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Bočkay A, Agudelo CF, Figurová M, Vargová N, Trbolová A. Effect of Butorphanol-Medetomidine and Butorphanol-Dexmedetomidine on Echocardiographic Parameters during Propofol Anaesthesia in Dogs. Animals (Basel) 2024; 14:1379. [PMID: 38731383 PMCID: PMC11083730 DOI: 10.3390/ani14091379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
This study compared the effects of butorphanol-medetomidine and butorphanol-dexmedetomidine combinations on echocardiographic parameters during propofol anaesthesia in dogs. The dogs were randomly divided into two groups. In the butorphanol-medetomidine (BM) group, butorphanol (0.2 mg/kg) and medetomidine (15 μg/kg) were intravenously administered; in the butorphanol-dexmedetomidine (BD) group, butorphanol (0.2 mg/kg) and dexmedetomidine (7.5 μg/kg) was used. Anaesthesia was induced with propofol and maintained with a constant-rate infusion of propofol (0.2 mg/kg/min). The echocardiographic parameters were assessed in conscious dogs (T0). Echocardiography was conducted again at 10 min post premedication (T1), followed by assessments at 30 (T2), 60 (T3), and 90 (T4) mins. The dogs were subjected to diagnostic procedures (radiography, computed tomography) under anaesthesia. A significant reduction in heart rate and cardiac output was noted in both groups at T1. There was no significant difference in the stroke volume between the BM and BD groups. The application of butorphanol-dexmedetomidine caused a significant increase in the left ventricular internal diameter in diastole and the diameter of the left atrium compared to that caused by butorphanol-medetomidine. This study documented that butorphanol-medetomidine and butorphanol-dexmedetomidine combinations caused similar reductions in heart rate and cardiac output in both groups. 'New´ valvular regurgitation occurred following their administration.
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Affiliation(s)
- Andrej Bočkay
- Small Animal Hospital, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Kosice, Slovakia; (C.F.A.); (M.F.); (N.V.); (A.T.)
| | - Carlos Fernando Agudelo
- Small Animal Hospital, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Kosice, Slovakia; (C.F.A.); (M.F.); (N.V.); (A.T.)
- Small Animal Referral Centre Sibra, Na Vrátkach13, 841 01 Bratislava, Slovakia
| | - Mária Figurová
- Small Animal Hospital, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Kosice, Slovakia; (C.F.A.); (M.F.); (N.V.); (A.T.)
| | - Nela Vargová
- Small Animal Hospital, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Kosice, Slovakia; (C.F.A.); (M.F.); (N.V.); (A.T.)
| | - Alexandra Trbolová
- Small Animal Hospital, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Kosice, Slovakia; (C.F.A.); (M.F.); (N.V.); (A.T.)
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Paramsothy J, Gutlapalli SD, Ganipineni VDP, Mulango I, Okorie IJ, Arrey Agbor DB, Delp C, Apple H, Kheyson B, Nfonoyim J, Isber N, Yalamanchili M. Propofol in ICU Settings: Understanding and Managing Anti-Arrhythmic, Pro-Arrhythmic Effects, and Propofol Infusion Syndrome. Cureus 2023; 15:e40456. [PMID: 37456460 PMCID: PMC10349530 DOI: 10.7759/cureus.40456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Propofol has revolutionized anesthesia and intensive care medicine owing to its favorable pharmacokinetic characteristics, fast onset, and short duration of action. This drug has been shown to be remarkably effective in numerous clinical scenarios. In addition, propofol has maintained an overwhelmingly favorable safety profile; however, it has been associated with both antiarrhythmic and proarrhythmic effects. This review concisely summarizes the dual arrhythmic cardiovascular effects of propofol and a rare but serious complication, propofol infusion syndrome (PRIS). We also discuss the need for careful patient evaluation, compliance with recommended infusion rates, and vigilant monitoring.
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Affiliation(s)
- Jananthan Paramsothy
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Sai Dheeraj Gutlapalli
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
- Internal Medicine Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vijay Durga Pradeep Ganipineni
- Internal Medicine, Thomas Hospital Infirmary Health, Fairhope, USA
- General Medicine, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Center, Chennai, IND
- General Medicine, Andhra Medical College/King George Hospital, Visakhapatnam, IND
| | - Isabelle Mulango
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Ikpechukwu J Okorie
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Divine Besong Arrey Agbor
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Crystal Delp
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Hanim Apple
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Borislav Kheyson
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Jay Nfonoyim
- Pulmonary and Critical Care, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Nidal Isber
- Electrophysiology, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Mallikarjuna Yalamanchili
- Anesthesiology, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
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Coleman SR, Cios TJ, Riela S, Roberts SM. The Effects of Propofol on Left Ventricular Global Longitudinal Strain. Semin Cardiothorac Vasc Anesth 2021; 25:185-190. [DOI: 10.1177/1089253221991372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To determine if hemodynamic changes secondary to propofol administration are a result of direct myocardial depression as measured by global longitudinal strain (GLS). The authors hypothesized that propofol would cause a significant worsening in GLS, indicating direct myocardial depression. Design Prospective, observational. Setting Endoscopy suite at a single academic medical center. Participants Patients undergoing outpatient, elective endoscopic procedures at an outpatient clinic of a single tertiary care academic medical center. Interventions None. Measurements and Main Results Limited transthoracic echocardiograms were performed before and after patients received propofol for endoscopic procedures. Post-processing measurements included GLS, 2D (dimensional) ejection fraction (2D EF), and 3D EF. Using paired sample Student’s t test, no statistically significant change in GLS, 2D EF, or 3D EF was found despite statistically significant hypotension. In fact, there was a trend toward more negative GLS (improved myocardial function) in patients after receiving propofol. Conclusion We found propofol did not cause a reduction in systolic function as measured by GLS, a sensitive measure of myocardial contractility. Therefore, decreases in blood pressure after a propofol bolus in spontaneously breathing patients are likely due to decreased vascular tone and not impaired left ventricular systolic function. These results should be considered in the management of propofol-induced hypotension for spontaneously breathing patients.
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Affiliation(s)
- Scott R. Coleman
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Theodore J. Cios
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Steven Riela
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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A Fast Parameter Identification Framework for Personalized Pharmacokinetics. Sci Rep 2019; 9:14143. [PMID: 31578414 PMCID: PMC6775128 DOI: 10.1038/s41598-019-50810-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/19/2019] [Indexed: 11/08/2022] Open
Abstract
This paper introduces a novel framework for fast parameter identification of personalized pharmacokinetic problems. Given one sample observation of a new subject, the framework predicts the parameters of the subject based on prior knowledge from a pharmacokinetic database. The feasibility of this framework was demonstrated by developing a new algorithm based on the Cluster Newton method, namely the constrained Cluster Newton method, where the initial points of the parameters are constrained by the database. The algorithm was tested with the compartmental model of propofol on a database of 59 subjects. The average overall absolute percentage error based on constrained Cluster Newton method is 12.10% with the threshold approach, and 13.42% with the nearest-neighbor approach. The average computation time of one estimation is 13.10 seconds. Using parallel computing, the average computation time is reduced to 1.54 seconds, achieved with 12 parallel workers. The results suggest that the proposed framework can effectively improve the prediction accuracy of the pharmacokinetic parameters with limited observations in comparison to the conventional methods. Computation cost analyses indicate that the proposed framework can take advantage of parallel computing and provide solutions within practical response times, leading to fast and accurate parameter identification of pharmacokinetic problems.
