Cerebral and Systemic Hemodynamic Effects of Intravenous Bolus Administration of Propofol in Neonates (original) (raw)
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Anesthesiology, 2002
Background Propofol is a commonly used anesthetic induction agent in pediatric anesthesia that, until recently, was used with caution as an intravenous infusion agent for sedation in pediatric intensive care. Few data have described propofol kinetics in critically ill children. Methods Twenty-one critically ill ventilated children aged 1 week to 12 yr were sedated with 4-6 mg. kg(-1).h(-1) of 2% propofol for up to 28 h, combined with a constant morphine infusion. Whole blood concentration of propofol was measured at steady state and for 24 h after infusion using high-performance liquid chromatography. Results A propofol infusion rate of 4 mg. kg(-1).h(-1) achieved adequate sedation scores in 17 of 20 patients. In 2 patients the dose was reduced because of hypotension, and 1 patient was withdrawn from the study because of a increasing metabolic acidosis. Mixed-effects population models were fitted to the blood propofol concentration data. The pharmacokinetics were best described by a...
Propofol decreases cerebral blood flow velocity in anesthetized children
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2002
P Pu ur rp po os se e: : Propofol, by virtue of its favourable pharmacokinetic profile, is suitable for maintenance of anesthesia by continuous infusion during neurosurgical procedures in adults. It is gaining popularity for use in pediatric patients. To determine the effects of propofol on cerebral blood flow in children, middle cerebral artery blood flow velocity (Vmca) was measured at different levels of propofol administration by transcranial Doppler (TCD) sonography.
British Journal of Anaesthesia, 2007
Background. Propofol is commonly used in children undergoing diagnostic interventions under anaesthesia or deep sedation. Because hypoxaemia is the most common cause of critical deterioration during anaesthesia and sedation, improved understanding of the effects of anaesthetics on pulmonary function is essential. The aim of this study was to determine the effect of different levels of propofol anaesthesia on functional residual capacity (FRC) and ventilation distribution. Methods. In 20 children without cardiopulmonary disease mean age (SD) 49.75 (13.3) months and mean weight (SD) 17.5 (3.9) kg, anaesthesia was induced by a bolus of i.v. propofol 2 mg kg 21 followed by an infusion of propofol 120 mg kg 21 min 21 (level I). Then, a bolus of propofol 1 mg kg 21 was given followed by a propofol infusion at 240 mg kg 21 min 21 (level II). FRC and lung clearance index (LCI) were calculated at each level of anaesthesia using multibreath analysis. Results. The FRC mean (SD) decreased from 20.7 (3.3) ml kg 21 at anaesthesia level I to 17.7 (3.9) ml kg 21 at level II (P,0.0001). At the same time, mean (SD) LCI increased from 10.4 (1.1) to 11.9 (2.2) (P¼0.0038), whereas bispectral index score values decreased from mean (SD) 57.5 (7.2) to 35.5 (5.9) (P,0.0001). Conclusions. Propofol elicited a deeper level of anaesthesia that led to a significant decrease of the FRC whereas at the same time the LCI, an index for ventilation distribution, increased indicating an increased vulnerability to hypoxaemia.
A manual propofol infusion regimen for neonates and infants
Pediatric Anesthesia, 2019
What is already known about this subject: Propofol infusion regimens for neonates and infants have been developed from clinical observations in children 0-3 years undergoing anesthesia. These regimens have not been reviewed using published neonatal and infant pharmacokinetic parameters. What this study adds: A pharmacokinetic parameter set using current propofol infusion regimens in neonates predicted propofol plasma concentrations 6-8 µg.mL-1 in the first 30 min that were not sustained during 100 min infusions. Re-evaluation of propofol plasma time-concentration profiles led to alternative dose regimens that achieve a target plasma concentration of 3 µg.mL-1. Neonates (38-44 weeks postmenstrual age) required a loading dose of 2 mg.kg-1 followed by an infusion rate of 9 mg.kg-1 .h-1 for the first 15 min, 7 mg.kg-1 .h-1 from 15 to 30 min, 6 mg.kg-1 .h-1 from 30 to 60 min, 5 mg.kg-1 .h-1 from 1 to 2 hours.
