaining general anesthesia with propofol, ensuring good intravenous hydration, avoiding hypotension, and providing effective analgesia. If PONV occurs in the immediate postoperative period, it is best treated with an antiemetic agent from a pharmacologic class different from that of the prophylactic agent. CONCLUSION Prophylactic antiemetic therapy for PONV is effective, but combinations of agents may be necessary for high-risk patients. Nonpharmacologic strategies are also important.
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Affiliation(s)
- Julie Golembiewski
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 60612-7230, USA.
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Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period. Eur J Anaesthesiol 2004. [DOI: 10.1097/00003643-200401000-00010] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Unlugenc H, Guler T, Gunes Y, Isik G. Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period. Eur J Anaesthesiol 2003; 20:668-73. [PMID: 12932071 DOI: 10.1017/s026502150300108x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare the antiemetic efficacy of ondansetron with two different hypnotic drugs (propofol 15 mg, midazolam 1 and 2 mg) for the treatment of established postoperative nausea and vomiting (PONV). METHODS Four-hundred-and-fifty-three patients scheduled for elective gynaecological or abdominal surgery were enrolled. One-hundred-and-twenty patients (26%) experienced postoperative emesis, and when nausea scores reached 2 or greater on a five-point scale, they were randomized to receive intravenously: propofol 15 mg (1.5 mL) in Group P, midazolam 1 mg in Group M1, midazolam 2 mg in Group M2 and ondansetron 4 mg in Group O. RESULTS Four patients (13.3%) in Group P, 13 patients (43.3%) in Group M1, five patients (16.6%) in Group M2 and one patient (3.3%) in Group O required a second dose of the study drug. After administration of the study drugs, nausea scores were significantly lower in all groups than before these drugs were given. No patient had a sedation score over 3 (the patients remained awake and/or responded to verbal contact). The sedative effects of midazolam and propofol lasted for a much shorter time than the antiemetic effects of these drugs. CONCLUSIONS Propofol and midazolam used in subhypnotic doses were as effective as ondansetron in treating PONV in patients undergoing abdominal or gynaecological surgery without untoward sedative or cardiovascular effects.
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Affiliation(s)
- H Unlugenc
- Cukurova University, Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey.
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Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period. Eur J Anaesthesiol 2003. [DOI: 10.1097/00003643-200308000-00014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schwieler L, Delbro DS, Engberg G, Erhardt S. The anaesthetic agent propofol interacts with GABA(B)-receptors: an electrophysiological study in rat. Life Sci 2003; 72:2793-801. [PMID: 12679195 DOI: 10.1016/s0024-3205(03)00182-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The mode of action by which propofol induces anaesthesia is not fully understood, although several studies suggest that the compound acts via potentiation of brain GABA(A)-receptors. The aim of the present study is to investigate a putative GABA(B)-receptor agonistic action of propofol. For this purpose the action of propofol on a GABA-receptor mediated regulation of dopamine neurons was analyzed with extracellular single unit recordings of dopaminergic neurons of the substantia nigra in chloral hydrate anaesthetized rats. Intravenous administration of propofol (1-16 mg/kg) was found to dose-dependently decrease the firing rate and burst firing activity of nigral DA neurons. These effects by propofol were effectively antagonized by pretreatment with the selective GABA(B)-receptor antagonist CGP 35348 (200 mg/kg, i.v.) but not by pretreatment with the GABA(A)-receptor antagonist picrotoxin (4.5 mg/kg, i.v.). It is proposed that an activation of central GABA(B)-receptors may, at least partially, contribute to the anesthetic properties of propofol.