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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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Cattai A, Rabozzi R, Ferasin H, Isola M, Franci P. Haemodynamic changes during propofol induction in dogs: new findings and approach of monitoring. BMC Vet Res 2018; 14:282. [PMID: 30208893 PMCID: PMC6134702 DOI: 10.1186/s12917-018-1608-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 08/31/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Propofol is one of the most widely used injectable anaesthetic agents in veterinary practice. Cardiovascular effects related to propofol use in dogs remain less well defined. The main objective of this study was to evaluate the haemodynamic changes during induction of general anaesthesia with propofol in healthy dogs, by a beat-to-beat continuous monitoring. All dogs were premedicated with intramuscular acepromazine (0.015 mg/kg) and methadone (0.15 mg/kg). Transthoracic echocardiography was used to measure the velocity time integral (VTI) of the left ventricular outflow tract. A syringe driver, programmed to deliver propofol 5 mg/kg over 30 s followed by a continuous infusion of 25 mg/kg/h, was used to induce and maintain anaesthesia. From the initiation of propofol administration, heart rate (HR) and mean invasive arterial blood pressure (MAP) were recorded every 5 s for 300 s, while aortic blood flow was continuously recorded and stored for 300 S. maximum cardiovascular depression was defined the lowest MAP (MAP_Tpeak) recorded during the monitored interval. VTI and VTI*HR were calculated at 0, 30, 90, 120, 150 and 300 s post administration of propofol, and at MAP_Tpeak. Haemodynamic effects of propofol in relation to plasma and biophase concentrations were also evaluated by pharmacokinetics simulation. RESULTS The median (range) HR was significantly higher (p = 0.006) at the moment of maximum hemodynamic depression (Tpeak) [105(70-148) bpm] compared with pre-induction values (T0) [65(50-120) bpm]. The median (range) MAP was significantly lower (p < 0.001) at Tpeak [61(51-69) mmHg] compared with T0 [88(72-97) mmHg]. The median (range) VTI and VTI*HR were similar at the two time points [11.9(8.1-17.3) vs 13,3(9,4-16,5) cm, and 1172(806-1554) vs 1002(630-1159) cm*bpm, respectively]. CONCLUSIONS Induction of anaesthesia with propofol causes a drop of arterial pressure in healthy dogs, however cardiac output is well maintained by compensatory chronotropic response. The magnitude of MAP_Tpeak may be strictly related with propofol plasma concentration.
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Affiliation(s)
- Andrea Cattai
- Department of Animal Medicine, Production and Health, Agripolis, Università degli Studi di Padova, Padua, Italy
| | | | - Heidi Ferasin
- Specialist Veterinary Cardiology Consultancy, Lymington Bottom, Four Marks, Hampshire, UK
| | - Maurizio Isola
- Department of Animal Medicine, Production and Health, Agripolis, Università degli Studi di Padova, Padua, Italy
| | - Paolo Franci
- Department of Animal Medicine, Production and Health, Agripolis, Università degli Studi di Padova, Padua, Italy
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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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Minghella E, Auckburally A, Pawson P, Scott ME, Flaherty D. Clinical effects of midazolam or lidocaine co-induction with a propofol target-controlled infusion (TCI) in dogs. Vet Anaesth Analg 2016; 43:472-81. [PMID: 26833994 DOI: 10.1111/vaa.12336] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/01/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the propofol requirement, cardiovascular and respiratory variables using midazolam or lidocaine with a propofol target-controlled infusion (PTCI) for induction of anaesthesia in healthy dogs. STUDY DESIGN Prospective, randomized, controlled blinded clinical trial. ANIMALS Sixty client-owned dogs [American Society of Anesthesiologists (ASA) I-II] undergoing surgical procedures. METHODS Thirty minutes after premedication with acepromazine (0.03 mg kg(-1) ) and morphine (0.2 mg kg(-1) ), PTCI was started and maintained at a plasma target concentration of 1 μg mL(-1) . Three minutes later, dogs (n = 20 per group) received either 5 mL 0.9% sodium chloride (SG), 2 mg kg(-1) of lidocaine (LG) or 0.2 mg kg(-1) of midazolam (MG) intravenously (IV) as a co-induction agent. Two minutes later, suitability for endotracheal intubation was assessed. If intubation was not possible, the propofol target was increased by 0.5 μg mL(-1) every 60 seconds until it was successfully achieved. Heart rate (HR), respiratory rate (fR ), and oscillometric systolic arterial pressure (SAP), mean arterial pressure (MAP) and diastolic arterial pressure (DAP) were recorded immediately prior to commencing PTCI (B0), prior to intubation (BI), immediately after (T0), and at 3 (T3) and 5 (T5) minutes post-intubation. End-tidal partial pressures of carbon dioxide (PE(') CO2 ) were recorded at T0, T3 and T5. The occurrence of excitement at any time point was noted. RESULTS The median (range) propofol target concentration for endotracheal intubation was significantly lower in MG, 1.5 (1.0-4.0) μg mL(-1) compared with LG, 2.5 (1.5-4.5) μg mL(-1) or SG, 3.0 (2.0-5.0) μg mL(-1) . Heart rate, MAP, fR and PE(') CO2 were similar in the three groups at all time points. No excitement was reported in any dog. CONCLUSIONS AND CLINICAL RELEVANCE Midazolam, but not lidocaine, provided a significant reduction in PTCI requirement for induction of anaesthesia thereby allowing successful intubation. However, cardiovascular and respiratory effects were not different between the groups.
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Affiliation(s)
- Enzo Minghella
- Institute of Biodiversity, Animal Health and Comparative Medicine, School of Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Adam Auckburally
- Institute of Biodiversity, Animal Health and Comparative Medicine, School of Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Patricia Pawson
- Institute of Biodiversity, Animal Health and Comparative Medicine, School of Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Marian E Scott
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Derek Flaherty
- Institute of Biodiversity, Animal Health and Comparative Medicine, School of Veterinary Medicine, University of Glasgow, Glasgow, UK
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Rocchi A, Ambrisko TD, Moens Y. Effect of dexmedetomidine vs. acepromazine–methadone premedication on limb to lung circulation time in dogs. Vet J 2013; 195:357-60. [PMID: 22940068 DOI: 10.1016/j.tvjl.2012.06.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 05/21/2012] [Accepted: 06/29/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Attilio Rocchi
- Division of Anaesthesiology and Perioperative Intensive Care, University of Veterinary Medicine, Veterinärplatz 1, 1020 Vienna, Austria.
