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Arginase II polymorphisms modify the hypotensive responses to propofol by affecting nitric oxide bioavailability. Eur J Clin Pharmacol 2021; 77:869-877. [PMID: 33410970 DOI: 10.1007/s00228-020-03059-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Propofol anesthesia is usually accompanied by hypotensive responses, which are at least in part mediated by nitric oxide (NO). Arginase I (ARG1) and arginase II (ARG2) compete with NO synthases for their common substrate L-arginine, therefore influencing the NO formation. We examined here whether ARG1 and ARG2 genotypes and haplotypes affect the changes in blood pressure and NO bioavailability in response to propofol. METHODS Venous blood samples were collected from 167 patients at baseline and after 10 min of anesthesia with propofol. Genotypes were determined by polymerase chain reaction. Nitrite concentrations were measured by using an ozone-based chemiluminescence assay, while NOx (nitrites + nitrates) levels were determined by using the Griess reaction. RESULTS We found that patients carrying the AG + GG genotypes for the rs3742879 polymorphism in ARG2 gene and the ARG2 GC haplotype show lower increases in nitrite levels and lower decreases in blood pressure after propofol anesthesia. On the other hand, subjects carrying the variant genotypes for the rs10483801 polymorphism in ARG2 gene show more intense decreases in blood pressure (CA genotype) and/or higher increases in nitrite levels (CA and AA genotypes) in response to propofol. CONCLUSION Our results suggest that ARG2 variants affect the hypotensive responses to propofol, possibly by modifying NO bioavailability. TRIAL REGISTRATION NCT02442232.
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2
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Dalla K, Bech-Hanssen O, Ricksten SE. General anesthesia and positive pressure ventilation suppress left and right ventricular myocardial shortening in patients without myocardial disease - a strain echocardiography study. Cardiovasc Ultrasound 2019; 17:16. [PMID: 31400770 PMCID: PMC6689330 DOI: 10.1186/s12947-019-0165-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/28/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Myocardial deformation imaging using speckle-tracking echocardiography to assess global longitudinal strain (GLS) is today considered a more sensitive measure of left ventricular (LV) systolic function than ejection fraction. General anesthesia and positive pressure ventilation (PPV) are known to change the right ventricular (RV) and LV loading conditions. However, little is known about the effects of anesthesia and PPV on RV free wall and LV GLS. We studied the influence of general anesthesia and PPV on RV and LV longitudinal strain in patients without myocardial disease. METHODS Twenty-one patients scheduled for non-cardiac surgery were included. The baseline examination was performed on the un-premedicated patients within 60 min of anesthesia. The second examination was performed 10-15 min after induction of anesthesia (propofol, remifentanil), intubation and start of PPV. The examinations included apical four-, two- and three-chamber projections, mitral and aortic Doppler flow velocities and tissue Doppler velocities of tricuspid and mitral annulus. LV end-systolic elastance (Ees) and aortic elastance were determined (Ea). RESULTS General anesthesia and PPV reduced the mean arterial blood pressure (- 29%, p < 0.0019), stroke volume index (- 13%, p < 0.001) and cardiac index (- 23%, p < 0.001). RV end-diastolic area index and LV end-diastolic volume index decreased significantly, while systemic vascular resistance was not significantly affected. Ees decreased significantly with the induction of anaesthesia (- 23%, p = 0.002), while there was a trend for a decrease in Ea (p = 0.053). The ventriculo-arterial coupling, Ea/Ees, was not significantly affected by the anesthetics and PPV. The LV GLS decreased from - 19.1 ± 2.3% to - 17.3 ± 2.9% (p < 0.001) and RV free wall strain decreased from - 26.5 ± 3.9% to - 24.1 ± 4.2% (p = 0.001). One patient (5%) had at baseline a LV GLS > - 16% compared with 6 patients (28%) during general anesthesia and PPV. Three patients (14%) had a RV free wall strain > - 24% compared to 8 patients (38%) during general anesthesia and PPV. CONCLUSIONS General anesthesia and PPV reduces systolic LV and RV function to levels considered indicating dysfunction in a substantial proportion of patients without myocardial disease.
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Affiliation(s)
- Keti Dalla
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Hino H, Matsuura T, Kihara Y, Tsujikawa S, Mori T, Nishikawa K. Comparison between hemodynamic effects of propofol and thiopental during general anesthesia induction with remifentanil infusion: a double-blind, age-stratified, randomized study. J Anesth 2019; 33:509-515. [DOI: 10.1007/s00540-019-02657-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022]
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4
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Shen T, Huh MH, Czer LS, Vaidya A, Esmailian F, Kobashigawa JA, Nurok M. Controversies in the Postoperative Management of the Critically Ill Heart Transplant Patient. Anesth Analg 2019; 129:1023-1033. [PMID: 31162160 DOI: 10.1213/ane.0000000000004220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Heart transplant recipients are susceptible to a number of complications in the immediate postoperative period. Despite advances in surgical techniques, mechanical circulatory support (MCS), and immunosuppression, evidence supporting optimal management strategies of the critically ill transplant patient is lacking on many fronts. This review identifies some of these controversies with the aim of stimulating further discussion and development into these gray areas.
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Affiliation(s)
- Tao Shen
- From the Departments of Anesthesiology.,Surgery, Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Lawrence S Czer
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Ajay Vaidya
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Jon A Kobashigawa
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Michael Nurok
- From the Departments of Anesthesiology.,Surgery, Cedars-Sinai Heart Institute, Los Angeles, California
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5
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Oliveira-Paula GH, Lacchini R, Pinheiro LC, Ferreira GC, Luizon MR, Garcia WNP, Garcia LV, Tanus-Santos JE. Endothelial nitric oxide synthase polymorphisms affect the changes in blood pressure and nitric oxide bioavailability induced by propofol. Nitric Oxide 2018; 75:77-84. [PMID: 29496565 DOI: 10.1016/j.niox.2018.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/14/2018] [Accepted: 02/23/2018] [Indexed: 11/26/2022]
Abstract
Propofol anesthesia is usually accompanied by hypotension, which is at least in part related to enhanced endothelial nitric oxide synthase (NOS3)-derived NO bioavailability. We examined here whether NOS3 polymorphisms (rs2070744, 4b/4a VNTR, rs3918226 and rs1799983) and haplotypes affect the changes in blood pressure and NO bioavailability induced by propofol. Venous blood samples were collected from 168 patients at baseline and after 10 min of anesthesia with propofol 2 mg/kg administered intravenously by bolus injection. Genotypes were determined by polymerase chain reaction and haplotype frequencies were estimated. Nitrite concentrations were measured by using an ozone-based chemiluminescence assay, while NOx (nitrites + nitrates) levels were determined by using the Griess reaction. We found that CT + TT genotypes for the rs3918226 polymorphism, the ba + aa genotypes for the 4b/4a VNTR and the CTbT haplotype were associated with lower decreases in blood pressure and lower increases in nitrite levels after propofol anesthesia. On the other hand, the TCbT and CCbT haplotypes were associated with more intense decreases in blood pressure and higher increases in nitrite levels in response to propofol. Our results suggest that NOS3 polymorphisms and haplotypes influence the hypotensive responses to propofol, possibly by affecting NO bioavailability.
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Affiliation(s)
- Gustavo H Oliveira-Paula
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Riccardo Lacchini
- Department of Psychiatric Nursing and Human Sciences, Ribeirao Preto College of Nursing, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Lucas C Pinheiro
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Graziele C Ferreira
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Marcelo R Luizon
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Waynice N P Garcia
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Luis V Garcia
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Jose E Tanus-Santos
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil.
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6
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Oliveira-Paula GH, Pinheiro LC, Ferreira GC, Garcia WNP, Lacchini R, Garcia LV, Tanus-Santos JE. Angiotensin converting enzyme inhibitors enhance the hypotensive effects of propofol by increasing nitric oxide production. Free Radic Biol Med 2018; 115:10-17. [PMID: 29138017 DOI: 10.1016/j.freeradbiomed.2017.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/04/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
Propofol anesthesia is usually accompanied by hypotension. Studies have shown that the hypotensive effects of propofol increase in patients treated with angiotensin-converting enzyme inhibitors (ACEi). Given that both propofol and ACEi affect nitric oxide (NO) signaling, the present study tested the hypothesis that ACEi treatment induces pronounced hypotensive responses to propofol by increasing NO bioavailability. In this study we evaluated 65 patients, divided into three groups: hypertensive patients chronically treated with ACEi (HT-ACEi; n = 21), hypertensive patients treated with other antihypertensive drugs instead of ACEi, such as angiotensin II receptor blockers, β-blockers or diuretics (HT; n = 21) and healthy normotensive subjects (NT; n = 23). Venous blood samples were collected at baseline and after 10min of anesthesia with propofol 2mg/kg administrated intravenously by bolus injection. Hemodynamic parameters were recorded at each blood sample collection. Nitrite levels were determined by using an ozone-based chemiluminescence assay, while NOx (nitrites+nitrates) levels were measured by using the Griess reaction. Additionally, experimental approaches were used to validate our clinical findings. Higher decreases in blood pressure after propofol anesthesia were observed in HT-ACEi group as compared with those found in NT and HT groups. Consistently, rats treated with the ACEi enalapril showed more intense hypotensive responses to propofol. The hypotensive effects of propofol were associated with increased NO production in both clinical and experimental approaches. Enhanced increases in nitrite levels after propofol anesthesia were observed in HT-ACEi patients compared with NT and HT groups. Accordingly, rats treated with enalapril showed increased vascular NO formation after propofol anesthesia compared with rats receiving vehicle. Our data show that ACEi enhance the hypotensive responses to propofol anesthesia and increase nitrite concentrations. These findings suggest that increased NO bioavailability may account for the enhanced hypotensive effects of propofol in ACEi-treated patients.