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Affiliation(s)
- L Schwieler
- Department of Physiology and Pharmacology, Karolinska Institute, 171 77, Stockholm, Sweden
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Viviand X, Fabre G, Ortéga D, Dayan A, Boubli L, Martin C. Target-controlled sedation-analgesia using propofol and remifentanil in women undergoing late termination of pregnancy. Int J Obstet Anesth 2003; 12:83-8. [PMID: 15321493 DOI: 10.1016/s0959-289x(02)00155-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Twenty-one women undergoing termination of pregnancy for severe fetal abnormality received remifentanil and propofol using a target-controlled infusion system and were studied prospectively. Target concentrations were initially set at 1 ng.mL(-1) for remifentanil and 0.8 microg.mL(-1) for propofol. Remifentanil concentration was adjusted to obtain visual analog scores <50 mm with preservation of ventilation. Visual analog scores assessed by the patients and physiologic data were recorded every 15 min until delivery. The median duration of administration was 150 min [10th-90th centiles: 42-282 min). Visual analog scores decreased within the first 5 min (P < 0.05) and remained under 50 mm for 91.7% of time. The median rate of infusion of remifentanil was 0.056 microg.kg(-1) min(-1) [10th-90th centiles: 0.037-0.15 ng.mL(-1)]. At delivery, the median target concentration was 2.2 ng.mL(-1) [10th-90th centiles: 1.25-4 ng.mL(-1)] for remifentanil and 0.8 microg.mL(-1) [10th-90th centiles: 0.32-1.12 microg.mL(-1)] for propofol. Remifentanil requirements were statistically correlated to gestational age, parity and duration of labor. No episodes of ventilatory depression, nausea, vomiting or pruritus were noted. Patients scored analgesia as excellent in 12 cases, good in 7 cases and moderate in 2 cases. Further studies are required to determine the place and the best regimen of remifentanil infusion for pain management in labor in those cases when epidural analgesia is contraindicated.
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Affiliation(s)
- X Viviand
- Department of Anesthesia, Hôpital Nord, Marseille, France.
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Dunn HG, Stoessl AJ, Ho HH, MacLeod PM, Poskitt KJ, Doudet DJ, Schulzer M, Blackstock D, Dobko T, Koop B, de Amorim GV. Rett syndrome: investigation of nine patients, including PET scan. Can J Neurol Sci 2002; 29:345-57. [PMID: 12463490 DOI: 10.1017/s0317167100002213] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We describe nine females with Rett Syndrome (RS), aged 14 to 26 years. All had had developmental delay before the end of their first year and had subsequently regressed to profound dementia with apraxia, ataxia, irregular respirations and often also seizures. METHODS The Revised Gesell developmental assessment and Alpern-Boll Developmental Profile were used in modified form. Volumetric measurements of basal ganglia using MRI were compared with the findings in nine age-matched volunteer females. Positron emission scans with [18F]-6-fluorodopa and [11C]-raclopride were performed under light anesthesia with intravenous Propofol, and the findings were compared with those in healthy control girls. Bidirectional sequencing of the coding regions of the MECP2 gene was investigated in blood samples for mutational analyses. RESULTS The RS females functioned at a mental age level ranging from about 4 to 15 months. The scores correlated with height, weight and head circumference. Magnetic resonance scans of basal ganglia showed a significant reduction in the size of the caudate heads and thalami in the Rett cases. Positron emission scans demonstrated that the mean uptake of fluorodopa in RS was reduced by 13.1% in caudate and by 12.5% in putamen as compared to the controls, while dopamine D2 receptor binding was increased significantly by 9.7% in caudate and 9.6% in putamen. Mutations in the coding regions of the MECP2 gene were present in all nine patients. No significant correlation between type and location of mutation and volumetric changes or isotope uptake was demonstrable. CONCLUSIONS Our findings suggest a mild presynaptic deficit of nigrostriatal activity in Rett syndrome.
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Affiliation(s)
- Henry G Dunn
- Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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36
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Dawidowicz AL, Kalityński R, Trocewicz J, Nestorowicz A, Fijałkowska A, Trela-Stachurska K. Investigation of propofol renal elimination by HPLC using supported liquid membrane procedure for sample preparation. Biomed Chromatogr 2002; 16:455-8. [PMID: 12378557 DOI: 10.1002/bmc.183] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One of the least explored subjects in the research on the metabolism of a widely used anaesthetic, propofol, is its excretion in an unchanged form. According to literature, the estimated percentage of applied propofol eliminated intact via kidneys is lower than 0.3%. The present study shows the amount of propofol excreted in an unchanged form with urine collected during the first 48 h after anaesthesia in five patients undergoing elective intracranial procedures. The drug was concentrated and selectively isolated from urine samples by supported liquid membrane technique and determined by HPLC with fluorescence detection. The amount of unchanged propofol eliminated with urine was approximately (0.004 +/- 0.002)% of the total applied dose. The obtained results may suggest that propofol in an unchanged form is not excreted by kidneys at all provided that all propofol determined in presented study originated from conjugates hydrolysis.
