The influence of propofol and midazolam/halothane anesthesia on hepatic Sv̄O2 and gastric mucosal pH during cardiopulmonary bypass (original) (raw)
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Clinics (São Paulo, Brazil), 2009
Cardiopulmonary bypass is known to alter propofol pharmacokinetics in patients undergoing cardiac surgery. However, few studies have evaluated the impact of these alterations on postoperative pharmacodynamics. This study was designed to test the hypothesis that changes in propofol pharmacokinetics increase hypnotic effects after cardiopulmonary bypass. Twenty patients scheduled for on-pump coronary artery bypass graft (group, n=10) or off-pump coronary artery bypass graft (group, n=10) coronary artery bypass grafts were anesthetized with sufentanil and a propofol target controlled infusion (2.0 microg/mL). Depth of hypnosis was monitored using the bispectral index. Blood samples were collected from the induction of anesthesia up to 12 hours after the end of propofol infusion, at predetermined intervals. Plasma propofol concentrations were measured using high-performance liquid chromatography, followed by a non-compartmental propofol pharmacokinetic analysis. Data were analyzed using...
European Journal of Clinical Pharmacology, 2008
Objective To investigate the effect of cardiac output and liver blood flow on propofol concentrations in critically ill patients in the intensive care unit. Methods Five medical/surgical critically ill patients were enrolled in this preliminary study. Liver blood flow was measured using sorbitol. The cardiac output was measured by bolus thermodilution. NONMEM ver. V was applied for propofol pharmacokinetic analysis. Results The clearance of propofol was positively influenced by the liver blood flow (P<0.005), whereas no significant correlation between cardiac output and propofol clearance was found. A correlation between liver blood flow and cardiac output or cardiac index could not be assumed in this patient group. Conclusions Liver blood flow is a more predictive indicator than cardiac output for propofol clearance in critically ill patients when the techniques of hepatic sorbitol clearance and bolus thermodilution, respectively, are used. Further study is needed to determine the role played by liver blood flow and cardiac output on the pharmacokinetics of highly extracted drugs in order to reduce the observed high interindividual variabilities in response in critically ill patients.
Pakistan Journal of Medical Sciences, 1969
Objectives: Comparison of effects of propofol and isosorbide dinitrate during rewarming on cardiopulmonary bypass in patients undergoing coronary artery bypasses grafting. Methods: It was randomized prospective clinical trial. One hundred and twenty patient (120) undergoing CABG surgery were included in this study. Group-I (Study group, n=60): in which only propofol infusion used during rewarming and Group-II (control Group, n=60) in which isosorbide dinitrate and propofol infusion combination was used during rewarming. The data was entered and analyzed through SPSS Version 19. Independent sample T-test and chi-square test were used for data analysis. P value of ≤ 0.05 was taken as significant. Results: Mean arterial pressures during rewarming were 63.41±3.61 mmHg in propofol group versus 60.80±4.86 mmHg in control group (p-value 0.001). Core temperature on weaning from cardiopulmonary bypass was 37.11±0.49 o C in propofol group and 37.00±0.18 o C in control group. After drop in core temperature was little more in propofol group (1.02±0.36 o C) versus 0.96±0.37 o C in control group but this difference was not statistically significant (p-value 0.41). Mean Ventilation time after surgery in propofol group was 4.65±0.65 hours versus 5.03±0.81 hours in control group (p-value 0.006). Conclusion: Propofol alone is capable of fulfilling the requirements of adequate rewarming during Cardiopulmonary bypass and can produce more hemodynamic stability and early post-operative recovery.
YAKUGAKU ZASSHI, 2007
It is not clear how levels of serum lipids and glucose and plasma osmolality change during propofol infusion in the pre-and postoperative period of coronary artery bypass graft surgery (CABG). This prospective, randomized, controlled trial evaluated changes in these parameters during propofol or midazolam infusion during and in the early postoperative period following surgery. Twenty patients undergoing CABG were randomized preoperatively into two groups: 10 patients received propofol (induction 1.5 mg/kg, maintenance 1.5 mg kg-1 h-1) and 10 patients received midazolam (induction 0.5 mg/kg, maintenance 0.1 mg kg-1 h-1). Both groups also received fentanyl (induction 20 mg/ kg, maintenance 10 mg kg-1). Serum lipids, glucose, and plasma osmolality were measured preinduction, precardiopulmonary bypass, at the end of cardiopulmonary bypass, at the end of surgery, and 4 and 24 h postoperatively. In the propofol group, we observed a signiˆcant increase in triglycerides and very low-density lipoprotein levels 4 h postoperatively. In the midazolam group, we observed a signiˆcant decrease in low-density lipoprotein, cholesterol at the end of cardiopulmonary bypass, end of surgery, and 4 and 24 h postoperatively and signiˆcant increase in osmolality at the end of cardiovascular bypass. Changes in glucose levels did not diŠer signiˆcantly diŠerent between the two groups. In patients with normal serum lipids, glucose, and plasma osmolality undergoing CABG, propofol infusion for maintenance anesthesia is not associated with dangerous changes in serum lipids, glucose, and plasma osmolality compared with midazolam. A propofol infusion technique for maintenance of anesthesia for cardiac surgery where serum lipids and glucose may be of concern could be recommended as an alternative to midazolam.