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Affiliation(s)
- Gustavo H Oliveira-Paula
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Lucas C Pinheiro
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Graziele C Ferreira
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Waynice N P Garcia
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Riccardo Lacchini
- Department of Psychiatric Nursing and Human Sciences, Ribeirao Preto College of Nursing, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Luis V Garcia
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Jose E Tanus-Santos
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil.
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Swanson E, Gordon RJ. Comparing a Propofol Infusion With General Endotracheal Anesthesia in Plastic Surgery Patients. Aesthet Surg J 2017; 37:NP48-NP50. [PMID: 28364531 DOI: 10.1093/asj/sjw265] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eric Swanson
- Plastic surgeon in private practice in Leawood, KS, USA
| | - Ronald J Gordon
- Attending Anesthesiologist, University of California, San Diego, La Jolla, CA, USA
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8
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Wouters PF, Van de Velde M, Van Hemelrijck J. Cardiovascular Effects of Propofol. Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1177/108925329700100204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Patrick F. Wouters
- Department of Anesthesiology, University Hospitals Gasthuisberg, and Center forExperimental Surgery and Anesthesiology, Katholieke Universiteit Leuven, Belgium
| | - Marc Van de Velde
- Department of Anesthesiology, University Hospitals Gasthuisberg, and Center forExperimental Surgery and Anesthesiology, Katholieke Universiteit Leuven, Belgium
| | - Jan Van Hemelrijck
- Department of Anesthesiology, University Hospitals Gasthuisberg, and Center forExperimental Surgery and Anesthesiology, Katholieke Universiteit Leuven, Belgium
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Thielmeier KA, Pank JR, Dowling RD, Gray LA. Anesthetic and Perioperative Considerations in Patients Undergoing Placement of Totally Implantable Replacement Hearts. Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/scva.2001.28914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The recent successful implantation of the AbioCor im plantable replacement heart at the Rudd Heart-Lung Institute, Jewish Hospital, Louisville, KY, has renewed clinical interest in the use of the mechanical replace ment heart as therapy for intractable heart failure. Al though the number of orthotopic heart transplants has plateaued in the past decade, the number of patients requiring transplantation continues to increase. This supply/demand discrepancy continues to be the main catalyst for the research and development of other therapies for the failing heart. This review addresses perioperative considerations, monitoring modalities, and perioperative therapeutic interventions that may help guide the cardiac anesthesiologist through the challenges presented by implantation of total replace ment hearts in end-stage cardiac patients.
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Affiliation(s)
- Kenneth A. Thielmeier
- Rudd Heart-Lung Center, Jewish Hospital, Medical Center Anesthesiologists, PSC, Department of Anesthesiology
| | - John R. Pank
- Rudd Heart-Lung Center, Jewish Hospital, Medical Center Anesthesiologists, PSC, Department of Anesthesiology
| | - Robed D. Dowling
- Rudd Heart-Lung Center, Jewish Hospital, Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, KY
| | - Laman A. Gray
- Rudd Heart-Lung Center, Jewish Hospital, Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, KY
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10
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Propofol-induced Inhibition of Catecholamine Release Is Reversed by Maintaining Calcium Influx. Anesthesiology 2016; 124:878-84. [PMID: 26808630 DOI: 10.1097/aln.0000000000001015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Propofol (2,6-diisopropylphenol) is one of the most frequently used anesthetic agents. One of the main side effects of propofol is to reduce blood pressure, which is thought to occur by inhibiting the release of catecholamines from sympathetic neurons. Here, the authors hypothesized that propofol-induced hypotension is not simply the result of suppression of the release mechanisms for catecholamines. METHODS The authors simultaneously compared the effects of propofol on the release of norepinephrine triggered by high K-induced depolarization, as well as ionomycin, by using neuroendocrine PC12 cells and synaptosomes. Ionomycin, a Ca ionophore, directly induces Ca influx, thus bypassing the effect of ion channel modulation by propofol. RESULTS Propofol decreased depolarization (high K)-triggered norepinephrine release, whereas it increased ionomycin-triggered release from both PC12 cells and synaptosomes. The propofol (30 μM)-induced increase in norepinephrine release triggered by ionomycin was dependent on both the presence and the concentration of extracellular Ca (0.3 to 10 mM; n = 6). The enhancement of norepinephrine release by propofol was observed in all tested concentrations of ionomycin (0.1 to 5 μM; n = 6). CONCLUSIONS Propofol at clinically relevant concentrations promotes the catecholamine release as long as Ca influx is supported. This unexpected finding will allow for a better understanding in preventing propofol-induced hypotension.
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11
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Abou-Arab MH, Feiner JR, Spigset O, Heier T. Alfentanil during rapid sequence induction with thiopental 4 mg/kg and rocuronium 0.6 mg/kg: tracheal intubation conditions. Acta Anaesthesiol Scand 2015; 59:1278-86. [PMID: 26176994 DOI: 10.1111/aas.12584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Opioids have become an integral part of anaesthesia induction. We aimed to determine the dose of alfentanil needed to obtain perfect tracheal intubation conditions during rapid sequence induction with standard doses of thiopental and rocuronium, where laryngoscopy was initiated 55 s after commencement of drug administration. The influence of covariates (sex, body weight, age, alfentanil plasma concentration at laryngoscopy) was tested. METHODS Eighty-four healthy individuals were randomly assigned to receive one of the seven assessor-blinded alfentanil doses (0, 10, 20, 30, 40, 50 and 60 μg/kg) in conjunction with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. For drug administration, 15 s was allowed. Laryngoscopy was initiated 40 s after rocuronium and tracheal intubation concluded within 70 s after commencement of drug administration. Alfentanil doses associated with 50%, 90% and 95% probability of perfect intubation conditions were determined with logistic regression. Multiple logistic regressions were used to test the influence of covariates. The relationship between alfentanil dose and concentration at laryngoscopy was analysed with linear regression. The effects of covariates on plasma concentrations of alfentanil were tested with multiple linear regressions. RESULTS Perfect intubation conditions of 95% probability was obtained with 56 μg/kg (confidence intervals 44-68). None of the covariates were significant predictors of perfect intubation conditions. Alfentanil plasma concentration correlated with dose and increased with increasing body weight (1.7 ng/ml/kg). CONCLUSION Perfect intubation conditions during rapid sequence induction can be obtained with clinically relevant doses of alfentanil in most healthy patients anaesthetized with thiopental 4 mg/kg and rocuronium 0.6 mg/kg.
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Affiliation(s)
- M. H. Abou-Arab
- Department of Anesthesia; Division of Emergencies and Critical Care Medicine; Oslo University Hospital; Oslo Norway
| | - J. R. Feiner
- Department of Anesthesia and Perioperative Care; University of California; UCSF; San Francisco CA USA
| | - O. Spigset
- Department of Clinical Pharmacology; St. Olav University Hospital; Trondheim Norway
- Department of Laboratory Medicine, Children's and Women's Health; Norwegian University of Science and Technology; Trondheim Norway
| | - T. Heier
- Department of Anesthesia; Division of Emergencies and Critical Care Medicine; Oslo University Hospital and University of Oslo; Oslo Norway
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12
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Sakai Y, Kawahito S, Takaishi K, Mita N, Kinoshita H, Hatakeyama N, Azma T, Nakaya Y, Kitahata H. Propofol-induced relaxation of rat aorta is altered by aging. THE JOURNAL OF MEDICAL INVESTIGATION 2014; 61:278-84. [PMID: 25264045 DOI: 10.2152/jmi.61.278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Propofol causes vasodilation via endothelium-dependent and -independent mechanisms. Because endothelial function is impaired with aging, the effects of propofol on endothelium-dependent vasodilation might be altered by aging. The aim of this study was thus to determine the effects of aging on vascular responses to propofol. METHODS Young (4-6 weeks old) or adult (16-25 weeks old) rats were anesthetized with sevoflurane. The thoracic aorta was dissected and cut into pieces 3-4 mm in length. In some rings, the endothelium was deliberately removed. The ring segment of the aorta was mounted for isometric force recording at a resting tension of 0.5-1.0 g in a 2 ml organ bath, containing Krebs-Ringer bicarbonate buffer. Arteries were precontracted with phenylephrine, and the function of endothelium was confirmed with acetylcholine. Then, we studied the concentration-dependent effects of propofol in endothelium-intact (control group) and -denuded aortic rings (denuded group), as well as those treated with N(ω)-nitro-L-arginine methylester (L-NAME group). RESULTS Relaxation due to propofol was observed in the control groups of both young and adult rats in a concentration-dependent manner, but the magnitude of relaxation was significantly greater in young rats. In addition, in young rats, relaxation due to propofol was significantly and equally reduced in both L-NAME and denuded groups at all propofol concentrations that we studied (10(-6)-10(-3) M). In adult rats, relaxation due to propofol was quite similar between control and L-NAME groups at all propofol concentrations, whereas it was significantly reduced in the denuded group. CONCLUSION These results suggest that endothelium-derived nitric oxide plays an important role in propofol-induced vasodilation in young rats, but not in adult rats.