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Affiliation(s)
- Andrzej L Dawidowicz
- Department of Chemical Physics and Physicochemical Separation Methods, Faculty of Chemistry, Maria Curie-Skłodowska University, PL 20-031 Lublin, Maria Curie-Skłodowska Sq. 3, Poland.
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Scheuller MC, Ellison D. Laryngeal mask anesthesia with intraoperative laryngoscopy for identification of the recurrent laryngeal nerve during thyroidectomy. Laryngoscope 2002; 112:1594-7. [PMID: 12352669 DOI: 10.1097/00005537-200209000-00011] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS A critical step in thyroidectomy involves definitive identification of the recurrent laryngeal nerve (RLN). Using the laryngeal mask airway, identification of the RLN can be facilitated by stimulation of the nerve while monitoring vocal cord movement with a fiberoptic laryngoscope. We present this technique as an effective and safe means to identify the RLN during thyroid surgery, with significant advantages over existing techniques in appropriately selected patients. STUDY DESIGN Retrospective case series. METHODS We performed thyroidectomy on 8 patients (13 RLN identifications) in which laryngeal mask airway anesthesia with fiberoptic laryngoscopy was used to identify the RLN. Results are reviewed with regard to postoperative vocal cord function, as well as intraoperative and postoperative courses with laryngeal mask airway anesthesia. RESULTS In all 13 cases in which the RLN was sought, it was definitively identified by witnessing brisk vocal cord movement on a video screen with stimulation of the RLN. No patient had postoperative vocal cord paresis or paralysis. Overall recovery from laryngeal mask airway anesthesia was uneventful and had advantages when compared with general anesthesia with endotracheal intubation. CONCLUSIONS Laryngeal mask airway anesthesia with intraoperative fiberoptic laryngoscopy to identify the RLN is effective and safe in carefully selected patients. Advantages include decreased postoperative throat discomfort, absence of coughing during emergence from anesthesia, and elimination of the possibility of vocal cord mobility impairment secondary to RLN ischemia from the endotracheal tube balloon. In addition, this technique is applicable in operations besides thyroid surgery, in which definitive identification of the RLN is indicated.
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Affiliation(s)
- Michael C Scheuller
- Department of Otolaryngology, University of California San Francisco, 94143-0342, USA.
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Hammas B, Thörn SE, Wattwil M. Superior prolonged antiemetic prophylaxis with a four-drug multimodal regimen - comparison with propofol or placebo. Acta Anaesthesiol Scand 2002; 46:232-7. [PMID: 11939911 DOI: 10.1034/j.1399-6576.2002.460302.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of this study was to compare the effects of a low-dose propofol infusion with a four-drug multimodal regimen for prophylaxis of postoperative nausea and vomiting (PONV). METHODS : PONV was studied in two patient groups with a known high incidence. Through a stratified randomization, 60 patients undergoing breast surgery and 120 patients undergoing abdominal surgery were randomized to three groups of equal size: the propofol group (P), the multidrug group (M) and the control group (C). All patients received general anesthesia, induction with propofol and maintenance with sevoflurane. After induction, patients in the P group received a continuous infusion of propofol 1 mg/kg/h during the operation and the first 4 postoperative h. Patients in the M group received dexamethasone 4 mg and three antiemetics, ondansetron 4 mg, droperidol 1.25 mg and metoclopramide 10 mg i.v. In the control group no prophylaxis was given. Nausea and pain were evaluated by incidence and a visual analog scale (0-10 cm). All emetic episodes were noted by the staff during the first 4 h and by the patients during the next 20 h. RESULTS The overall incidence of PONV during the first 24 h postoperatively was significantly lower in the M group (24%) than in the P group (49%) (P<0.01) or the C group (70%) (P<0.001). The incidence of PONV increased significantly both in patients undergoing breast surgery and abdominal surgery after termination of propofol. The number of patients who vomited was significantly lower in the M group, both in breast surgery patients (5%) and abdominal surgery patients (3%) compared to patients in the propofol groups (breast 16% NS; abdominal 29%, P<0.05) and in the control groups (breast 37%, P<0.01; abdominal 29%, P<0.01). CONCLUSION The incidence of PONV is very high in patients undergoing breast and abdominal surgery. In the present study antiemetic prophylaxis with a combination of droperidol, ondansetron, metoclopramide and dexamethasone was more effective in preventing PONV, especially vomiting, than a postoperative low-dose infusion of propofol, which had a short lasting effect.