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Hatakeyama N, Sakuraya F, Matsuda N, Kimura J, Kinoshita H, Kemmotsu O, Yamazaki M, Hattori Y. Pharmacological Significance of the Blocking Action of the Intravenous General Anesthetic Propofol on the Slow Component of Cardiac Delayed Rectifier K+ Current. J Pharmacol Sci 2009; 110:334-43. [DOI: 10.1254/jphs.09060fp] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ndoko SK, Tual L, Ait Mamar B, Sauvat S, Jabre P, Zakhouri M, Rosanval O, Abdi M, Kirsch M, Pouzet B, Loisance D, Dhonneur G. Isoflurane, 0.5 Minimum Alveolar Concentration Administered Through the Precardiopulmonary Bypass Period, Reduces Postoperative Dobutamine Requirements of Cardiac Surgery Patients: A Randomized Study. J Cardiothorac Vasc Anesth 2007; 21:683-9. [PMID: 17905274 DOI: 10.1053/j.jvca.2006.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Cardioprotective properties have been shown with halogenated volatile agents. It was hypothesized that low-dose isoflurane administered before aortic cross-clamping may reduce the amount of dobutamine required to improve impaired postoperative cardiac function after various types of cardiac surgery. DESIGN A prospective, randomized trial. SETTING An anesthesia and intensive care unit, university hospital. PARTICIPANTS Two hundred eighty cardiac surgery patients. INTERVENTIONS All patients allocated to either isoflurane treatment (T) or no treatment (control group [C]) received total intravenous anesthesia. In the treatment group, isoflurane was administered at a 0.5 minimum alveolar concentration (MAC) from tracheal intubation to initiation of cardiopulmonary bypass (CPB). During weaning from CPB, dobutamine was introduced by using a hemodynamically driven decision tree. MEASUREMENTS AND MAIN RESULTS The number of patients receiving dobutamine was comparable (66 v 78, p = 0.07, in T and C groups, respectively). The total amount of postoperative dobutamine indexed to patient weight, considered as the primary endpoint, was reduced in the isoflurane-treated group (4.2 +/- 8 v 7.2 +/- 15, p < 0.02, in T and C, respectively). Isoflurane was identified as an independent variable significantly (odds ratio [confidence interval]) influencing the total amount of postoperative dobutamine (0.53 [0.31-0.92], p < 0.02). Postoperative troponin I release at 20 hours was not affected by isoflurane treatment. CONCLUSIONS This study revealed that exposure to 0.5 MAC isoflurane before CPB reduced the total amount of dobutamine required to normalize postoperative cardiac dysfunction in various types of cardiac surgical patients.
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Affiliation(s)
- Serge K Ndoko
- Department of Anesthesiology and Surgical Intensive Care, Paris XII, University Hospital Henri Mondor, Créteil, France.
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Haddad WM, Bailey JM, Hayakawa T, Hovakimyan N. Neural network adaptive output feedback control for intensive care unit sedation and intraoperative anesthesia. ACTA ACUST UNITED AC 2007; 18:1049-66. [PMID: 17668661 DOI: 10.1109/tnn.2007.899164] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The potential applications of neural adaptive control for pharmacology, in general, and anesthesia and critical care unit medicine, in particular, are clearly apparent. Specifically, monitoring and controlling the depth of anesthesia in surgery is of particular importance. Nonnegative and compartmental models provide a broad framework for biological and physiological systems, including clinical pharmacology, and are well suited for developing models for closed-loop control of drug administration. In this paper, we develop a neural adaptive output feedback control framework for nonlinear uncertain nonnegative and compartmental systems with nonnegative control inputs. The proposed framework is Lyapunov-based and guarantees ultimate boundedness of the error signals. In addition, the neural adaptive controller guarantees that the physical system states remain in the nonnegative orthant of the state space. Finally, the proposed approach is used to control the infusion of the anesthetic drug propofol for maintaining a desired constant level of depth of anesthesia for noncardiac surgery.
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Affiliation(s)
- Wassim M Haddad
- School of Aerospace Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0150, USA.
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Haskins SC. Comparative cardiovascular and pulmonary effects of sedatives and anesthetic agents and anesthetic drug selection for the trauma patient. J Vet Emerg Crit Care (San Antonio) 2006. [DOI: 10.1111/j.1476-4431.2006.00188.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Di Filippo A, Cammelli R, Novelli A, Mazzei T, Tonelli F, Fallani S, Cassetta MI, Messeri D, De Gaudio AR. Intraoperative Positive Fluid Balance Improves Tissue Diffusion of Ceftizoxime. Chemotherapy 2005; 51:51-6. [PMID: 15870497 DOI: 10.1159/000085610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 11/02/2004] [Indexed: 11/19/2022]
Abstract
AIM OF STUDY To demonstrate that administration of fluids and the consequent improvement of fluid balance during a surgical procedure can modify the tissue diffusion of ceftizoxime. METHODS Twenty-eight patients (30-79 years) undergoing major abdominal surgery of the colon were administered ceftizoxime 30 mg/kg i.v. at induction of anesthesia. A sample of arterial blood was taken before administration of the drug (t0) and then again at the time of vascular occlusion of the colon segment to be removed (t1). A sample of the segment of removed colon was taken. The patients were divided into two groups on the basis of the fluid balance between t0 and t1: group A (n = 17) with a fluid balance <1,000 ml and group B (n = 11) with a fluid balance >1,000 ml. The parameters evaluated in each group were: weight, height and age of the patients, serum and tissue antibiotic concentration, percent ratio of serum and tissue concentration, time elapsed between t0 and t1, volume of administered fluids between t0 and t1, diuresis and hourly diuresis between t0 and t1 and body fluid distribution, obtained using a bioelectrical impedance analyzer. The mean results obtained in the two groups were then compared using Student's t test. RESULTS The balance of fluids calculated up to t1 was 675 +/- 308 ml for group A and 1,411 +/- 405 ml for group B (p < 0.01). The means of the recorded values that showed statistically significant differences were: mean percent concentration ratio (43.6 +/- 8.4 vs. 84 +/- 16%; p < 0.05), concentration in the colonic segment (16.3 +/- 7.9 vs. 37.2 +/- 25.9 mg/ml; p < 0.05), urinary volume gathered up to t1 (538 +/- 557 vs. 169 +/- 104 ml; p < 0.05), hourly urinary volume up to t1 (311.1 +/- 296 vs. 97.6 +/- 77.9 ml/h; p < 0.05), percent variation of resistance (95.1 +/- 5.1 vs. 89.7 +/- 8.6; p < 0.05). The other means did not show any significant statistical differences. CONCLUSIONS A higher tissue water level seems to facilitate the penetration of the antibiotic into the tissue according to the pharmacokinetic characteristics of ceftizoxime: high amount of free drug (not bound to plasma proteins) and high hydrosolubility.
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Affiliation(s)
- A Di Filippo
- University of Florence, Department of Critical Care, Section of Anesthesiology and Intensive Care, Unit of Surgery, Pistoia, Infectious Diseases Unit, Florence, Italy.