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Affiliation(s)
- Yoko Sakai
- Department of Anesthesiology, Tokushima University Hospital
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Yu T, Peng X, Liu L, Li Q, Huang Y, Guo F, Yang Y, Qiu H. Propofol increases preload dependency in septic shock patients. J Surg Res 2014; 193:849-55. [PMID: 25266601 DOI: 10.1016/j.jss.2014.08.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 07/23/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Predicting fluid responsiveness is crucial for fluid administration in septic shock patients. Midazolam and propofol decrease vascular tone and venous return, which may influence preload dependency. However, little is known about the effects of these two sedatives on preload dependency in septic shock patients. We evaluated the effects of sedation with propofol or midazolam on preload dependency in septic shock patients who have been fluid resuscitated. METHODS Forty-three septic shock patients who were undergoing early goal-directed therapy resuscitated within 24 h were enrolled. The patients were randomly divided into the midazolam group and the propofol group. An initial passive leg-raising test (PLR1) was performed to evaluate passive leg raising test (PLR) responsiveness. Then, the patients were infused with midazolam or propofol. After increasing the doses of the sedatives to titrate to a Ramsay 4 score, a second passive leg raising test (PLR2) was conducted to evaluate PLR responsiveness. The primary end-point was the preload dependency before and after sedation with midazolam or propofol. RESULTS In the midazolam-PLR1-negative patients, there was no difference between the changes in the cardiac index induced by PLR1 (PLR1-Δ cardiac function index [CI]) and the changes in the cardiac index induced by PLR2 (PLR2-Δ CI) (+1.4% ± 7.4% versus +1.7% ± 6.4%, P > 0.05). However, in the propofol-PLR1-negative patients, there was a significant increase in the PLR-Δ CI after sedation to a Ramsay 4 score compared with a Ramsay 3 score (+7.3% ± 4.8% versus +3.2% ± 4.7%, P = 0.008). There were no differences between PLR1-Δ CI and PLR2-Δ CI within the midazolam-PLR1-positive patients or within the propofol-PLR1-positive patients. CONCLUSIONS In titrating the sedation level from a Ramsay 3 score to a Ramsay 4 score, propofol but not midazolam increased preload dependency in septic shock patients with fluid nonresponsiveness.
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Affiliation(s)
- Tao Yu
- Department of Critical Care Medicine, Nanjing Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Xiao Peng
- Department of Critical Care Medicine, Nanjing Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Ling Liu
- Department of Critical Care Medicine, Nanjing Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Qing Li
- Department of Critical Care Medicine, Nanjing Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Yingzi Huang
- Department of Critical Care Medicine, Nanjing Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Fengmei Guo
- Department of Critical Care Medicine, Nanjing Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Yi Yang
- Department of Critical Care Medicine, Nanjing Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Haibo Qiu
- Department of Critical Care Medicine, Nanjing Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China.
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Abstract
The structural defects associated with the various forms of congenital heart disease lead to pathological and functional changes that place patients at risk for adverse events, and in fact the perioperative incidence of morbidity and mortality has been documented to be increased in children with congenital heart disease. Patients with congenital heart disease can present to the anesthesiologist in a relatively precarious state of balance of several hemodynamic factors, including preload, ventricular contractility, systemic vascular resistance, pulmonary vascular resistance, heart rate, and cardiac rhythm. Anesthetic drugs can affect each of these, and an ideal anesthetic drug for such patients does not exist. The purpose of this article is to review the hemodynamic effects of anesthetic drugs and how they may contribute to the occurrence of adverse events in children with congenital heart disease.
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Affiliation(s)
- Robert H. Friesen
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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15
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Twite MD, Friesen RH. The anesthetic management of children with pulmonary hypertension in the cardiac catheterization laboratory. Anesthesiol Clin 2014; 32:157-173. [PMID: 24491655 DOI: 10.1016/j.anclin.2013.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Children need cardiac catheterization to establish the diagnosis and monitor the response to treatment when undergoing drug therapy for the treatment of pulmonary arterial hypertension (PAH). Children with PAH receiving general anesthesia for cardiac catheterization procedures are at significantly increased risk of perioperative complications in comparison with other children. The most acute life-threatening complication is a pulmonary hypertensive crisis. It is essential that the anesthesiologist caring for these children understands the pathophysiology of the disease, how anesthetic medications may affect the patient's hemodynamics, and how to manage an acute pulmonary hypertensive crisis.
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Affiliation(s)
- Mark D Twite
- Department of Anesthesiology, University of Colorado School of Medicine, CO, USA.
| | - Robert H Friesen
- Department of Anesthesiology, University of Colorado School of Medicine, CO, USA
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Matsunaga F, Gao L, Huang XP, Saven JG, Roth BL, Liu R. Molecular interactions between general anesthetics and the 5HT2B receptor. J Biomol Struct Dyn 2013; 33:211-8. [PMID: 24365264 DOI: 10.1080/07391102.2013.869483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Serotonin modulates many processes through a family of seven serotonin receptors. However, no studies have screened for interactions between general anesthetics currently in clinical use and serotonergic G-protein-coupled receptors (GPCRs). Given that both intravenous and inhalational anesthetics have been shown to target other classes of GPCRs, we hypothesized that general anesthetics might interact directly with some serotonin receptors and thus modify their function. METHODS Radioligand binding assays were performed to screen serotonin receptors for interactions with propofol and isoflurane as well as for affinity determinations. Docking calculations using the crystal structure of 5-HT2B were performed to computationally confirm the binding assay results and locate anesthetic binding sites. RESULTS The 5-HT2B class of receptors interacted significantly with both propofol and isoflurane in the primary screen. The affinities for isoflurane and propofol were determined to be 7.78 and .95 μM, respectively, which were at or below the clinical concentrations for both anesthetics. The estimated free energy derived from docking calculations for propofol (-6.70 kcal/mol) and isoflurane (-5.10 kcal/mol) correlated with affinities from the binding assay. The anesthetics were predicted to dock at a pharmacologically relevant binding site of 5HT2B. CONCLUSIONS The molecular interactions between propofol and isoflurane with the 5-HT2B class of receptors were discovered and characterized. This finding implicates the serotonergic GPCRs as potential anesthetic targets.
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Affiliation(s)
- Felipe Matsunaga
- a Department of Anesthesiology and Critical Care , Perelman School of Medicine, University of Pennsylvania , 336 John Morgan Building, 3620 Hamilton Walk, Philadelphia , PA 19104 , USA
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Paço CD, Vane MF, Andrade RBD, Domingues MA, Carvalho LRD, dos Santos DC, Takahira RK, Modolo NSP, Vane LA. Effects of propofol in lipid-based emulsion and in microemulsion on the incidence of endothelial lesion in rabbits. Acta Cir Bras 2013; 28:833-41. [PMID: 24316856 DOI: 10.1590/s0102-86502013001200005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/12/2013] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To compare the incidence of endothelial injury after single-dose or continuous propofol infusion in conventional lipid-based emulsion (LE) versus microemulsion (ME). METHODS Forty-two rabbits (2.5-4.5 Kg) were randomly allocated into seven groups of six animals each: SHAM- surgical treatment alone; Bolus Control Group - 3 mL-intravenous (IV) bolus of saline; Continuous Infusion Control Group - 3 mL- IV bolus of saline followed by a continuous infusion of 0.2 ml/kg/min for 60 min; Bolus LE Propofol Group - IV bolus of LE propofol (3 mg/kg); Bolus ME Propofol Group - IV ME propofol bolus (3 mg/kg); Continuous LE Propofol Group - IV LE propofol bolus (3 mg/kg) followed by a continuous infusion of 0.2 ml/kg/min for 60 min; Continuous ME Propofol Group - IV ME propofol bolus (3 mg/kg) followed by a continuous infusion of 0.2 ml/kg/min for 60 min. RESULTS There were no statistically significant differences between the studied groups in blood pressure, in central venous pressure and in the biochemical profile. No significant differences were found in inflammatory mediators and in tissue analysis between the two emulsions. CONCLUSION Microemulsion and lipid-based emulsion propofol had similar inflammatory, biochemical and microscopy profiles. Thus, microemulsion propofol can be used as an alternative to lipid-based emulsion propofol.