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Affiliation(s)
- B Hammas
- Department of Anesthesia and Intensive Care, Orebro Medical Center Hospital, Orebro, Sweden
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Yoon HD, Yoon ES, Dhong ES, Park SH, Han SK, Koo SH, Kim WK. Low-dose propofol infusion for sedation during local anesthesia. Plast Reconstr Surg 2002; 109:956-63. [PMID: 11884816 DOI: 10.1097/00006534-200203000-00023] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The safety and efficacy of lose-dose propofol for sedation were investigated on 90 consenting patients who had undergone surgical procedures with local anesthesia. After being premedicated with intravenous midazolam 0.05 mg.kg(-1), all patients were randomly divided into two groups and received intravenously either a loading dose of propofol 0.8 mg.kg(-1) followed by a continuous infusion of propofol 30 microg.kg(-1)min(-1) (propofol group) or an equivalent volume of saline (placebo group) during operation. Study groups were compared with respect to the level of sedation, hemodynamic variables, oxygen saturation, and the incidence of intraoperative side effects. In addition, the discharge time and the satisfaction of both patients and surgeons with this sedative technique were assessed. Propofol reduced patients' discomfort and lowered their arterial pressure and heart rate during the infiltration of local anesthetics. It also promoted an adequate level of sedation without clinically significant oxygen desaturation in the intraoperative period. Surgeons and patients in the propofol group showed a higher level of satisfaction than those in the placebo group. There was no significant difference between the two groups with regard to the incidence of adverse effects and the discharge time. In conclusion, it was found that the use of low-dose propofol infusion was a safe and effective sedative technique for local anesthesia.
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Affiliation(s)
- Hee-Dong Yoon
- Department of Anesthesiology, College of Medicine, Korea University Ansan Hospital, 516 Gogan-Dong, Ansan-City, Kyong gi-Do, 425-020 Republic of Korea
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Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia 2002; 43:146-53. [PMID: 11903460 DOI: 10.1046/j.1528-1157.2002.28501.x] [Citation(s) in RCA: 347] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND New continuous infusion antiepileptic drugs (cIV-AEDs) offer alternatives to pentobarbital for the treatment of refractory status epilepticus (RSE). However, no prospective randomized studies have evaluated the treatment of RSE. This systematic review compares the efficacy of midazolam (MDL), propofol (PRO), and pentobarbital (PTB) for terminating seizures and improving outcome in RSE patients. METHODS We performed a literature search of studies describing the use of MDL, PRO, or PTB for the treatment of RSE published between January 1970 and September 2001, by using MEDLINE, OVID, and manually searched bibliographies. We included peer-reviewed studies of adult patients with SE refractory to at least two standard AEDs. Main outcome measures were the frequency of immediate treatment failure (clinical or electrographic seizures occurring 1 to 6 h after starting cIV-AED therapy) and mortality according to choice of agent and titration goal (cIV-AED titration to "seizure suppression" versus "EEG background suppression"). RESULTS Twenty-eight studies describing a total of 193 patients fulfilled our selection criteria: MDL (n = 54), PRO (n = 33), and PTB (n = 106). Forty-eight percent of patients died, and mortality was not significantly associated with the choice of agent or titration goal. PTB was usually titrated to EEG background suppression by using intermittent EEG monitoring, whereas MDL and PRO were more often titrated to seizure suppression with continuous EEG monitoring. Compared with treatment with MDL or PRO, PTB treatment was associated with a lower frequency of short-term treatment failure (8 vs. 23%; p < 0.01), breakthrough seizures (12 vs. 42%; p < 0.001), and changes to a different cIV-AED (3 vs. 21%; p < 0.001), and a higher frequency of hypotension (systolic blood pressure <100 mm Hg; 77 vs. 34%; p < 0.001). Compared with seizure suppression (n = 59), titration of treatment to EEG background suppression (n = 87) was associated with a lower frequency of breakthrough seizures (4 vs. 53%; p < 0.001) and a higher frequency of hypotension (76 vs. 29%; p < 0.001). CONCLUSIONS Despite the inherent limitations of a systematic review, our results suggest that treatment with PTB, or any cIV-AED infusion to attain EEG background suppression, may be more effective than other strategies for treating RSE. However, these interventions also were associated with an increased frequency of hypotension, and no effect on mortality was seen. A prospective randomized trial comparing different agents and titration goals for RSE with obligatory continuous EEG monitoring is needed.