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Ouattara A, Boccara G, Lecomte P, Souktani R, Le Cosquer P, Mouren S, Coriat P, Riou B. Amplification by Hyperoxia of Coronary Vasodilation Induced by Propofol. Anesth Analg 2004; 98:595-603, table of contents. [PMID: 14980904 DOI: 10.1213/01.ane.0000100681.15355.ac] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
UNLABELLED We tested the hypothesis that in vitro coronary and myocardial effects of propofol (10-300 microM) should be significantly modified in an isolated and erythrocyte-perfused rabbit heart model in the absence (PaO(2) = 137 +/- 16 mm Hg, n = 12) or in the presence (PaO(2) = 541 +/- 138 mm Hg, n = 12) of hyperoxia. The induction of hyperoxia provoked a significant coronary vasoconstriction (-13% +/- 7%). Propofol induced increased coronary vasodilation in the presence of hyperoxia. Because high oxygen tension has been reported to induce a coronary vasoconstriction mediated by the closure of adenosine triphosphate-sensitive potassium channels, we studied the effects of propofol in 2 additional groups of hearts (n = 6 in each group) pretreated by glibenclamide (0.6 microM) and cromakalim (0.5 microM) in the absence and presence of hyperoxia, respectively. The pretreatment by glibenclamide induced a coronary vasoconstriction (-16% +/- 7%) which did not affect propofol coronary vasodilation. The pretreatment by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. Propofol induced a significant decrease in myocardial performance for a concentration >100 micro M both in the absence and presence of hyperoxia. We conclude that propofol coronary vasodilation is amplified in the presence of hyperoxia. This phenomenon is not explained by the previous coronary vasoconstriction induced by glibenclamide. However, the pretreatment of hearts by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. The myocardial effects of propofol were not affected by the presence of hyperoxia. IMPLICATIONS Propofol induced a coronary vasodilation that was amplified in the presence of hyperoxia. This phenomenon does not seem to be related to previous coronary vasoconstriction. The myocardial effects of propofol were not significantly modified in the presence of hyperoxia.
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Zheng D, Upton RN, Martinez AM. The contribution of the coronary concentrations of propofol to its cardiovascular effects in anesthetized sheep. Anesth Analg 2003; 96:1589-1597. [PMID: 12760980 DOI: 10.1213/01.ane.0000060561.16583.a7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Linking physiological pharmacokinetic models to models of the cardiovascular system requires knowledge of the sites in the body that mediate a drug's cardiovascular effects. We examined the role of the coronary concentrations of propofol. Nine sheep anesthetized with isoflurane (2%) were instrumented acutely for cardiovascular measurements. In a random crossover design, they were administered ramped coronary artery (CA) infusions of propofol to selectively enrich the myocardium (as indicated by the coronary sinus blood concentration) or IV infusions to achieve the same concentration range in all sites of the body. Reductions in left ventricular myocardial contractility (LV dP/dt(max)) and mean arterial blood pressure were linearly related to the propofol concentration. For the CA route, LV dP/dt(max) was reduced by 52 mm Hg/s for each milligram per liter increase in coronary sinus propofol concentration. For the IV route, the reduction in LV dP/dt(max) was equivalent to that with the CA route, showing that the coronary propofol concentration was the major contribution to this effect. For the CA route, mean arterial blood pressure was reduced by 0.6 mm Hg for each milligram per liter. There was a larger reduction (2.5 mm Hg x mg(-1) x L(-1)) for the IV route. Therefore, this effect was predominantly mediated by propofol concentrations elsewhere in the body. IMPLICATIONS With use of selective coronary artery infusions in sheep, the coronary concentrations of propofol were shown to be the major contributor to the cardiac depression caused by propofol but were a less significant contributor to the hypotension caused by this drug. Models of the cardiovascular effects of propofol should account for these relationships.
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Affiliation(s)
- Da Zheng
- Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital/University of Adelaide, North Terrace, Adelaide, Australia
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Kehl F, Kress TT, Mraovic B, Hettrick DA, Kersten JR, Warltier DC, Pagel PS. Propofol alters left atrial function evaluated with pressure-volume relations in vivo. Anesth Analg 2002; 94:1421-6, table of contents. [PMID: 12031999 DOI: 10.1097/00000539-200206000-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED The effects of IV anesthetics on left atrial (LA) function in vivo are unknown. We tested the hypothesis that propofol alters LA mechanics evaluated with pressure-volume relations in barbiturate-anesthetized dogs (n = 9) instrumented for measurement of aortic, LA, and left ventricular (LV) pressures (micromanometers) and LA volume (epicardial orthogonal sonomicrometers). LA myocardial contractility (E(es)) and dynamic chamber stiffness were assessed with end-systolic and end-reservoir pressure-volume relations, respectively. Relaxation was determined from the slope of LA pressure decline after contraction corrected for peak LA pressure. LA stroke work and reservoir function were assessed by A and V loop area, respectively, from the steady-state pressure-volume diagram. LA-LV coupling was determined by the ratio of E(es) to LV elastance. Dogs received propofol (5, 10, 20, or 40 mg. kg(-1). h(-1)) in a random manner, and LA function was determined after a 15-min equilibration at each dose. Propofol decreased heart rate, mean arterial blood pressure, and the maximal rate of increase of LV pressure. Propofol caused dose-related reductions in E(es), dynamic chamber stiffness, and E(es)/LV elastance. An increase in V loop area and declines in LA stroke work, emptying fraction, and the active LA contribution to LV filling also occurred. Relaxation was unchanged. The results indicate that propofol depresses LA myocardial contractility, reduces dynamic chamber stiffness, maintains reservoir function, and impairs LA-LV coupling but does not alter LA relaxation in vivo. IMPLICATIONS Propofol depresses contractile function of left atrial (LA) myocardium, impairs mechanical matching between the LA and the left ventricular (LV), and reduces the active LA contribution to LV filling in vivo. Compensatory decreases in chamber stiffness contribute to relative maintenance of LA reservoir function during the administration of propofol.
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Affiliation(s)
- Franz Kehl
- Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Kehl F, Kress TT, Mraovic B, Hettrick DA, Kersten JR, Warltier DC, Pagel PS. Propofol Alters Left Atrial Function Evaluated with Pressure-Volume Relations In Vivo. Anesth Analg 2002. [DOI: 10.1213/00000539-200206000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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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: 48] [Impact Index Per Article: 2.1] [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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van Klarenbosch J, Stienen GJ, de Ruijter W, Scheffer GJ, de Lange JJ. The differential effect of propofol on contractility of isolated myocardial trabeculae of rat and guinea-pig. Br J Pharmacol 2001; 132:742-8. [PMID: 11159727 PMCID: PMC1572596 DOI: 10.1038/sj.bjp.0703849] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
1. The effects of propofol on myocardial contractility were studied in rat, in which the contractile activation mainly depends on calcium derived from the sarcoplasmic reticulum (SR), and guinea-pig, in which transsarcolemmal influx of calcium plays a major role. 2. Intact and chemically skinned trabeculae from the right ventricle were studied. Intact trabeculae were electrically stimulated and force development during steady state and post rest contractions was measured. In saponin skinned trabeculae Ca(2+) uptake and release by the SR was studied. In Triton skinned trabeculae the influence of propofol on calcium sensitivity of the myofilaments was studied. 3. In intact rat trabeculae propofol in concentrations of 28, 112 and 280 microM did not change peak force development nor the pattern of post rest contraction. In guinea-pig trabeculae propofol significantly reduced peak force to respectively 64, 40 and 23% of control values and the post rest contractions were potentiated. In skinned trabeculae propofol did not affect Ca(2+) handling by the SR, nor did it change force production and Ca(2+) sensitivity of the myofilaments. 4. This study shows that, in contrast to rat, in guinea-pig propofol directly depresses myocardial contractility, probably by decreasing transsarcolemmal Ca(2+) influx. There is no significant influence of propofol on Ca(2+) handling by the SR, nor on the contractile proteins.