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Operative care and surveillance in severe trauma patients. Interference between resuscitation treatments and anaesthesiology, and consequence on immunity. ACTA ACUST UNITED AC 2013; 32:516-9. [PMID: 23916514 DOI: 10.1016/j.annfar.2013.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Major trauma remains a worldwide cause of morbi-mortality. Early mortality is the consequence of hemorrhagic shock and traumatic brain injury. During early resuscitation, anaesthesia is often mandatory to perform surgery. It is mandatory to master the hemodynamic effects of hypnotic drugs in order to anticipate their potential deleterious effects in the setting of hemorrhagic shock. After early resuscitation, trauma patients present a high prevalence of nosocomial pneumonia, which sustains major morbidity. Nosocomial pneumonia are the consequence of an overwhelming systemic inflammatory response syndrome (SIRS) as well as a trauma-related immunosuppression. The administration of hemisuccinate of hydrocortisone modulates the SIRS and reduces the risk of nosocomial pneumonia as well as the length of mechanical ventilation. Finally in the operating theatre, fighting against hypothermia and un-anatomical positions, which can aggravate rhabdomyolysis, are both mandatory.
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Yu T, Huang Y, Guo F, Yang Y, Teboul JL, Qiu H. The effects of propofol and dexmedetomidine infusion on fluid responsiveness in critically ill patients. J Surg Res 2013; 185:763-73. [PMID: 23953789 DOI: 10.1016/j.jss.2013.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/19/2013] [Accepted: 07/03/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND We studied the effects of propofol or dexmedetomidine on preload dependency and fluid responsiveness in critically ill patients. METHODS In the study, we included 91 patients with acute circulatory failure (70 ± 15 y) who received propofol (n = 45 patients, PROP group) or dexmedetomidine (n = 46 patients, DEX group). An initial passive leg-raising (PLR 1) test was performed in all patients to evaluate preload dependency at baseline. Propofol and dexmedetomidine were infused and titrated according to the Richmond Agitation Sedation Scale; the results ranged from -2 to -1, and the bispectral index values ranged from 60-75. A second PLR test (PLR 2) was performed before administration of a 250-mL normal saline fluid challenge over a 5-min period. We obtained central venous pressure and cardiac index (CI) measurements before and after the two PLR tests and volume expansion. An increase of ≥10% in CI during PLR was considered to be a positive test finding that was indicative of preload dependency, whereas an increase of <10% in CI during PLR was considered to be a negative test finding. RESULTS At baseline, 22 of 45 patients had negative PLR 1 in the PROP group, whereas 20 of 46 patients had negative PLR 1 in the DEX group. After propofol or dexmedetomidine sedation, there were significant decreases in CI (-9.5% [±6.6%] versus -16.4% [±8.5%], P < 0.001) in the PROP and DEX groups, respectively. In the PROP group, there were significant increases in CI (+18.4% [±9.5%] versus +10.7% [±12.3%], P < 0.05) induced by PLR 2 compared with that induced by PLR 1. In the DEX group, there were no significant increases in CI (+13.2% [±14.9%] versus +12.8% [±17.7%]) induced by PLR 2 compared with that induced by PLR 1. Although the mean arterial pressure values increased comparably with the volume expansion observed in both groups, the volume expansion resulted in a significantly higher increase in CI compared with the baseline values in the PROP group (3.2 ± 0.8 versus 3.2 ± 0.7 L/min/m(2)) but not in the DEX group (2.9 ± 0.7 versus 3.1 ± 0.8 L/min/m(2), P < 0.05). CONCLUSIONS We observed that propofol infusion, but not dexmedetomidine infusion, can increase preload dependency and fluid responsiveness in patients with circulatory failure.
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Affiliation(s)
- Tao Yu
- Department of Critical Care Medicine, Nanjing Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China
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Dorantes Mendez G, Aletti F, Toschi N, Canichella A, Dauri M, Coniglione F, Guerrisi M, Signorini MG, Cerutti S, Ferrario M. Baroreflex sensitivity variations in response to propofol anesthesia: comparison between normotensive and hypertensive patients. J Clin Monit Comput 2013; 27:417-26. [PMID: 23314842 DOI: 10.1007/s10877-012-9426-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 12/27/2012] [Indexed: 11/24/2022]
Abstract
The aim of this paper is to compare baroreflex sensitivity (BRS) following anesthesia induction via propofol to pre-induction baseline values through a systematic and mathematically robust analysis. Several mathematical methods for BRS quantification were applied to pre-operative and intra-operative data collected from patients undergoing major surgery, in order to track the trend in BRS variations following anesthesia induction, as well as following the onset of mechanical ventilation. Finally, a comparison of BRS trends in chronic hypertensive patients (CH) with respect to non hypertensive (NH) patients was performed. 10 NH and 7 CH patients undergoing major surgery with American Society of Anesthesiologists classification score 2.5 ± 0.5 and 2.6 ± 0.5 respectively, were enrolled in the study. A Granger causality test was carried out to verify the causal relationship between RR interval duration and systolic blood pressure (SBP), and four different mathematical methods were used to estimate the BRS: (1) ratio between autospectra of RR and SBP, (2) transfer function, (3) sequence method and (4) bivariate closed loop model. Three different surgical epochs were considered: baseline, anesthetic procedure and post-intubation. In NH patients, propofol administration caused a decrease in arterial blood pressure (ABP), due to its vasodilatory effects, and a reduction of BRS, while heart rate (HR) remained unaltered with respect to baseline values before induction. A larger decrease in ABP was observed in CH patients when compared to NH patients, whereas HR remained unaltered and BRS was found to be lower than in the NH group at baseline, with no significant changes in the following epochs when compared to baseline. To our knowledge, this is the first study in which the autonomic response to propofol induction in CH and NH patients was compared. The analysis of BRS through a mathematically rigorous procedure in the perioperative period could result in the availability of additional information to guide therapy and anesthesia in uncontrolled hypertensive patients, which are prone to a higher rate of hypotension events occurring during general anesthesia induction.
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Affiliation(s)
- Guadalupe Dorantes Mendez
- Department of Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, MI, Italy
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Williams GD, Friesen RH. Administration of ketamine to children with pulmonary hypertension is safe: pro-con debate: Pro Argument. Paediatr Anaesth 2012; 22:1042-52. [PMID: 25631695 DOI: 10.1111/pan.12033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Glyn D Williams
- Department of Anesthesia, Lucile Packard Children's Hospital at Stanford, Stanford University, Stanford, CA, USA.
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Mcintosh MP, Iwasawa K, Rajewski RA, Fujisawa T, Goto H. Hemodynamic Profile in Rabbits of Fospropofol Disodium Injection Relative to Propofol Emulsion Following Rapid Bolus Injection. J Pharm Sci 2012; 101:3518-25. [DOI: 10.1002/jps.23162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/09/2012] [Accepted: 03/12/2012] [Indexed: 11/07/2022]
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Durand M. [Anaesthesia and vasomotor tone during CPB: intravenous anaesthetics]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31 Suppl 1:S31-S33. [PMID: 22721519 DOI: 10.1016/s0750-7658(12)70052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Anaesthesia during CBP is frequently provided using intravenous anaesthetic drugs, particularly propofol. The effects of the different drugs have been studied during CPB. These drugs have an arterial and venous vasodilator effect during CPB which is dose dependent and is more pronounced for propofol. High doses of propofol or thiopental reduce cerebral blood flow but provide no additional neurological protection.
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Affiliation(s)
- M Durand
- Unité De Réanimation Cardiovasculaire et Thoracique, Pole Anesthésie Réanimation, Hôpital Albert Michallon, BP 217, 38043 Grenoble cedex 9, France. MDurand@CHU- Grenoble.fr
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Moriyama T, Tsuneyoshi I, Kanmura Y. Effects of a novel benzodiazepine derivative, JM-1232(-), on human gastroepiploic artery in vitro. J Cardiothorac Vasc Anesth 2011; 25:72-7. [PMID: 20599400 DOI: 10.1053/j.jvca.2010.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the effects of JM-1232(-) on norepinephrine (10(-6) mol/L)- and high K(+) (40 mmol/L)-induced contractions in isolated human gastroepiploic arteries (GEA), and to compare them with the effects of midazolam and propofol. In addition, to investigate whether the benzodiazepine-receptor antagonist, flumazenil, or μ-opioid-receptor antagonist, naloxone, influenced the vascular effects of JM-1232(-). DESIGN An in vitro experimental study. SETTING University laboratory. PARTICIPANTS GEA segments were used from 69 patients undergoing coronary artery bypass graft surgery. MEASUREMENTS AND MAIN RESULTS JM-1232(-) produced dose-dependent relaxation effects in the rings. Although these effects of JM-1232(-) were greater than those of midazolam and propofol at high concentrations (10(-5)-10(-4) mol/L), there were no significantly different relaxation effects at the clinical concentrations of 3 × 10(-6) mol/L JM-1232(-), 3 × 10(-6) mol/L midazolam, and 1 × 10(-5) mol/L propofol. In addition, all these effects were independent of the presence of a functional endothelium. Vasorelaxation induced by JM-1232(-) on norepinephrine-preconstricted GEA was inhibited by flumazenil, but not by naloxone. CONCLUSIONS These results indicate that JM-1232(-) dose-dependently relaxes smooth muscle in human GEA, this effect being independent of the endothelium. Within the ranges of plasma concentrations achieved in clinical practice, JM-1232(-) had similar vasorelaxation effects to midazolam and propofol. JM-1232(-)-induced vasorelaxation was inhibited by flumazenil, indicating that JM-1232(-)-induced vasorelaxation occurred via peripheral benzodiazepine receptor activation in the GEA.