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Affiliation(s)
- Jan Claassen
- Department of Neurology, Division of Critical Care Neurology, and the Comprehensive Epilepsy Center, Neurological Institute, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
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Teshima D, Nagahama H, Makino K, Kataoka Y, Oishi R. Microanalysis of propofol in human serum by semi-microcolumn high-performance liquid chromatography with UV detection and solid-phase extraction. J Clin Pharm Ther 2001; 26:381-5. [PMID: 11679029 DOI: 10.1046/j.1365-2710.2001.00375.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop a simple analytical method for monitoring the low serum levels of propofol found when administered for the sedation of patients in the intensive care unit (ICU). METHODS A high-performance liquid chromatographic method (HPLC) was used with UV detection. Solid-phase extraction (SPE) cartridges and a semi-microcolumn (TSK gel ODS-80Ts, 2.0 mm i.d. x 25 cm, 5 microm) were used to improve sensitivity. Propofol in the eluate obtained from the SPE cartridge was concentrated to about five times the initial concentration. RESULTS The sensitivity using the semi-microcolumn was amplified by about three-fold. The assay showed a good linearity with a quantification limit 20 ng/mL. Intra- and inter-assay coefficients of variation were less than 2.2% and 10.0%, respectively. The mean recoveries ranged from 97.6 to 109.5%. CONCLUSION The HPLC method described should be useful for measuring the low serum propofol levels found when the drug is used for ICU sedation.
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Affiliation(s)
- D Teshima
- Department of Hospital Pharmacy, Faculty of Medicine, Kyushu University, Maidashi, Fukuoka, Japan.
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Abstract
OBJECTIVE The purpose of this study was to evaluate whether propofol abolishes morphine-induced effects on gastric emptying and gastric tone. METHOD The study was carried out before anesthesia in 40 patients (ASA I-II). Gastric tone was measured in 20 patients by an electronic barostat. Volume changes were thereby registered continuously in an intragastric flaccid bag with a constant preset pressure. All patients received i.v. morphine 0.1 mg x kg(-1) before the measurements and, in a randomized order, 10 of the patients also received a bolus dose of propofol 1 mg. kg-1 before morphine. Gastric emptying was studied with the paracetamol method in 20 patients. All patients received morphine 0.1 mg x kg(-1) i.v. 10 min before oral ingestion of 1.5 g paracetamol in 200 ml water and, in a randomized order, 10 of the patients also received propofol, a bolus dose of 0.3 mg x kg(-1) before morphine, followed by an infusion of 1 mg x kg(-1) x h(-1) during the whole study (2 h). RESULTS The volume in the intragastric bag increased in all patients receiving morphine without propofol. In the group that received propofol before morphine, the volume in the intragastric bag decreased in all patients. The volume differences between the groups were statistically significant (P<0.01). There were no statistically significant differences of the AUC60, Cmax and Tmax of serum paracetamol concentrations between the morphine and propofol-morphine groups. CONCLUSION Propofol did not abolish morphine-induced delay of gastric emptying even if propofol abolished the decrease of gastric tone induced by morphine.
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Affiliation(s)
- B Hammas
- Department of Anesthesiology and Intensive Care, Orebro Medical Center Hospital, Orebro, Sweden.