Neurobehavioural Effects of Propofol on the Neonate Following Elective Caesarean Section
BJA: British Journal of Anaesthesia, 1989
There are few studies of the neonatal effects of propofol when given as an induction agent for Caesarean section. Although propofol has been reported to produce ventilatory depression [1], in a pilot study Couper and Lombard [2] did not observe adverse neonatal effects (evaluated by Apgar score) after a single bolus of 2.5 mg kg" 1 administered for elective Caesarean section. After a single bolus dose of propofol, a maternal: fetal plasma concentration ratio of 0.70 was found [3] (less than that reported for thiopentone [4]), and the mean UA:UV ratio at delivery indicated complete distribution throughout the fetus and a relatively rapid equilibration of propofol. In this study [3], 70% of neonates showed an Amiel-Tison's score [5] of less than 35 at 30 min after delivery. This depression was not present at 2 and 24 h; however, the study was limited by lack of control data. The purpose of the present study was to evaluate the neonatal neurobehavioural effects of propofol used as an induction agent for general anaesthesia for elective Caesarean section. PATIENTS AND METHODS The Early Neonatal Neurobehavioural Scale (ENNS) [6] was administered to 60 neonates in a study approved by the local Human Investigation Committee. Informed consent was obtained from all mothers. Forty mothers undergoing elective Caesarean section under general anaesthesia were allocated randomly to receive either propofol 2.8 mg/kg pregnant body weight (PBW) (study
Intravenous Propofol Allows Fast Intubation in Neonates and Young Infants Undergoing Major Surgery
Frontiers in Pediatrics, 2019
Aim of the study: In selected surgical neonates and infants, the rapidity of induction and intubation may represent an important factor for their safety. Propofol is an anesthetic characterized by a rapid onset and fast recovery time that may reduce time of anesthetic induction and improve post-anesthetic outcome. The aim of this study was to evaluate the safety and efficacy of anesthesia induction in full-term neonates and young infants after propofol bolus administration. Methods: A retrospective case-control study including infants below 6 months of age, undergoing general anesthesia between 2011 and 2013, was carried out. Patients that received intravenous propofol bolus to induce anesthesia were compared to patients who received inhaled sevoflurane. Time to reach successful orotracheal intubation (OTI) was measured in seconds. The quality of OTI was defined as "excellent," "good," and "poor," based on established classification and was reported. Hemodynamic parameters as systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), heart rate (HR), and oxygen saturation (SaO2) were collected before OTI (t0), at OTI (t1), and at spontaneous breathing recovery (t2). Main adverse effects were recorded for both groups. Results are median (IQ range) or prevalence; p < 0.05 was considered significant. Results: 160 infants were enrolled in the study, 80 received propofol and 80 inhaled sevoflurane. Major surgery (involving organs in the thoracic, abdominal, or pelvic cavities) was performed in 64 and 54% of patients in the propofol and sevoflurane group, respectively (p = 0.07). Patients in the propofol group showed a shorter time for OTI [11.5 (4.0-65) vs. 360.0 (228.0-720.0) seconds, (p < 0.0001)]. No difference was found in the quality of OTI between the two groups. No significant complications were recorded in either group. Conclusions: Propofol is a safe and effective anesthetic in neonates and infants permitting rapid induction of anesthesia and rapid intubation, without negative impact on the quality of intubation and haemodynamic compromise.
Disposition of propofol infusions for caesarean section
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 1991
The disposition of propofol was studied in women undergoing elective Caesarean section. Indices of maternal recovery and neonatal assessment were correlated with venous concentrations of propofol. After induction of anaesthesia with propofol 2.0 mg · kg−1, ten patients received propofol 6 mg · kg−1 · hr−1 with nitrous oxide 50 per cent in oxygen (low group) and nine were given propofol 9 mg · kg−1 · hr−1 with oxygen 100 per cent (high group). Pharmacokinetic variables were similar between the groups. The mean ± SD Vss = 2.38 ± 1.16 L · kg−1, Cl = 39.2 ± 9.75 ml · min−1kg−1 and t1/2β= 126 ± 68.7 min. At the time of delivery (8–16 min), the concentration of propofol ranged from 1.91–3.82 μg · ml−1 in the maternal vein (MV), 1.00–2.00 μg · ml−1 in the umbilical vein (UV) and 0.53–1.66 μg · ml−1 in the umbilical artery (UA). Neonates with high UV concentrations of propofol at delivery had lower neurologic and adaptive capacity scores 15 minutes later. The concentrations of propofol were similar between groups during the infusion but they declined at a faster rate in the low group postoperatively. Maternal recovery times did not depend on the total dose of propofol but the concentration of propofol at the time of eye opening was greater in the high group than the low group (1.74 ± 0.51 vs 1.24 ± 0.32 μg · m−1, P Nous avons mesuré l’élimination du propofol lors de césariennes électives et avons mis en relation le réveil maternel et la performance du nouveauné avec la concentration veineuse de propofol. Après une dose d’induction de 2,0 mg · kg−1 de propofol, nous en perfusions 6 mg · kg−1 · h−1 de plus chez dix patientes qui respiraient 50 pour cent de protoxyde d’azote avec de l’oxygène (groupe 1) et 9 mg · kg−1 · h−1 chez neuf respirant de l’oxygène pur (groupe 2). Les variables pharmacocinétiques étaient semblables dans les deux groupes avec un Vss de 2,38 ±1,16 L · kg−1, une Cl de 39,2 ± 9,75 ml · mn−1 kg−1 et une t1/2β de 126 ± 68,7 mn. Au moment de la naissance (8–16 min post-induction), les concentrations de propofol allaient de 1,91 à 3,82 μg · ml−1 dans le sang veineux maternel, de 1,00 à 2,00 μg · ml−1 dans la veine ombilicale et de 0,53 à 1,66 μg · ml−1 dans l’artère ombilicale. Les nouveauxnés au sang veineux ombilical plus riche en propofol, avaient, 15 minutes après la naissance,un «neurologic and adaptative capacity score» plus bas. Semblables pendant la période de perfusion. les concentrations de propofol diminuèrent plus vite chez le groupe 1 après l’opération. La dose totale de propofol n’influençait pas le réveil des patientes mais, à l’ouverture des yeux, celles du groupe 2 en avaient des concentrations plus élevées: 1,74 ±0,51 vs 1,24 ± 0,32 μg · ml−1, P
BMC Anesthesiology, 2021
Background Exhaled propofol concentrations correlate with propofol concentrations in adult human blood and the brain tissue of rats, as well as with electroencephalography (EEG) based indices of anesthetic depth. The pharmacokinetics of propofol are however different in children compared to adults. The value of exhaled propofol measurements in pediatric anesthesia has not yet been investigated. Breathing system filters and breathing circuits can also interfere with the measurements. In this study, we investigated correlations between exhaled propofol (exP) concentrations and the Narkotrend Index (NI) as well as calculated propofol plasma concentrations. Methods A multi-capillary-column (MCC) combined with ion mobility spectrometry (IMS) was used to determine exP. Optimal positioning of breathing system filters (near-patient or patient-distant) and sample line (proximal or distal to filter) were investigated. Measurements were taken during induction (I), maintenance (M) and emergence...