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Affiliation(s)
- Takahiro Moriyama
- Department of Anesthesiology and Critical Care Medicine, Kagoshima University School of Medicine, Kagoshima, Japan.
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Cave DA, Fry KM, Buchholz H. Anesthesia for noncardiac procedures for children with a Berlin Heart EXCOR Pediatric Ventricular Assist Device: a case series. Paediatr Anaesth 2010; 20:647-59. [PMID: 20456063 DOI: 10.1111/j.1460-9592.2010.03314.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report our experience of providing anesthesia for noncardiac procedures in children with in situ Berlin Heart EXCOR Pediatric ventricular assist devices and to suggest principles of anesthetic management. BACKGROUND With the initiation of the first North American training and support center for Berlin Heart at our institution in 2006, we have been asked to provide anesthesia for noncardiac procedures to these children. No current anesthetic approach to these children has been reported. METHODS/MATERIALS Anesthetic records for all noncardiac procedures for children with Berlin Heart between August 2006 and February 2009 in a tertiary care pediatric hospital were retrospectively reviewed. Charts were reviewed for demographic and clinical data, perioperative management, and occurrence of hypotension. RESULTS Twenty-nine procedures were performed on 11 patients. Hypotension was a common occurrence with all anesthetic induction and maintenance agents even at low doses. Ketamine induction, however, was less likely to produce hypotension, odds ratio for hypotension 0.1333 (95% confidence range 0.021-0.856). Hypotension was responsive to fluid bolus (60%) and alpha-receptor agonists (100%). Preoperative stability and presence of biventricular ventricular assist device (BiVAD) did not predict intraoperative hemodynamic course. CONCLUSIONS Unlike patients with other ventricular assist devices, these children do not tolerate reductions in systemic vascular resistance (SVR) because of the relatively fixed cardiac output of this device. Agents that reduce SVR should be avoided where possible. Preoperative stability is not predictive. Fluids and alpha-agonists should be first-line response to hypotension in this population. Further study of this unusual population is warranted to further delineate best anesthetic practice.
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Affiliation(s)
- Dominic A Cave
- Department of Anesthesiology and Pain Medicine, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada.
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Gragasin FS, Davidge ST. The effects of propofol on vascular function in mesenteric arteries of the aging rat. Am J Physiol Heart Circ Physiol 2009; 297:H466-74. [DOI: 10.1152/ajpheart.01317.2008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hypotension following administration of propofol, an anesthetic agent, is strongly predicted by advanced age and is partly due to direct vasodilation. We hypothesized that propofol increases nitric oxide (NO)-mediated vasodilation by enhancing its bioavailability in the aged adult vasculature, leading to greater vasodilation than in the young adult. Small mesenteric arteries from rats aged 13–15 versus 3 to 4 mo were compared in this study. Reactivity to propofol (1–100 μM) alone and with the addition of acetylcholine (ACh; 0.1–10 μM) in endothelial-intact and dunuded arteries following phenylephrine constriction was assessed using myography. NG-nitro-l-arginine methyl ester (l-NAME) and meclofenamate (Meclo) were used to inhibit NO and prostaglandin synthesis, respectively. Superoxide dismutase (SOD) and catalase were used as antioxidants during ACh relaxation and were compared with propofol in aging arteries. Propofol alone induced greater relaxation in 1) endothelial-intact compared with denuded arteries and 2) aged compared with young arteries, which were inhibited by l-NAME. ACh-induced relaxation was greater in young compared with aged control arteries; however, propofol pretreatment increased this relaxation in aged but not in young arteries. Additionally, propofol inhibited ACh-induced relaxation in arteries treated with l-NAME + Meclo [relaxation attributed to endothelium-derived hyperpolarizing factor (EDHF)]. Pretreatment with SOD and catalase increased relaxation to ACh in aged arteries similar to propofol. In conclusion, propofol causes relaxation in small mesenteric arteries in an endothelial-dependent and independent manner and increases ACh-induced relaxation in aged arteries. Interestingly, propofol inhibits EDHF-mediated relaxation but increases availability of NO, which leads to overall vascular relaxation.
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Analgesia and Chemical Restraint for the Emergent Veterinary Patient. Vet Clin North Am Small Anim Pract 2008; 38:1329-52, vii. [DOI: 10.1016/j.cvsm.2008.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Koch M, De Backer D, Vincent J, Barvais L, Hennart D, Schmartz D. Effects of propofol on human microcirculation. Br J Anaesth 2008; 101:473-8. [DOI: 10.1093/bja/aen210] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hatschbach E, Silva FDC, Beier SL, Lima AFDM, Massone F. Comparative study between target-controlled-infusion and continuous-infusion anesthesia in dogs treated with methotrimeprazine and treated with propofol and remifentanil. Acta Cir Bras 2008; 23:65-72. [DOI: 10.1590/s0102-86502008000100011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 10/29/2007] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To compare two propofol infusion techniques in bitches subjected to ovaryhisterectomy by estimating the efficiency of the propofol target-dose, evaluating the cardiorespiratory and hemogasimetric attributes, and the bispectral scale index (BIS) as well as the recovery period characteristics. METHODS: Twenty anesthetized bitches were divided into two groups of 10 each (G1, G2). Animals of G1 were pre-treated with methotrimeprazine and anesthetized with target-controlled propofol infusion by means of a Harvard infusion pump combined to remifentanil through a syringe pump. RESULTS: Bradycardia and light hypotension, hemogasimetric and respiratory stability besides a good myorelaxation, more evident during continuous infusion and good hypnosis. CONCLUSIONS: Dosis used in both techniques, after methotrimeprazine pre-treatment and combined to the opioid, were efficient for the surgery. The target-controlled anesthesia required a smaller anesthetic consumption (propofol) with faster recovery periods.
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Lai HC, Lai HC, Wang KY, Lee WL, Ting CT, Liu TJ. Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery. Br J Anaesth 2007; 99:184-90. [PMID: 17576968 DOI: 10.1093/bja/aem126] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Whether and how pulmonary hypertension (PH) impacts perioperative outcome in non-cardiac surgery is incompletely understood. METHODS From November 1999, all patients undergoing non-cardiac, non-local anaesthetic surgery and ever examined by echocardiography within 30 days before surgery were screened. Those having echocardiographic pulmonary artery systolic pressure >70 mm Hg were enrolled provided they were not already intubated. Case-matched peers with normal pulmonary pressures served as controls. Perioperative outcomes were compared between the two groups, and predictors of adverse perioperative outcomes were investigated by multivariate logistic regression analysis. RESULTS From November 1999 to August 2004, a total of 62 patients (male 38, mean age 67 yr) with PH were found. Compared with the case-matched controls, patients with PH experienced equivalently smooth operative courses, but significantly more frequent postoperative heart failure (9.7 vs 0%, P = 0.028), delayed tracheal extubation (21 vs 3%, P = 0.004), and in-hospital deaths (9.7 vs 0%, P = 0.028). Multivariate regression analysis identified emergency surgery [odds ratio (OR), 44.738; P = 0.028], coronary artery disease (CAD; OR, 9.933; P = 0.042), and systolic pulmonary artery pressure (OR, 1.101; P = 0.026) as independent predictors of postoperative mortality and surgery-specific cardiac risk level (OR, 6.791; P = 0.033) and CAD (OR 6.546, P = 0.017) as predictors of morbidity. CONCLUSION PH is an important predictor of adverse cardiopulmonary outcome in non-cardiac surgery as reflected by markedly increased postoperative complications, especially in patients with coexistent high-risk clinical and surgical characteristics.
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Affiliation(s)
- H-C Lai
- Department of Anaesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan
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McIntosh MP, Narita H, Kameyama Y, Rajewski RA, Goto H. Evaluation of mean arterial blood pressure, heart rate, and sympathetic nerve activity in rabbits after administration of two formulations of etomidate. Vet Anaesth Analg 2007; 34:149-56. [PMID: 17444927 DOI: 10.1111/j.1467-2995.2006.00312.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate and compare the effects of the aqueous sulfobutyl ether beta-cyclodextrin (SBE-CD) etomidate formulation and the commercial etomidate formulation on mean arterial pressure (MAP), heart rate, and sympathetic outflow using neuraxis-intact and baro-denervated rabbits. STUDY DESIGN Prospective experimental study. ANIMALS Twenty-seven male New Zealand white rabbits. METHODS Under basal anesthesia (urethane) and ventilation with intermittent positive pressure (IPPV), the New Zealand white rabbits underwent surgical preparation including isolation of the left renal sympathetic nerve and, in the baro-denervated models, additional combined denervation of bilateral carotid sinus, aortic, and vagal nerves. After hemodynamic stabilization, both neuraxis-intact and baro-denervated animals received bolus intravenous (IV) injection (0.6 mg kg(-1)) of either the SBE-CD or commercial etomidate formulation over 5 seconds (n = 6 animals per group). RESULTS Mean arterial pressure decreased significantly in all four groups to the same extent. However, the rate of MAP decrease was lower in the SBE-CD-treated groups relative to the commercial formulation. Renal sympathetic nerve activity was decreased significantly less in the SBE-CD group in the baro-denervated studies. Independent pharmacokinetic evaluation demonstrated that the two formulations had comparable plasma concentration-time profiles. CONCLUSIONS AND CLINICAL RELEVANCE Etomidate in the commercial drug product is solubilized with propylene glycol, a cosolvent associated with adverse side effects on injection. An aqueous formulation of etomidate has been developed, which utilizes SBE-CD as a solubilizing agent. The data suggest that the SBE-CD etomidate formulation may be a safer IV induction formulation than the commercial etomidate drug product.