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Leijten FS, Teunissen NW, Wieneke GH, Knape JT, Schobben AF, van Huffelen AC. Activation of interictal spiking in mesiotemporal lobe epilepsy by propofol-induced sleep. J Clin Neurophysiol 2001; 18:291-8. [PMID: 11528301 DOI: 10.1097/00004691-200105000-00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to test whether low-dose propofol increases the number of interictal spikes in patients with mesiotemporal lobe epilepsy, and to determine whether this is the result of intrinsic properties and is restricted to the primary epileptogenic focus. Controlled infusion of propofol in step-up/-down target concentrations of 0, 0.3, 0.6, and 0.8 mg/L was administered to 10 patients during a 3.5-hour daytime EEG registration. The number of spikes were counted and related to propofol concentration and sleep level. Results were compared with a spontaneous, nocturnal first sleep cycle in 9 of 10 patients. All patients entered nonrapid eye movement 1 sleep during propofol administration, and 8 reached nonrapid eye movement 2 sleep. In 7 patients who showed spikes, spikes were related to sleep (P < 0.05) and not to increasing (P = 0.1) or decreasing (P = 0.5) propofol concentration. Six of nine patients showed more spikes during spontaneous (nocturnal) sleep than during propofol-induced sleep. Contralateral spiking was not suppressed selectively. Low-dose propofol is a safe means of increasing spiking in these patients because it induces sleep. There were no signs of an intrinsic epileptogenicity of propofol or a selective effect on ipsilateral spikes. Controlled sleep induction will increase the yield of interictal spikes during short interictal recordings such as in magnetoencephalography.
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Affiliation(s)
- F S Leijten
- Department of Clinical Neurophysiology, University Medical Centre, Utrecht, The Netherlands
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Rhoney DH, Parker D. Use of sedative and analgesic agents in neurotrauma patients: effects on cerebral physiology. Neurol Res 2001; 23:237-59. [PMID: 11320605 DOI: 10.1179/016164101101198398] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sedation and analgesia is used primarily in the intensive care unit (ICU) to limit the stress response to critical illness, provide anxiolysis, improve ventilatory support, and facilitate adequate ICU care. However, in the neurotrauma ICU there are many other reasons for the use of these agents. The primary aim is to prevent secondary cerebral damage by maintaining adequate cerebral perfusion pressures. This is accomplished in several different ways. Controlling intracranial pressure (ICP) and maintaining an adequate mean arterial pressure (MAP) is at the cornerstone of this management. Lowering the metabolic demands of the brain is also an important consideration as a treatment strategy. Analgesic and sedative agents are utilized to prevent undesirable increases in ICP and to lower cerebral metabolic demands. Concerns surrounding the use of these agents include time to awakening after discontinuation, effect on the cerebrovasculature, and the effect on patient outcome. There are many different pharmacological agents available, each with their distinct advantages and disadvantages. The purpose of this review is to evaluate the pharmacokinetic and pharmacological effects of each of these agents when used in neurotrauma patients.
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Affiliation(s)
- D H Rhoney
- Departments of Pharmacy Practice and Neurology, Wayne State University and Detroit Receiving Hospital, Detroit, MI, USA.
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LeBlanc JG, Blackstock D, Macnab AJ, Gagnon F, Gagnon R, Russell J, Ring T. Effects of propofol on cerebral oxygenation during cardiopulmonary bypass in children. Can J Anaesth 2000; 47:1082-9. [PMID: 11097537 DOI: 10.1007/bf03027959] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Neurologic complications occur following cardiopulmonary bypass surgery. We conducted a randomized, controlled, single-blind study to determine the effect of propofol on the redox status of cytaa3, and to evaluate its potential for decreasing neurologic complications. METHODS AND MATERIALS Twenty-four children (median age: 3.3 yr; median weight: 14.4 kg) scheduled for elective cardiopulmonary bypass surgery were assigned to either the experimental group (Group P, given sufficient propofol to eliminate brain electrical activity as measured on EEG (i.e. burst suppression)) or the control group (Group C, no propofol). Near infrared spectroscopy data were collected at one-second intervals throughout the surgical procedures. Pre- and postoperative neurologic examinations were completed by a physician blinded to the group to which the patient was assigned. Change in cytochrome aa3 data at 10-min intervals (10, 20, 30, 40 min) following start of bypass were compared between groups by repeated measures analysis of variance. RESULTS The patterns of change in redox state of cytochrome were different between the two groups (P < 0.002). The pattern of change within Group P was similar to that in hypothermic patients in Group C. There were correlations between change in cytaa3 redox status and temperature in the control subjects. There were no gross neurologic complications in either group. CONCLUSIONS Propofol appears to stabilize the energy supply/demand equilibrium of the brain during cardiopulmonary bypass surgery and thus theoretically could reduce the incidence or severity of neurologic complications.