Effect of induction of general anesthesia with propofol and fentanyl on hemodynamic response
2019
Background: Induction of general anesthesia with propofol and fentanyl is frequently associated with changes in arterial blood pressure and heart rate. At present, there are no clinical studies investigating the relation between baseline cardiac autonomic tonus and cardiovascular instability after induction of general anesthesia with propofol and fentanyl. Material and methods: A randomized prospective study was performed with approval of Ethic Committee. Written informed consent was obtained from all patients. We enrolled in the study 47 ASA physical status I-II patients scheduled for elective surgical procedures. Heart rate variability by Holter ECG, arterial blood pressure (systolic, diastolic, mean), and heart rate were measured at baseline, after premedication, as well as after induction of general anesthesia with propofol 2.5mg/kg and fentanyl 1.0 mkg/kg. Results: our research revealed that increased baseline cardiac parasympathetic tonus was a risk factor for development of sinus bradycardia (OR = 21.0 (95%CI 3.9-112.8, p<0.0002) and sinus bradycardia associated with arterial hypotension (OR = 19.2 (95%CI 4.1-88.6, p<0.0001). Conclusions: Induction of general anesthesia with propofol and fentanyl was associated frequently with arterial hypotension and sinus bradycardia. Increased cardiac parasympathetic tonus at rest represents a risk factor for development of arterial hypotension and sinus bradycardia after administration of propofol and fentanyl for induction of general anesthesia.
2015
Numerous studies suggested that propofol anesthesia is intuitively appealing for its simplicity, stability and safety, permitting the rapid recovery of patients undergoing cardiac surger. However, its use for induction of anesthesia is often results in transient hypotension. The aim of this study was to determine the safety of modified propofol protocol for induction in low ejection fraction cardiac patients undergoing CABG surgery. Fifty patients with ejection fraction between 30% - 60% who were planned for coronary artery bypass graft surgery were included in this study. Patients were divided into two groups of 25 patients each, according to their left ventricular ejection fractions (EF). Group N (EF between 60%-45%) and Group L (EF between 30%-45%). All the patients were given midazolam/fentanyl/vecuronium and propofol for induction according to pre-defined protocol to prevent hypotension and facilitate early intubation. Hemodynamic variables were registered at fixed points. To p...
The effect of propofol and desflurane anaesthesia on human hepatic blood flow: a pilot study*
Anaesthesia, 2010
This study tested the hypothesis that propofol is associated with a higher hepatic blood flow in humans compared with desflurane. Using a cross over study design, 10 patients received first propofol and then desflurane, and a further 10 patients received desflurane and then propofol. Blood flow index in the right and middle hepatic veins, stroke volume index and cardiac index were assessed by transoesophageal echocardiography. Mean arterial blood pressure, stroke volume index and cardiac index were the same in both groups. Propofol was associated with significantly greater blood flow index in the right hepatic vein (median (IQR [range]) 199 (146-237 [66-388]) vs. 149 (112-189 [42-309]) ml.min)1 .m)2 ; p = 0.005) and middle hepatic vein (150 (122-191 [57-341]) vs. 125 (92-149 [47-362]) ml.min)1 .m)2 ; p < 0.001) compared with desflurane. In routine clinical conditions, propofol anaesthesia was associated with significantly greater hepatic blood flow than desflurane anaesthesia.
Hepatic effects of propofol in the hypoxic rat model
Marmara Medical Journal, 1991
The aim of this study was to demonstrate the effects of propofol on liver parenchyma in the presence of hypoxic conditions of different levels for different durations of time. 64 Sprague-Dawley rats of both sexes were used in the experiment. They were divided into two groups each containing 32 subjects. In one group rats were given propofol 2 mg/kg intraperitoneally, rats in the other group had no such administration. These two groups were divided into four subgroups (n=8). The subgroups were subjected to mild hypoxia (14% 02) and severe hypoxia (10% 02) for both short term (15 minutes) and a longer term (30 minutes). At the end of the experiment after decapitation, hepatectomy was performed and the specimen sections were examined using a light microscope. The histopathological examination of specimens from the liver of the subjects exposed to severe hypoxia for 30 minutes with propofol showed a significant decrease of congestion, disappearence of vacuolization and an increase in granularity when compared with the specimens of the control group under similar conditions without propofol. However observations of the specimens from the short term experiments either with or without propofol administration did not show such observations. On the other hand in the mild hypoxic group, the specimens from the subgroup treated with propofol showed insignificant granulation and congestion when compared to those without propofol treatment. It is thus concluded that, propofol may protect the liver from the effects of hypoxia by decreasing the oxygen demand of the organ.