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Affiliation(s)
- Michelle P McIntosh
- The Center for Drug Delivery Research, The University of Kansas, Lawrence, KS, USA.
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Bergmann L, Kottenberg-Assenmacher E, Peters J. Management of a Patient With Right Ventricular Drainage Cannula Obstruction After Biventricular Assist Device Implantation. J Cardiothorac Vasc Anesth 2007; 21:262-4. [PMID: 17418745 DOI: 10.1053/j.jvca.2006.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Lars Bergmann
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany.
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Abou-Arab MH, Heier T, Caldwell JE. Dose of alfentanil needed to obtain optimal intubation conditions during rapid-sequence induction of anaesthesia with thiopentone and rocuronium. Br J Anaesth 2007; 98:604-10. [PMID: 17403707 DOI: 10.1093/bja/aem064] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The primary aim of the present study was to determine the dose of alfentanil that must be added to a rapid-sequence induction (RSI) regimen using thiopentone and rocuronium to obtain optimal intubation conditions in >95% of the individuals. METHODS A total of 60 ASA I patients were randomly allocated to five different alfentanil dose groups (0, 15, 30, 45, or 60 microg kg-1). A blinded dose of alfentanil followed by thiopentone 4 mg kg-1 and rocuronium 1 mg kg-1 was administered in rapid succession, and tracheal intubation was attempted 40 s thereafter. The relationship between the alfentanil dose and the probability of optimal intubation conditions was determined by non-linear logistic regression analysis. Blood pressure (BP) changes were recorded continuously using an intra-arterial catheter. RESULTS The success rate of optimal intubation conditions increased with increasing doses of alfentanil. The alfentanil dose needed to obtain optimal intubation conditions in >95% of the patients was 36.4 (CI 33.4-39.4) microg kg-1. In 12 patients, the systolic BP declined to <90 mm Hg during the 3 min immediately after intubation. CONCLUSION Adding 36-40 microg kg-1 alfentanil to a regimen of thiopentone and rocuronium during RSI of anaesthesia may significantly increase the success rate of optimal intubation conditions. Significant hypotension requiring vasopressor treatment may occur.
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Affiliation(s)
- M H Abou-Arab
- Department of Anesthesia, Aker University Hospital, Oslo, Norway
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Abstract
OBJECTIVE The vascular response to intravenous thiopental in patients on cardiopulmonary bypass during deep hypothermia was examined. DESIGN This was a prospective observational study. SETTING A university teaching hospital. PARTICIPANTS Twenty-one consecutive adult patients undergoing pulmonary thromboendarterectomy during which deep hypothermic circulatory arrest was instituted. INTERVENTIONS Immediately before circulatory arrest, each patient was administered a 500-mg dose of thiopental intravenously. Arterial blood pressure was monitored and recorded by using a femoral artery catheter and serum electrolytes, acid-base status and arterial hematocrit were determined immediately before the administration of thiopental. MEASUREMENTS AND MAIN RESULTS Thiopental was associated with a dose-related increase in mean arterial pressure of 32 +/- 11 mmHg (p < 0.0001). Thiopental also resulted in an increase in arterial pH of 0.08 +/- 0.03. A positive correlation between the magnitude of the pH change and the magnitude of the hypertensive response was suggested but did not reach statistical significance (p = 0.066). Of the other factors investigated, only serum-ionized calcium had a statistically significant association with the vascular response in that higher ionized calcium was associated with less hypertensive response (p = 0.014). CONCLUSIONS The administration of thiopental to deeply hypothermic patients during cardiopulmonary bypass is associated with a dramatic increase in mean arterial blood pressure. The mechanism responsible for this vasoconstrictive response may involve thiopental's potentiation of the effects of norepinephrine in the peripheral vasculature.
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Mathews KA, Dyson DH. Analgesia and chemical restraint for the emergent patient. Vet Clin North Am Small Anim Pract 2005; 35:481-515, viii. [PMID: 15698921 DOI: 10.1016/j.cvsm.2004.10.012] [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: 11/19/2022]
Abstract
This article discusses analgesia and chemical restraint for the emergency patient. As illness or injury affect all organ systems, specific recommendations and considerations of analgesic, anesthetic, and restraining regimens are presented. As animals of all ages, from neonates to geriatric and those that are pregnant or lactating,may require management of their illness or injury, recommendations for these patients are also presented.
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Affiliation(s)
- Karol A Mathews
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1.
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Nishikawa K, Kanaya N, Kawamata M, Namiki A. Left ventricular mechanical performance in elderly patients after induction of anaesthesia. A comparison of inhalational induction with sevoflurane and intravenous induction with fentanyl and propofol. Anaesthesia 2004; 59:948-53. [PMID: 15488051 DOI: 10.1111/j.1365-2044.2004.03798.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We investigated changes in left ventricular mechanical performance in 40 patients aged > 70 years in whom anaesthesia had been induced with sevoflurane or with fentanyl and propofol. The ratio of ventricular contractility to arterial properties, which reflects left ventricular performance, was estimated from the ratio of ventricular end-systolic elastance to effective arterial elastance. This ratio decreased after induction in both groups, the magnitude of the decrease being significantly greater in the fentanyl/propofol group than in the sevoflurane group. Decreases in mean arterial pressure after induction of anaesthesia in the two groups were similar, whereas the magnitude of the decrease in heart rate in the sevoflurane group was greater than that in the fentanyl/propofol group. Sevoflurane may therefore be preferable to fentanyl and propofol for induction of anaesthesia in elderly patients because of its lesser effect on left ventricular performance.
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Affiliation(s)
- K Nishikawa
- Department of Anaesthesiology, Sapporo Medical University, School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan.
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Kolh P, Lambermont B, Ghuysen A, Tchana-Sato V, Dogné JM, D'Orio V, Gerard P, Larbuisson R, Limet R. Comparison of the Effects of Propofol and Pentobarbital on Left Ventricular Adaptation to an Increased Afterload. J Cardiovasc Pharmacol 2004; 44:294-301. [PMID: 15475825 DOI: 10.1097/01.fjc.0000133050.11105.c2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to compare the hemodynamic effects of pentobarbital and propofol and their effects on cardiovascular adaptation to an abrupt increase in left ventricular afterload. Experiments were performed in 12 open-chest pigs instrumented for measurement of aortic pressure and flow, and left ventricular pressure and volume. In one group (n = 6), anesthesia was obtained with sodium pentobarbital (3 mg x kg(-1) x h(-1)), and, in the second group B (n = 6), with propofol (10 mg x kg(-1) x h(-1)). Both groups received sufentanil (0.5 microg x kg(-1) x h(-1)) and pancuronium bromide (0.1 mg x kg(-1)). Left ventricular function was assessed by the slope of end-systolic pressure-volume relationship and stroke work. After baseline recordings, left ventricular afterload was increased by aortic banding. The cardiovascular adaptations triggered by the aortic banding, such as tachycardia, vasoconstriction, and augmentation of myocardial contractility were prevented with propofol, suggesting interference with the baroreflex. Increase in left ventricular afterload decreased mechanical efficiency, regardless of anesthetic agent. These results showed that pentobarbital at 3 mg x kg(-1) x h(-1) has less deleterious hemodynamic effects than propofol at 10 mg x kg(-1) x h(-1).
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Affiliation(s)
- Philippe Kolh
- Hemodynamic Research Center (HemoLiège), University of Liège, Belgium.
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Tyner TR, Shahbazian R, Nakashima J, Kane S, Sian K, Yamaguchi KT. Propofol Improves Skin Flap Survival in a Rat Model. Ann Plast Surg 2004; 53:273-7. [PMID: 15480016 DOI: 10.1097/01.sap.0000116382.30876.bb] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accumulation of neutrophils in a random pattern skin flap has been demonstrated to contribute to the necrosis of distal flap tissue. This study proposes that administration of propofol anesthesia can effectively reduce neutrophil activity and enhance skin flap survival. The study was a randomized controlled trial using male Sprague-Dawley rats as subjects. For flap survival studies, a 3- by 12-cm, dorsal, cranial-based, random pattern skin flap was elevated and reapproximated. Flaps were examined for viability 10 days postsurgery. To assess neutrophil activity, flap biopsies were taken 12, 24, or 48 hours postsurgery from distal, middle, and proximal flap regions, and myeloperoxidase enzyme content was analyzed. Animals were randomly assigned to 1 of 4 groups: group 1, ketamine anesthesia (controls); group 2, propofol anesthesia; group 3, ketamine anesthesia plus 10% lipid emulsion (propofol vehicle); group 4, ketamine anesthesia without flap elevation (nonoperated controls for myeloperoxidase study). Flap survival was significantly improved in the propofol group compared with both the ketamine and vehicle control groups (P <0.01). Increased flap viability was correlated with a reduction in myeloperoxidase content in the propofol group compared with control operated animals, with minor variations observed in the different flap regions and time points tested. This study indicates that the use of propofol can potentially improve skin flap survival. The beneficial effects may be attributed to a reduction in neutrophil activity within the flap.