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Affiliation(s)
- J van Klarenbosch
- Department of Anaesthesiology, Academisch Ziekenhuis, Vrije Universiteit, Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Oztekin S, Kalkan S, Ozzeybek D, Tuncok Y, Guven H, Elar Z. The effects of propofol on normal and hypercholesterolemic isolated rabbit heart. GENERAL PHARMACOLOGY 2000; 35:65-70. [PMID: 11707311 DOI: 10.1016/s0306-3623(01)00092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aim of the present study was to compare the effects of propofol on cardiac contractile force in normal and hypercholesterolemic isolated rabbit hearts. While one group was fed with standard chow pellets (150 g/day), the other group received cholesterol (1% w/w) in addition to the same amount of rabbit chow pellets during 1 month. Hearts from standard-fed rabbits were given intralipid solvent or 25, 50 and 100 microM propofol by infusion. Hypercholesterolemic rabbit hearts were administered 25, 50 and 100 microM propofol by infusion. All concentrations of propofol did not result in any significant change of the heart rates (HR) in two groups. Propofol (25, 50 and 100 microM) infusion induced a concentration- and time-dependent inhibition in left ventricular pressure (LVP) in standard chow diet group (P<.05,.05 and.05, respectively). In hypercholesterolemic rabbit hearts, 25 and 50 microM propofol infusion developed a significant inhibition in LVP when compared with the standard chow diet group (P<.05 and.05, respectively). Propofol (100 microM) infusion developed a significant increase in LVP after 20 min in hypercholesterolemic rabbit hearts when compared with normal rabbit hearts (P<.05). Supratherapeutic concentration of propofol might have cardioprotective effect on hypercholesterolemic rabbit hearts.
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Affiliation(s)
- S Oztekin
- Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylul University, Balcova 35340, Izmir, Turkey
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Schenkman KA, Yan S. Propofol impairment of mitochondrial respiration in isolated perfused guinea pig hearts determined by reflectance spectroscopy. Crit Care Med 2000; 28:172-7. [PMID: 10667518 DOI: 10.1097/00003246-200001000-00028] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To simultaneously determine the effect of propofol on myocardial oxygenation, mitochondrial function, and whole organ function in an isolated heart model, using optical reflectance spectroscopy. DESIGN Controlled laboratory investigation. SETTING Research laboratory. SUBJECTS Twenty adult guinea pigs. INTERVENTIONS Isolated hearts were perfused alternately with a modified oxygenated Krebs-Henseleit buffer and with buffer containing varied concentrations of propofol. Ninety seconds of ischemia were produced during perfusion with each solution studied. MEASUREMENTS AND MAIN RESULTS Myoglobin oxygen saturation, cytochrome c and cytochrome a/a3 redox state, and ventricular pressure were continuously measured from isolated guinea pig hearts during a 2-hr period. Myoglobin oxygen saturation increased and both cytochromes became more oxidized in the presence of propofol. During ischemia, myoglobin desaturation and cytochrome reduction were delayed and less complete in the presence of propofol. The mean ischemic time to 50% myoglobin desaturation was, on average, 14.3 secs with buffer perfusion, and increased to 24.5, 27.9, and 41.8 secs, with 50, 100, and 200 microM propofol perfusion, respectively. Ventricular function decreased linearly with increasing propofol concentration. From baseline buffer perfusion, maximal dP/dt per cardiac cycle decreased on average by 30.4%, 40.9%, and 69.4%, with 50, 100, and 200 microM propofol perfusion, respectively. CONCLUSIONS Propofol impairs either oxygen utilization or inhibits electron flow along the mitochondrial electron transport chain in the guinea pig cardiomyocyte. Propofol also significantly decreases ventricular performance in the isolated perfused heart. These effects are linearly correlated with propofol concentration in the range studied.
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Affiliation(s)
- K A Schenkman
- Department of Pediatrics, University of Wisconsin, Madison, USA.
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Lejay M, Hanouz JL, Lecarpentier Y, Coriat P, Riou B. Modifications of the inotropic responses to alpha- and beta-adrenoceptor stimulation by propofol in rat myocardium. Anesth Analg 1998; 87:277-83. [PMID: 9706916 DOI: 10.1097/00000539-199808000-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Propofol induces cardiovascular depression but without significant effect on intrinsic myocardial contractility in many species. However, its interactions with adrenoceptor stimulation are unknown. We studied the effects of propofol (1 and 10 microg/mL) and its solvent on the inotropic response induced by phenylephrine (10(-8)-10(-4) M) or isoproterenol (10(-8)-10(-4) M) in rat left ventricular papillary muscles in vitro (Krebs-Henseleit solution, 29 degrees C, pH 7.40, calcium 0.5 mM, stimulation frequency 12 pulses/min). We also studied the lusitropic effects in isotonic and isometric conditions. In control groups, phenylephrine (127% +/- 3% of baseline; P < 0.05) and isoproterenol (169% +/- 11% of baseline; P < 0.05) induced a positive inotropic effect. Propofol (10 microg/mL) completely abolished the positive inotropic effect of phenylephrine (100% +/- 3% of baseline; P = not significant). In contrast, at the lowest concentration (1 microg/mL), propofol did not modify the positive inotropic effect of phenylephrine. Propofol did not modify the inotropic effect of isoproterenol. Propofol (10 microg/mL) enhanced the positive lusitropic effect of isoproterenol under low-load (P < 0.05) but not under high-load conditions. IMPLICATIONS A high concentration of propofol abolished the positive inotropic effect of alpha- but not beta-adrenoceptor stimulation and enhanced the positive lusitropic effect of beta-adrenoceptor stimulation.