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Affiliation(s)
- J G LeBlanc
- Division of Cardiovascular and Thoracic Surgery, Children's and Women's Hospital of British Columbia, University of British Columbia, Vancouver, Canada.
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Hocking G, Balmer HG. A single sub-anaesthetic dose of propofol to reduce patient recall of peribulbar block. J ROY ARMY MED CORPS 2000; 146:196-8. [PMID: 11143688 DOI: 10.1136/jramc-146-03-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We audited a total of 1233 patients scheduled for elective cataract extraction or trabeculectomy using peri-bulbar anaesthesia. A bolus of propofol provided sedation to cover insertion of the block. During an initial two-year period we collected data on the amount of propofol used to sedate 481 patients. Multiple linear regression analysis was then used to obtain an equation to link the dose used to age and weight in those who were adequately sedated. The dose of propofol in milligrams was calculated as 56 + 0.25 x weight (kg) - 0.53 x age (yrs). We subsequently assessed the effectiveness of this formula at abolishing recall of the injections whilst not compromising the airway on a further 752 patients. This simple regime was effective at abolishing recall of the block in 78.6% of the patients studied and avoids the cost and logistic implications of more complicated drug delivery systems. Use of the formula does not significantly alter the incidence of recall compared to sedation provided by an experienced ophthalmic anaesthetist. We hope it will provide a guide for more junior anaesthetists to obtain the satisfactory sedation level that comes with experience.
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Affiliation(s)
- G Hocking
- Department of Anaesthesia, MDHU Frimley Park Hospital, Frimley, Camberley, Surrey, GU16 5UJ.
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47
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Treepongkaruna S, Lee K, Giltinan D, Catto-Smith AG. School absenteeism after upper gastrointestinal endoscopy in children. J Gastroenterol Hepatol 2000; 15:555-62. [PMID: 10847444 DOI: 10.1046/j.1440-1746.2000.02204.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS To examine the functional impact of upper gastrointestinal endoscopy as a day procedure, particularly in relation to subsequent school attendance. METHODS Symptoms and morbidities were prospectively recorded from school-aged children during observation in hospital and for 3 days at home after endoscopy by using a structured questionnaire. Reasons for school absence were identified. RESULTS Sixty children (31 boys, 29 girls) were enrolled in the study (mean age 10.6 +/- 2.8 years, range 6.1-16.2 years). Following the procedure, symptoms were reported at home in 68.3% (same day), 56.7% (day 1) and 20% (day 2).The commonest symptoms were sore throat, tiredness and dizziness. Twenty-nine children (48.3%) did not attend school on the day following the procedure but most (26 of 29) had returned to school by the second day. The main reason for their absence was residual physical discomfort related to the procedure (55.2%). CONCLUSIONS Persisting physical discomfort and school absenteeism are common following upper gastrointestinal endoscopy in children.
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Affiliation(s)
- S Treepongkaruna
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia
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Horta ML, Ramos L, Gonçalves ZR. The inhibition of epidural morphine-induced pruritus by epidural droperidol. Anesth Analg 2000; 90:638-41. [PMID: 10702450 DOI: 10.1097/00000539-200003000-00025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED IV droperidol inhibits epidural morphine-induced pruritus, but this effect disappears when the dose is increased from 2.5 to 5.0 mg. This study was performed to determine whether epidural droperidol would have a similar effect. In this double-blinded study, we enrolled 140 patients undergoing Cesarean delivery under epidural anesthesia who were randomly allocated to four groups. Anesthesia consisted of 150 mg of 0.5% bupivacaine with 1:200,000 epinephrine, with 2 mg of morphine and 0.0, 1.25, 2.5, or 5.0 mg of droperidol (Groups 1 to 4). During the postoperative period, patients were assessed for pruritus (absent, mild, moderate, or severe) and other untoward symptoms. The chi(2) test was used to compare the incidence of the side effects. For the analysis of pruritus, we used the Mantel-Haenszel test for linear association. Droperidol induced a dose-related reduction in the incidence of pruritus (P < 0.001). This reduction was independent of the incidence of somnolence, which increased with droperidol dose (P < 0.05 when the incidence of somnolence in Groups 1 and 4 was compared). We conclude that droperidol, in doses up to 5 mg epidurally, induces a dose-related reduction in the incidence of pruritus without inducing significant side effects. IMPLICATIONS Epidural morphine is effective for pain control but yields some side effects, including pruritus, that can be severe. Studying patients undergoing Cesarean delivery, we found a dose-related reduction in the incidence of pruritus using epidural droperidol.