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Affiliation(s)
- Tim R Tyner
- Department of Surgery, University Medical Center, Veterans Administration Medical Center, University of California--San Francisco Fresno Medical Education Program, Fresno, CA 93702, USA
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Nagakawa T, Yamazaki M, Hatakeyama N, Stekiel TA. The mechanisms of propofol-mediated hyperpolarization of in situ rat mesenteric vascular smooth muscle. Anesth Analg 2003; 97:1639-1645. [PMID: 14633534 DOI: 10.1213/01.ane.0000087043.61777.1f] [Citation(s) in RCA: 25] [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
UNLABELLED Previously, we reported that propofol hyperpolarizes vascular smooth muscle (VSM) cells of small arteries and veins. The current study was designed to determine whether propofol-mediated hyperpolarization is the result of specific effects on potassium channels known to exist in VSM and on steps in the intracellular nitric oxide (NO), cyclic guanosine monophosphate (cGMP), and cyclic adenosine monophosphate (cAMP) second messenger pathways. VSM transmembrane potentials (E(m)) were measured in situ in sympathetically denervated, small mesenteric arteries and veins of Sprague-Dawley rats. Effects of propofol on VSM E(m) were determined before and during superfusion with specific inhibitors of VSM calcium-activated (K(Ca)), adenosine triphosphate-sensitive (K(ATP)), voltage-dependent (K(v)), and inward rectifying (K(IR)) potassium channels and with endogenous mediators of vasodilation. Propofol significantly hyperpolarized VSM in small mesenteric vessels. This hyperpolarization was abolished on inhibition of K(Ca) and K(ATP) channel activity and on inhibition of NO and cGMP (but not cAMP). Assuming a close inverse correlation between the magnitude of VSM E(m) and contractile force, these results suggest that propofol induces hyperpolarization and relaxation in denervated, small mesenteric vessels by activation of K(Ca) and K(ATP) channels. Such channel activation may be mediated by activation of NO and cGMP, but not cAMP, second messenger pathways. IMPLICATIONS The results of this study indicate that propofol-mediated hyperpolarization in vascular smooth muscle can be attributed to the activation of calcium-activated, adenosine triphosphate-sensitive potassium channels, the nitric oxide, and cyclic guanosine monophosphate pathways.
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Affiliation(s)
- Tamotsu Nagakawa
- *Department of Anesthesiology, Toyama Medical and Pharmaceutical University, Toyama, Japan, and the †Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Samain E, Clichet A, Bouillier H, Chamiot-Clerc P, Safar M, Marty J, Renaud JF. Propofol differently alters vascular reactivity in normotensive and hypertensive rats. Clin Exp Pharmacol Physiol 2002; 29:1015-7. [PMID: 12366394 DOI: 10.1046/j.1440-1681.2002.03760.x] [Citation(s) in RCA: 7] [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
1. The effect of propofol on arterial tone in hypertension is poorly understood. We examined the effect of increasing concentrations of propofol (5.6 x 10-8 to 2.8 x 10-3 mol/L) on isometric tension developed by noradrenaline (10-7 mol/L)-contracted aortic rings from 12-week-old Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR). 2. In both WKY rats and SHR, propofol induced a dose-dependent inhibition of contraction induced by noradrenaline, but the amplitude of relaxation was larger in the SHR than in WKY rats. 3. The effects of propofol was endothelium independent in WKY rats, whereas in SHR relaxation induced by propofol was greater in endothelium-intact than in endothelium-denuded rings. 4. In conclusion, we found significant differences in the effect of propofol in hypertensive rats, which may be related to differences in structural and functional properties of the arterial wall observed in hypertension.
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Affiliation(s)
- Emmanuel Samain
- Department of Medical Research, CNRS ESA 8078, Marie Lannelongue Hospital, University of Paris, Le Plessis-Robinson, France.
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Affiliation(s)
- Samir Patel
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Sprung J, Ogletree-Hughes ML, McConnell BK, Zakhary DR, Smolsky SM, Moravec CS. The effects of propofol on the contractility of failing and nonfailing human heart muscles. Anesth Analg 2001; 93:550-9. [PMID: 11524317 DOI: 10.1097/00000539-200109000-00006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We determined the direct effects of propofol on the contractility of human nonfailing atrial and failing atrial and ventricular muscles. Atrial and ventricular trabecular muscles were obtained from the failing human hearts of transplant patients or from nonfailing hearts of patients undergoing coronary artery bypass surgery. Isometric contraction variables were recorded before and after propofol was added to the bath in concentrations between 0.056 and 560 microM. The effects of propofol were compared with its commercial vehicle intralipid. To test beta-adrenergic effects in the presence of propofol, 1 microM isoproterenol was added at the end of each experiment. To determine the cellular mechanisms responsible for the actions of propofol, we examined its effects on actomyosin ATPase activity and sarcoplasmic reticulum (SR) Ca(2+) uptake in nonfailing atrial tissues. Propofol caused a concentration-dependent decrease in maximal developed tension in all muscles, which became significant (P < 0.05) at concentrations exceeding the clinical range (> or =56 microM). Isoproterenol restored contractility to the level achieved before exposure to propofol (P > 0.05 compared with baseline). Failing ventricular muscle exposed to propofol exhibited somewhat diminished ability to recover contractility in response to isoproterenol (P < 0.05 versus failing muscle exposed to intralipid only). Propofol induced a concentration-dependent decrease in the uptake of Ca(2+) into SR vesicles. At the same time, in the presence of 56 microM propofol, the Ca(2+)-activated actomyosin ATPase activity was shifted leftward, demonstrating an increase in myofilament sensitivity to Ca(2+). We conclude that propofol exerts a direct negative inotropic effect in nonfailing and failing human myocardium, but only at concentrations larger than typical clinical concentrations. Negative inotropic effects are reversible with beta-adrenergic stimulation. The negative inotropic effect of propofol is at least partially mediated by decreased Ca(2+) uptake into the SR; however, the net effect of propofol on contractility is insignificant at clinical concentrations because of a simultaneous increase in the sensitivity of the myofilaments to activator Ca(2+).
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Affiliation(s)
- J Sprung
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Intravenous ketamine attenuates arterial pressure changes during the induction of anaesthesia with propofol. Eur J Anaesthesiol 2001. [DOI: 10.1097/00003643-200102000-00005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Álvarez Ruiz A, Tamayo Lomas L, Castañeda Casado F. El propofol no inhibe la vasoconstricción pulmonar hipóxica. Med Intensiva 2001. [DOI: 10.1016/s0210-5691(01)79707-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sandström K, Wallerstedt SM, Tornebrandt K, Bodelsson M. Effects of propofol on desipramine-sensitive [3H]-noradrenaline uptake kinetics in rat femoral artery. Acta Anaesthesiol Scand 2000; 44:1011-6. [PMID: 10981582 DOI: 10.1034/j.1399-6576.2000.440820.x] [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: 11/23/2022]
Abstract
BACKGROUND The intravenous anaesthetic propofol inhibits the neuronal uptake of noradrenaline (uptake1) from the vascular sympathetic neuromuscular junction, resulting in an enhancement of the sympathetic neurotransmission. This could be important for maintenance of blood pressure during propofol anaesthesia. The aim of the present study was to determine how propofol influences the kinetics of uptake1. METHODS Isolated segments of rat femoral arteries were incubated with [3H]-noradrenaline in the presence or absence of propofol and the radioactivity taken up was measured in a scintillation counter. The uptake1 inhibitor, desipramine, was used to delineate the specific neuronal uptake. RESULTS Desipramine and 10 microM propofol significantly reduced the uptake in segments incubated with 0.1 microM [3H]-noradrenaline. Propofol at 1 microM and 100 microM did not affect the uptake. Non-linear regression analysis of specific uptake yielded Km 0.50 microM, Vmax 1.6 pmol mg(-1) 15 min(-1) and Hill coefficient 1.1. Propofol (1-10 microM) increased the Km value and propofol (10-100 microM) increased the Vmax value concentration-dependently, while the Hill coefficient was not affected. CONCLUSION Propofol seems to have a biphasic effect on the uptake of noradrenaline in the vascular sympathetic neuromuscular junction. At lower propofol concentrations there is a decrease in the affinity of the noradrenaline transporters. The resulting uptake inhibition is counteracted at higher propofol concentrations by an increase in the efficacy of the uptake.