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MESH Headings
- Adrenergic alpha-Agonists/pharmacology
- Adrenergic beta-Agonists/pharmacology
- Anesthetics, Intravenous/pharmacology
- Animals
- In Vitro Techniques
- Isoproterenol/pharmacology
- Myocardial Contraction/drug effects
- Phenylephrine/pharmacology
- Propofol/pharmacology
- Rats
- Rats, Wistar
- Receptors, Adrenergic, alpha/drug effects
- Receptors, Adrenergic, alpha/physiology
- Receptors, Adrenergic, beta/drug effects
- Receptors, Adrenergic, beta/physiology
- Stimulation, Chemical
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Affiliation(s)
- M Lejay
- Laboratoire d'Anesthésiologie, Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire Pitié-Salpêtrière, Université Paris VI, France
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Pagel PS, Hettrick DA, Kersten JR, Lowe D, Warltier DC. Propofol, but not thiopentone or etomidate, enhances isoflurane-induced coronary vasodilatation in dogs. Can J Anaesth 1998; 45:809-17. [PMID: 9793674 DOI: 10.1007/bf03012155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To test the hypothesis that thiopentone, propofol, and etomidate alter the coronary vascular effects of abruptly administered isoflurane. METHODS Dogs (n = 6) received inspired isoflurane 5% in the presence of thiopentone (20 mg.kg-1 induction dose and 20 mg.kg-1.hr-1 infusion), propofol (5 mg.kg-1 induction dose and 40 mg.kg-1.hr-1 infusion), etomidate (2 mg.kg-1 induction dose and 5 mg.kg-1.hr-1 infusion), or isoflurane (1.0 MAC) anaesthesia in a random fashion. Haemodynamics were assessed in the conscious state, during baseline anaesthesia, and at 30 sec intervals for five minutes after beginning isoflurane 5%. RESULTS Rapidly administered isoflurane caused greater (P < 0.05) reductions in coronary vascular resistance in thiopentone- or propofol--than in isoflurane-anaesthetized dogs. Isoflurane produced greater (P < 0.05) increases in the ratio of coronary blood flow velocity to pressure-work index (an index of myocardial oxygen consumption; +109 +/- 19% during isoflurane alone vs +182 +/- 27% change from baseline during propofol and isoflurane) consistent with relatively greater direct coronary vasodilatation during baseline propofol than during baseline isoflurane anaesthesia. Isoflurane caused larger increases in coronary blood flow velocity in dogs anaesthetized with etomidate concomitant with higher coronary perfusion pressure and pressure-work index than in those anaesthetized with isoflurane alone. CONCLUSIONS The results suggest that thiopentone, propofol, and etomidate each uniquely modify the coronary vascular responses to abrupt administration of high inspired concentrations of isoflurane in chronically instrumented dogs.
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Affiliation(s)
- P S Pagel
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee 53226, USA.
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26
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Modifications of the Inotropic Responses to alpha- and beta-Adrenoceptor Stimulation by Propofol in Rat Myocardium. Anesth Analg 1998. [DOI: 10.1213/00000539-199808000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Watanabe S, Itou T, Kaneko S, Isomura T, Kano T. Intraoperative hemodynamic management for minimally invasive direct coronary artery bypass: two case reports. J Anesth 1998; 12:36-40. [PMID: 28921330 DOI: 10.1007/bf02480764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/1997] [Accepted: 10/02/1997] [Indexed: 10/24/2022]
Affiliation(s)
- Seiji Watanabe
- Department of Anesthesiology, Kurume University School of Medicine, 67 Asahimachi, 830, Kurume, Fukuoka, Japan
| | - Takahiko Itou
- Department of Anesthesiology, Kurume University School of Medicine, 67 Asahimachi, 830, Kurume, Fukuoka, Japan
| | - Shinya Kaneko
- Department of Anesthesiology, Kurume University School of Medicine, 67 Asahimachi, 830, Kurume, Fukuoka, Japan
| | - Tadashi Isomura
- Department of 2nd Surgery, Kurume University School of Medicine, 67 Asahimachi, 830, Kurume, Fukuoka, Japan
| | - Tatsuhiko Kano
- Department of Anesthesiology, Kurume University School of Medicine, 67 Asahimachi, 830, Kurume, Fukuoka, Japan
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D'Attellis N, Nicolas-Robin A, Delayance S, Carpentier A, Baron JF. Early extubation after mitral valve surgery: a target-controlled infusion of propofol and low-dose sufentanil. J Cardiothorac Vasc Anesth 1997; 11:467-73. [PMID: 9187997 DOI: 10.1016/s1053-0770(97)90057-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In the current study, the use of a target-controlled infusion of low-dose propofol was combined with a continuous infusion of sufentanil for patients undergoing mitral valve surgery. The purpose of the study was to evaluate the hemodynamic stability, the time to awakening and spontaneous ventilation, and the feasibility in an early extubation setting of a total intravenous anesthetic technique. DESIGN Prospective study. SETTING University hospital. PARTICIPANTS Fifteen patients scheduled for elective mitral valve surgery. INTERVENTIONS Induction of anesthesia consisted of sufentanil (1 microgram/kg), propofol (1 microgram/mL) target plasma concentration achieved over 3 minutes, and atracurium (0.5 mg/kg). The propofol target-controlled infusion was maintained at 1 microgram/mL throughout surgery and stopped at skin closure. A continuous infusion of sufentanil at 1.8 micrograms/kg/hr was started after induction and reduced to 0.9 microgram/kg/hr at the start of cardiopulmonary bypass and stopped at the end of bypass. Atracurium was infused at a rate of 0.5 mg/kg/hr up to sternal closure. No inhalation agents were used. MEASUREMENTS AND MAIN RESULTS Hemodynamic data were within normal limits. Six patients (40%) responded to verbal commands within 15 minutes postoperatively, 10 (67%) within the first hour, and all patients recovered within 2 hours. Four patients (27%) resumed spontaneous ventilation within the first 15 postoperative minutes. The time to successful spontaneous ventilation was 169 +/- 42 minutes. Spontaneous ventilation was associated with a 21% increase in cardiac index. Total sufentanil dose was 328 +/- 28 micrograms (4.6 +/- 0.2 microgram/kg), whereas total propofol dose was 862 +/- 44 mg (13.1 +/- 1.2 mg/kg). No patient required reintubation. CONCLUSION The simplicity of the method with only one change in infusion rate is a major advantage. The technique permits predictable recovery and return to spontaneous ventilation in all patients. Its use in patients entering early extubation protocols is appealing for its reproducibility, simplicity, and safety.
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Affiliation(s)
- N D'Attellis
- Department of Anesthesiology and Intensive Care, Broussais Hospital, Paris, France
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Hebbar L, Dorman BH, Roy RC, Spinale FG. The Direct Effects of Propofol on Myocyte Contractile Function After Hypothermic Cardioplegic Arrest. Anesth Analg 1996. [DOI: 10.1213/00000539-199611000-00010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hebbar L, Dorman BH, Roy RC, Spinale FG. The direct effects of propofol on myocyte contractile function after hypothermic cardioplegic arrest. Anesth Analg 1996; 83:949-57. [PMID: 8895268 DOI: 10.1097/00000539-199611000-00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Propofol is being used more often in cardiac surgery, particularly after hypothermic, hyperkalemic cardioplegic arrest (HHCA). The purpose of this study was to examine the effects of propofol on isolated myocyte contractile function under both normothermic conditions and after simulated HHCA and rewarming. Myocytes were isolated from the left ventricle of eight pigs. Myocyte contractile function was measured under both normothermic conditions and after simulated HHCA (incubation at 4 degrees C for 2 h in crystalloid cardioplegia; K+ = 24 mEq/L) using computer-assisted videomicroscopy in the presence of 2, 4, and 6 micrograms/mL propofol (11.2, 22.4, and 33.6 microM/L, respectively). Isoproterenol (25 nM) was then added and contractile function measurements repeated. Propofol caused significant dose-dependent reductions in myocyte velocity of shortening (baseline = 67 +/- 2 microns/s; propofol = 2 micrograms/mL, 45 +/- 4 microns/s; and propofol = 6 micrograms/mL, 27 +/- 3 microns/s; P < 0.05). HHCA and rewarming caused a significant reduction in myocyte velocity of shortening (29 +/- 0.9 microns/s, P < 0.05), with further significant dose-dependent reductions in contractile function after the addition of propofol. Propofol caused a decrease in beta-adrenergic responsiveness under normothermic conditions, but not after simulated HHCA. Results from the present study demonstrated for the first time that the reduction in isolated myocyte contractile function after simulated HHCA is further decreased by propofol administration.