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Affiliation(s)
- M L Horta
- Departments of Anesthesiology, Santa Casa de Misericórdia de Pelotas, and Hospital Universitário São Francisco de Paula da UCPEL, Pelotas, RS, Brazil. marcio
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Grouzmann E, Borgeat A, Fathi M, Gaillard RC, Ravussin P. Plasma and cerebrospinal fluid concentrations of neuropeptide Y, serotonin, and catecholamines in patients under propofol or isoflurane anesthesia. Can J Physiol Pharmacol 2000. [DOI: 10.1139/y99-122] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Propofol is a widely used anesthetic for both induction and maintenance of anesthesia during surgery. A strong feeling of hunger has been reported during the early recovery period after propofol anesthesia. We have investigated the effect of propofol on appetite in 10 patients undergoing a craniotomy and in parallel measured neuropeptide Y (NPY), catecholamines, and serotonin levels in the cerebrospinal fluid and plasma during anesthesia. Ten patients anesthetized with a volatile agent (isoflurane) served as a control group. Plasma NPY and catecholamines levels were not affected by surgery at any time. We observed a strong increase in NPY concentrations in the cerebrospinal fluid independently of the anesthetic technique agent used, whereas catecholamines were unchanged. We found that serotonin concentrations decreased significantly in the plasma (but not in the cerebrospinal fluid) of patients treated by propofol when compared with the control group; this decrease was associated with an increase of hunger early postoperatively. We concluded that the proappetite effect of propofol is mediated through a decrease of serotonin at the peripheral level.Key words: catecholamines, serotonin, neuropeptide Y (NPY), cerebrospinal fluid, serum, appetite.
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Adachi YU, Uchihashi Y, Watanabe K, Satoh T. Small dose midazolam or droperidol reduces the hypnotic dose of propofol at the induction of anaesthesia. Eur J Anaesthesiol 2000; 17:126-31. [PMID: 10758457 DOI: 10.1046/j.1365-2346.2000.00624.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We investigated the effect of a small dose of midazolam, ketamine, droperidol or lidocaine on the propofol dose required for hypnosis during induction of general anaesthesia. These drugs were randomly administered to 100 patients about to undergo scheduled surgery. Propofol was then infused at a rate of 250 microg kg-1 min-1 and the hypnotic dose to produce hypnosis was evaluated. Midazolam (20 microg kg-1) and droperidol (20 microg kg-1) significantly reduced the mean hypnotic dose of propofol (mean) S.D.) compared with the placebo (43.7 +/- 17.8 mg, 61.9 +/- 10.6 mg and 72.5 +/- 27.7 mg after pretreatment with midazolam, droperidol and placebo, respectively), whereas ketamine (0.1 mg kg-1) and lidocaine (1 mg kg-1) did not significantly affect the hypnotic dose of propofol (63. 1 +/- 25.6 mg and 65.1 +/- 24.8 mg, respectively). Only midazolam when compared with saline administration, (176 +/- 66 s and 298 +/- 126 s, respectively), shortened the time to achieve hypnosis. The changes in blood pressure (non-invasive) and heart rate were not significantly different in all groups during the induction of anaesthesia and oro-tracheal intubation. These results raise the possibility that new combinations of central nervous system drugs, such as droperidol and propofol, have a potential to reduce the dose of intravenous anaesthetics, including propofol, that produce hypnosis without significant adverse effects.
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Affiliation(s)
- Y U Adachi
- Department of Anesthesiology, National Defense Medical College, Tokorozawa City, Saitama, Japan
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