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Affiliation(s)
- K Sandström
- Department of Anaesthesia and Intensive Care, University Hospital, Lund, Sweden
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Dyson DH. Chemical restraint and analgesia for diagnostic and emergency procedures. Vet Clin North Am Small Anim Pract 2000; 30:885-98, viii. [PMID: 10932831 DOI: 10.1016/s0195-5616(08)70013-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Diagnostic or emergency procedures are a necessity; however, the accompanying stress, discomfort, and pain must be considered and alleviated. The requirement for restraint and analgesia varies with the individual animal and its condition. Safe protocols are suggested for specific patient concerns. Recommendations for stabilization are included to reduce the detrimental effects of the drugs used. Alternatives are presented when feasible for animals in less critical condition. Technique of administration and dose adjustment is covered, as is drug selection.
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Affiliation(s)
- D H Dyson
- Department of Clinical Studies (Anesthesiology), Ontario Veterinary College, University of Guelph, Canada
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Samain E, Bouillier H, Marty J, Safar M, Dagher G. The effect of propofol on angiotensin II-induced Ca(2+) mobilization in aortic smooth muscle cells from normotensive and hypertensive rats. Anesth Analg 2000; 90:546-52. [PMID: 10702434 DOI: 10.1097/00000539-200003000-00009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
UNLABELLED We studied the effect of propofol (5.6-560 micromol/L; 1-100 microg/mL) on the mechanisms involved in Ca(2+) mobilization elicited by angiotensin II (AngII) in Wistar Kyoto (WKY) and spontaneously hypertensive (SHR) rats. We studied the variations in intracellular Ca(2+) ([Ca(2+)](i)) concentrations in cultured aortic vascular smooth muscle cells (VSMCs) isolated from 6-wk-old WKY and SHR rats loaded with the Ca(2+)-sensitive fluorescent dye, Fura-2, using fluorescent imaging microscopy. In the absence of external Ca(2+), AngII (1 micromol/L) induced a transient [Ca(2+)](i) mobilization from internal stores that was larger in SHR than in WKY rats. Ca(2+) influx was assessed after external Ca(2+) (1 mmol/L) reintroduction. Propofol (1-100 microg/mL) added 5 min before the experiments did not alter AngII-induced Ca(2+) release from internal stores in either strain. By contrast, Ca(2+) influx elicited by AngII was significantly decreased by propofol. This effect occurred at a smaller concentration of propofol in the SHR than in the WKY rats. When Ca(2+) stores were depleted by exposure of cells to thapsigargin, an inhibitor of the sarcoendoplasmic reticulum Ca(2+)-ATPase, reintroduction of Ca(2+) to the medium induced a capacitative Ca(2+) influx of similar magnitude than that elicited by AngII. This influx was also significantly decreased by propofol at 100 microg/mL ( WKY: 27 +/- 3% of control values, n = 107; SHR: 16 +/- 3%, n = 47; P < 0.001). In conclusion, propofol decreased AngII-induced Ca(2+) influx through voltage-independent channels, without altering Ca(2+) release from internal stores in aortic VSMCs. The hypertensive rats were found to be more sensitive to the effect of propofol than the normotensive rats. This suggests that the response of VSMCs to AngII may be altered by propofol. IMPLICATIONS In rat aortic vascular smooth muscle cells, propofol reduced angiotensin II-elicited Ca(2+) entry through capacitative Ca(2+) channels without altering Ca(2+) release from intracellular stores. Spontaneously hypertensive rats were more sensitive to these effects of propofol than normotensive rats. The response of vascular smooth muscle cells to angiotensin II may be altered by propofol.
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Affiliation(s)
- E Samain
- Department of Anesthesiology, Beaujon Hospital, University Xavier Bichat, Clichy. INSERM U337, Paris, France
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Effects of propofol on haemodynamics and on regional blood flows in dogs submitted or not to a volaemic expansion. Eur J Anaesthesiol 1999. [DOI: 10.1097/00003643-199909000-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Although questions may still remain regarding the use of this unique sedative-hypnotic drug with anesthetic properties in high-risk patients, our studies have provided cardiopulmonary and neurological evidence of the efficacy and safety of propofol when used as an anesthetic under normal and selected impaired conditions in the dog. 1. Propofol can be safely and effectively used for the induction and maintenance of anesthesia in normal healthy dogs. Propofol is also a reliable and safe anesthetic agent when used during induced cardiovascular and pulmonary-impaired conditions without surgery. The propofol requirements to induce the safe and prompt induction of anesthesia prior to inhalant anesthesia with and without surgery have been determined. 2. The favorable recovery profile associated with propofol offers advantages over traditional anesthetics in clinical situations in which rapid recovery is important. Also, propofol compatibility with a large variety of preanesthetics may increase its use as a safe and reliable i.v. anesthetic for the induction and maintenance of general anesthesia and sedation in small animal veterinary practice. Although propofol has proven to be a valuable adjuvant during short ambulatory procedures, its use for the maintenance of general anesthesia has been questioned for surgery lasting more than 1 hour because of increased cost and marginal differences in recovery times compared with those of standard inhalant or balanced anesthetic techniques. When propofol is used for the maintenance of anesthesia in combination with a sedative/analgesic, the quality of anesthesia is improved as well as the ease with which the practitioner can titrate propofol; therefore, practitioners are able to use i.v. anesthetic techniques more effectively in their clinical practices. 3. Propofol can induce significant depression of respiratory function, characterized by a reduction in the rate of respiration. Potent alpha 2 sedative/analgesics (e.g., xylazine, medetomidine) or opioids (e.g., oxymorphone, butorphanol) increase the probability of respiratory depression during anesthesia. Appropriate consideration of dose reduction and speed of administration of propofol reduces the degree of depression. Cardiovascular changes induced by propofol administration consist of a slight decrease in arterial blood pressures (systolic, mean, diastolic) without a compensatory increase in heart rate. Selective premedicants markedly modify this characteristic response. 4. When coupled with subjective responses to painful stimuli, EEG responses during propofol anesthesia provide clear evidence that satisfactory anesthesia has been achieved in experimental dogs. When propofol is used as the only anesthetic agent, a higher dose is required to induce an equipotent level of CNS depression compared with the situation when dogs are premedicated. 5. The propofol induction dose requirement should be appropriately decreased by 20% to 80% when propofol is administered in combination with sedative or analgesic agents as part of a balanced technique as well as in elderly and debilitated patients. As a general recommendation, the dose of propofol should always be carefully titrated against the needs and responses of the individual patient, as there is considerable variability in anesthetic requirements among patients. Because propofol does not have marked analgesic effects and its metabolism is rapid, the use of local anesthetics, nonsteroidal anti-inflammatory agents, and opioids to provide postoperative analgesia improves the quality of recovery after propofol anesthesia. 6. The cardiovascular depressant effects of propofol are well tolerated in healthy animals, but these effects may be more problematic in high-risk patients with intrinsic cardiac disease as well as in those with systemic disease. In hypovolemic patients and those with limited cardiac reserve, even small induction doses of propofol (0.75-1.5 mg/kg i.v.) can produce profound hypotens
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Affiliation(s)
- C E Short
- College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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50
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Boillot A, Haddad E, Vallet B, Barale F. [Effects of anesthetic agents on arterial reactivity]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1999; 18:415-29. [PMID: 10365203 DOI: 10.1016/s0750-7658(99)80090-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review the effects of halogenated and intravenous anaesthetics on arterial vasoreactivity. DATA SOURCE Articles were obtained from a MEDLINE review (search terms: 'vascular smooth muscle, endothelium' used separately or associated with following anaesthetic agents: 'halothane, isoflurane, enflurane, desflurane, sevoflurane, thiopentone, propofol, ketamine, etomidate'. Other sources included review articles and textbooks. STUDY SELECTION AND DATA EXTRACTION All experimental studies published since 1975 were analysed and pertinent data extracted. DATA SYNTHESIS Within the vascular wall, arterial vasoreactivity involves the endothelium and the vascular smooth muscle. In vivo, arterial vasoreactivity is regulated by neuronal, hormonal, and metabolic factors. In vitro, the direct action of anaesthetic agents on the vessel can be studied in the absence of such factors. In vitro studies with arterial rings have shown that inhalational anaesthetics directly decrease endothelium-independent contraction induced by various pharmacological agents. This direct effect of anaesthetics results from a decrease in intracellular calcium, mainly caused by an inhibition of transsarcoplasmic calcium influx. Volatile anaesthetics decrease endothelium-dependent vasorelaxation at a site(s) within the nitric oxide (NO) signalling pathway, located downstream from the NO-related receptors and upstream from guanylyl cyclase. They may also decrease endothelium-independent vasorelaxation by inhibiting NO activation of guanylate cyclase. Intravenous anaesthetics, such as propofol, barbiturates, ketamine and etomidate also decrease vasoconstriction by various degrees. Propofol is the most potent inhibitor of vasoconstriction and thiopental the least one. All these IV anaesthetics have been shown to inhibit in some circumstances both endothelium-dependent and -independent vasorelaxation. Further studies are required to enable a better understanding of the mechanism and the site of action of these vascular effects of anaesthetics. For example, the investigation of the effects of anaesthetic agents on vascular reactivity in diseases associated with endothelial dysfunction may indirectly provide insight into the role of endothelium.
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Affiliation(s)
- A Boillot
- Département d'anesthésie et de réanimation chirurgicale, Hôpital Jean-Minjoz, Besançon, France
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