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Affiliation(s)
- L Hebbar
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston 29425-2207, USA
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Booke M, Armstrong C, Hinder F, Conroy B, Traber LD, Traber DL. The effects of propofol on hemodynamics and renal blood flow in healthy and in septic sheep, and combined with fentanyl in septic sheep. Anesth Analg 1996; 82:738-43. [PMID: 8615490 DOI: 10.1097/00000539-199604000-00011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Sepsis is characterized by myocardial depression and systemic vasodilation, both of which are most likely mediated by nitric oxide. Propofol inhibits nitric oxide synthase and may therefore be beneficial in sepsis. On the other hand, renal blood flow, known to be only minimally affected by propofol in healthy subjects, may be drastically reduced in septic individuals, because the renal microvasculature is known to be very sensitive to nitric oxide. In this study, the effects of propofol in healthy and in septic sheep, and in combination with fentanyl, were analyzed and compared with nonanesthetized septic sheep. In healthy sheep, propofol caused only minor hemodynamic changes. In septic sheep, however, hemodynamics deteriorated. Renal blood flow was reduced to 60% +/- 10% of the preseptic baseline and to 39% +/- 4% of the septic value. This reduction was selective, since the cardiac output decreased significantly less. These adverse effects of propofol on hemodynamics and renal blood flow were reduced when propofol was combined with fentanyl.
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Affiliation(s)
- M Booke
- Department of Anesthesiology, University of Texas Medical Branch, Galveston 77555-0833, USA
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Booke M, Armstrong C, Hinder F, Conroy B, Traber LD, Traber DL. The Effects of Propofol on Hemodynamics and Renal Blood Flow in Healthy and in Septic Sheep, and Combined with Fentanyl in Septic Sheep. Anesth Analg 1996. [DOI: 10.1213/00000539-199604000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Amrinone has been shown to have therapeutic effects on bupivacaine-induced cardiovascular toxicity, but its exact effects on the heart are not well understood. This study evaluated the regional myocardial effect of amrinone on bupivacaine-induced cardiovascular toxicity in in situ beating hearts in 10 dogs using a selective coronary perfusion and sonomicrometry. In the control group, bupivacaine was administered into the left anterior descending coronary artery (LAD) for 15 min at four steps: baseline, step 1, step 2 and step 3, (calculated LAD plasma concentrations; 0, 5, 5 and 10 mu g center dot ml-1, respectively). In the amrinone group, amrinone (5 mu g center dot ml-1) was simultaneously infused at steps 2 and 3 in addition to bupivacaine infusions. Regional myocardial function of the LAD supplied area was evaluated by analysis of the left ventricular pressure-segment length loop. In the control group, systolic shortening decreased from the baseline (10.5 +/- 1.3%, mean +/- SEM) to step 3 (0.1 +/- 1.3%), and post-systolic shortening increased from the baseline (18.0 +/- 3.7%) to step 3 (52.3 +/- 5.5%) dose-dependently. In contrast, with amrinone infusion at steps 2 and 3, both variables returned to near baseline values. These results indicate that amrinone reverses bupivacaine-induced regional myocardial dysfunction.
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Affiliation(s)
- Y Fujita
- Department of Anesthesiology, Kawasaki Medical School, Kurashiki-City, Okayama, Japan
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Vermeyen KM, De Hert SG, Adriaensen HF. Onset of segmental relaxation dysfunction with decreased myocardial tissue perfusion: modulation by propofol. J Cardiothorac Vasc Anesth 1995; 9:379-88. [PMID: 7579106 DOI: 10.1016/s1053-0770(05)80091-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To estimate myocardial oxygen needs by studying the effects of reduced coronary blood flow on segmental myocardial function. To study the tolerance of limited oxygen supply to a myocardial segment during propofol administration. DESIGN A prospective experimental study. SETTING An experimental animal laboratory in a university. PARTICIPANTS Eighteen adult dogs, weighing 20 to 35 kg. INTERVENTIONS Open thorax open pericardium experiments were performed under standard anesthetic conditions. Segment length gauges were placed subendocardially in an anteroapical and in a basal segment. Flow to the anteroapical segment was reduced by tightening a micrometer-controlled snare placed around the second diagonal coronary artery. Left ventricular pressure-length signals allowed for identification of onset of relaxation dysfunction. Myocardial tissue flow at onset of relaxation dysfunction was defined as critical flow. Tracer microspheres were used to measure subepicardial, midwall, and subendocardial flow at critical flow. MEASUREMENTS AND MAIN RESULTS Stability of the model and reproducibility of critical flow were studied in a first series of six dogs with the hearts paced at 110 beats/min. Hemodynamics, left ventricular, and segmental myocardial function during critical flow were stable. Subendocardial critical flow was identical with each flow reduction (45% +/- 5, 44% +/- 8, and 43% +/- 5 of baseline myocardial tissue flow). In a second series of six dogs, critical flow was measured at pacing rates 100 beats/min, 150 beats/min, and 100 beats/min with propranolol, 0.1 mg/kg, pretreatment. Critical flows were 38% +/- 5, 55% +/- 6, and 17% +/- 2 of baseline, respectively (p < 0.05). In a third series of six dogs, critical flow was measured during sufentanil, 0.6 microgram/kg/min, and increasing doses of propofol (P0: 0.0 mg/kg/h, P4: 4.0 mg/kg/h and P8: 8.0 mg/kg/h). Heart rate was kept constant at 110 beats/min. When compared with P0, hemodynamic and left ventricular contraction parameters were stable at P4 but were decreased at P8. At P0, critical flow was: 0.63 +/- 0.14, at P4: 0.34 +/- 0.09, and at P8: 0.25 +/- 0.07 mL/min/g (p < 0.05). CONCLUSION Critical myocardial tissue flow was reproducible and sensitive for altered myocardial oxygen needs. The negative inotropic properties of P decreased myocardial oxygen needs during unchanged hemodynamic and left ventricular contraction parameters. A higher P dose depressed left ventricular function.
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Affiliation(s)
- K M Vermeyen
- Department of Anesthesiology, University Hospital Antwerp, Belgium
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Sherry KM, Sartain J, Bell JH, Wilkinson GA. Comparison of the use of a propofol infusion in cardiac surgical patients with normal and low cardiac output states. J Cardiothorac Vasc Anesth 1995; 9:368-72. [PMID: 7579104 DOI: 10.1016/s1053-0770(05)80089-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study compared the hemodynamic effects of a propofol infusion with fentanyl analgesia in patients undergoing cardiac surgery with normal and low cardiac output states. Low cardiac output was defined as a cardiac index less than 2.5 L/min/m2 with a minimum pulmonary capillary wedge pressure of 7 mmHg. DESIGN A prospective and open study. SETTING A single center cardiothoracic unit within a teaching hospital. PARTICIPANTS Patients were assigned to group P, poor cardiac output or group N, normal cardiac output, after thermodilution pulmonary artery catheter assessments. INTERVENTIONS Both groups received a propofol infusion, 8 mg/kg/hr, until induction of anesthesia, followed by 4 mg/kg/hr until the intensive care unit. Fentanyl, 15 micrograms/kg, and pancuronium, 0.15 mg/kg, were administered after induction. The lungs were ventilated with oxygen. MEASUREMENTS AND MAIN RESULTS Hemodynamic assessments were repeated at intervals until cardiopulmonary bypass. Changes within and between groups were compared using t tests on percentage change from baseline. Group N had significantly greater decreases in cardiac index, stroke volume, and left ventricular stroke work index than group P. There were comparable decreases in mean arterial pressure on induction of anesthesia, 14% and 8% in group N and group P, respectively. In both groups, right ventricular ejection fraction was unchanged. CONCLUSIONS The use of a propofol infusion for induction and maintenance of anesthesia in patients with low cardiac output states undergoing cardiac surgery is not contraindicated.
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Affiliation(s)
- K M Sherry
- Department of Anesthesia, Northern General Hospital, Sheffield, England
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Branca D, Vincenti E, Scutari G. Influence of the anesthetic 2,6-diisopropylphenol (propofol) on isolated rat heart mitochondria. COMPARATIVE BIOCHEMISTRY AND PHYSIOLOGY. PART C, PHARMACOLOGY, TOXICOLOGY & ENDOCRINOLOGY 1995; 110:41-5. [PMID: 7749602 DOI: 10.1016/0742-8413(94)00078-o] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The influence of the anesthetic 2,6-diisopropylphenol on isolated rat heart mitochondria has been investigated at a range of concentrations encompassing high and low clinical values. Low clinical concentrations of the anesthetic appeared unable to affect both oxidative phosphorylation and calcium homeostasis. 2,6-diisopropylphenol at high clinical levels decreased both the transmembrane electrical potential and the synthesis of ATP, while leaving mitochondrial calcium homeostasis unaffected. The results obtained suggest that isolated heart mitochondria are substantially insensitive to low clinical concentrations of 2,6-diisopropylphenol, thus largely excluding the possibility that mitochondrial alterations might be involved in the cardiac depression induced by this anesthetic.
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Affiliation(s)
- D Branca
- Dipartimento di Chimica Biologica, Università di Padova, Italy
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Abstract
Propofol is a greater cardiovascular depressant agent than barbiturates (thiopentone, methohexitone). It is agreed that propofol changes the ventricular load as a result of its vasodilating effects, and that it depresses the sympathetic nervous system and the baroreflex, which result in a moderate bradycardia. The direct effects of propofol on the myocardium remain controversial. Propofol has no significant direct effect on intrinsic myocardial contractility and the decrease in cardiac output is related to anaesthesia on the one hand and to changes in ventricular load and the activity of the cardiac autonomic nervous system on the other hand. It is therefore understandable that the overall depressant effect of the cardiovascular system is amplified in patients whose ventricular function is closely dependent upon ventricular load and/or the activity of the sympathetic nervous system, and that the association with drugs causing bradycardia must be avoided. The logical therapeutic solution to propofol related cardiovascular depression, when deemed necessary, consists of vascular fluid loading and/or the administration of a vasoconstrictor.
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Affiliation(s)
- B Riou
- Département d'Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris
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Belo SE, Kolesar R, Mazer CD. Intracoronary propofol does not decrease myocardial contractile function in the dog. Can J Anaesth 1994; 41:43-9. [PMID: 8111942 DOI: 10.1007/bf03009660] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The intravenous administration of propofol is associated with a considerable decrease in arterial blood pressure. The present study was undertaken to test the hypothesis that myocardial function is not affected by propofol and therefore does not contribute to the hypotensive effect of this anaesthetic agent. Propofol was administered in anaesthetized, open-chest dogs by direct arterial infusion into the left anterior descending coronary artery (LAD). Mean arterial blood pressure, heart rate, left ventricular pressure, dP/dt, regional lactate and oxygen extraction, as well as coronary blood flow were measured. Diastolic function was determined by calculation of the time constant of isovolumetric relaxation from the left ventricular pressure measurement and dP/dt. Contractility was evaluated by measuring regional systolic shortening in an area of the myocardium supplied by the LAD. This was compared with systolic shortening in the distribution of the circumflex (CIRC) artery and with the effects obtained with the intracoronary administration of thiopentone. Intracoronary infusions of propofol and thiopentone did not produce any change in systemic arterial blood pressure, heart rate, or left ventricular end diastolic pressure. Propofol, at a concentration of 5 or 10 micrograms.ml-1 did not decrease systolic shortening in the area perfused by the LAD while thiopentone (40 micrograms.ml-1) reduced systolic shortening by 33% (P < or = 0.05). Neither drug had an effect on systolic shortening in the CIRC area, LAD blood flow or diastolic function. The results of this study suggest that propofol does not have an effect on myocardial contractility. The hypotension associated with the intravascular administration of propofol is more likely due to either a direct vascular or a central effect.
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Affiliation(s)
- S E Belo
- Department of Anaesthesia, St. Michael's Hospital, University of Toronto, Ontario
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Abstract
Propofol is an intravenous anaesthetic which is chemically unrelated to other iv anaesthetics. Most anaesthetists are now becoming familiar with propofol's pharmacokinetic and pharmacodynamic properties. It has proved to be a reliable drug that can be used safely for induction and maintenance of anaesthesia for most surgical procedures and unlike other anaesthetic agents, it can especially be extended into the postoperative setting or intensive care unit for sedation. Propofol's greatest attributes are its pharmacokinetic properties which result in a rapid, clear emergence and lack of cumulative effects even after prolonged administration. Compared with other iv anaesthetics, the induction dose of propofol has a relatively higher incidence of respiratory depression, short-lived apnoea and blood pressure reduction that may occasionally be marked. Possible mechanisms for the hypotension may relate to (1) its action on peripheral vasculature (vasodilatation), (2) decreased myocardial contractility, (3) resetting of the baroreflex activity and (4) inhibition of the sympathetic nervous system outflow. In vitro studies indicate that propofol depresses the immunological reaction to bacterial challenge as well as the chemotactic activity. Clinical studies, in cardiac surgery, have demonstrated that propofol, in association with an opioid, is a logical anaesthetic choice. Propofol is about to receive approval for continuous iv sedation. Comparative studies of propofol and midazolam have clearly demonstrated the superiority of propofol in terms of rapid recovery and precise control of the level of sedation.
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Affiliation(s)
- N R Searle
- Department of Anaesthesia, Montreal Heart Institute, Quebec, Canada
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