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PubMed1994

Continuous infusions of propofol administered to dogs: effects on ICG and propofol disposition.

We have studied the effects of stepwise increasing infusion rates of propofol 200-500 micrograms kg-1 min-1 on blood concentrations of propofol and the disposition and clearance of a bolus dose of indocyanine green (ICG) 0.5 mg kg-1 in 10 acutely instrumented dogs. Drug concentrations and ICG clearance were measured 30 min after each change of infusion rate and after reverting for 60 min to the basal propofol infusion rate. Increasing infusion rates resulted in significant prolongation of the elimination half-life of ICG and decrease in ICG clearance at the largest infusion rate (500 micrograms kg-1 min-1) compared with the basal rate. Similarly, there were greater than predicted blood concentrations of propofol at the largest infusion rate. When the infusion rate reverted to 200 micrograms kg-1 min-1, and continued for 60 min, there was a significant difference between the initial blood concentration of propofol at this basal infusion rate and this latter value (P < 0.01). These changes reflect the persistent myocardial depression observed during the recovery phase.

Animals↗

PubMed1997

Meta-analytic comparison of prophylactic antiemetic efficacy for postoperative nausea and vomiting: propofol anaesthesia vs omitting nitrous oxide vs total i.v. anaesthesia with propofol.

Data from two published and one new meta-analysis were reviewed to compare the antiemetic efficacy of three different anaesthetic regimens: (i) propofol anaesthesia compared with another anaesthetic (control); (ii) anaesthesia without nitrous oxide compared with the same anaesthetic with nitrous oxide (control); (iii) propofol anaesthesia without nitrous oxide (TIVA) compared with another anaesthetic with nitrous oxide (control). Efficacy (prevention of postoperative nausea and vomiting compared with control) was estimated using odds ratio and number-needed-to-treat methods, and compared within a range of 20-60% control event rates for early efficacy (0-6 h) and 40-80% for late efficacy (0-48 h). Propofol anaesthesia or omitting nitrous oxide had similar effects on vomiting, both early and late. Propofol (but not omitting nitrous oxide) decreased the incidence of nausea. TIVA studies were documented poorly; appropriate comparison with other interventions were not possible. Efficacy of treatments should be compared within a setting-specific range of control event rates. There is insufficient evidence that TIVA with propofol is an anaesthetic technique with a low emetogenic potency.

Anesthetics, Combined↗

PubMed2005

Spectral entropy monitoring is associated with reduced propofol use and faster emergence in propofol-nitrous oxide-alfentanil anesthesia.

BACKGROUND: This multicenter study evaluated the effect of a new depth of anesthesia-monitoring device based on time-frequency-balanced spectral entropy of electroencephalogram monitoring (GE Healthcare Finland, Helsinki, Finland) on consumption of anesthetic drugs and recovery times after anesthesia. METHODS: The study was a prospective, randomized, single-blind study performed in six hospitals in Finland, Sweden, and Norway. After institutional review board approval and written informed consent from each patient, the patients were randomly allocated to anesthesia with entropy values either shown (entropy group) or not shown (control group). Anesthesia was maintained with propofol, nitrous oxide, and alfentanil. In the entropy group, propofol was given to keep the state entropy value between 45 and 65, and alfentanil was given to keep the state entropy-response entropy difference below 10 units and heart rate and blood pressure within +/-20% of the baseline values. The control group patients were anesthetized to keep heart rate and blood pressure within +/-20% of the baseline values. Statistical methods included Mann-Whitney U test and unpaired t tests. RESULTS: A total of 368 patients were studied. In the entropy group, entropy values were higher during the whole operation and especially during the last 15 min (P < 0.001). Consequently, propofol consumption was smaller in the entropy group during the whole anesthesia period (P < 0.001) and especially during the last 15 min (P < 0.001). This shortened the time delay in the early recovery parameters in the entropy group. CONCLUSION: Entropy monitoring assisted titration of propofol, especially during the last part of the procedures, as indicated by higher entropy values, decreased consumption of propofol, and shorter recovery times in the entropy group.

Adult↗

PubMed1989

Opioid supplementation during propofol anaesthesia. The effects of fentanyl or alfentanil on propofol anaesthesia in daycase surgery.

Sixty patients of ASA grade 1 or 2 who presented for minor daycase gynaecological or urological procedures were randomly allocated to three groups. Group A received fentanyl 1 microgram/kg and Group B alfentanil 5 micrograms/kg prior to induction. Group C received no pre-induction opioid. anaesthesia was induced intravenously with propofol and maintained using nitrous oxide 67% in oxygen supplemented with 20-mg bolus doses of propofol as required. The pre-induction administration of fentanyl or alfentanil was not found significantly to affect either the doses of propofol required for induction or maintenance or the quality of anaesthesia compared with propofol alone. These results suggest that for minor outpatient procedures under general anaesthesia, the concomitant use of a short-acting opioid confers no benefits over propofol with oxide and oxygen alone.

Adjuvants, Anesthesia↗

PubMedDate not supplied

Sedation for outpatient endometrial biopsy: comparison of remifentanil-propofol and alfentanil-propofol.

The purpose of the study was to compare the clinical activity of remifentanil or alfentanil under propofol sedation with regard to respiratory rate, sedation and recovery rate when used for outpatient endometrial biopsy. Patients were randomized to receive intravenously either bolus remifentanil 0.4 microgram/kg and propofol 1 mg/kg in the remifentanil group (n = 30), or bolus alfentanil 20 micrograms/kg and propofol 1 mg/kg in the alfentanil group (n = 30). Patients were monitored for heart rate, systolic and diastolic arterial pressure, peripheral O2 saturation (SpO2), respiration rate, and Aldrete sedation score. Pulse oximetry was used to monitor heart rate and SpO2 during endometrial biopsy. Apnoea was observed in five patients from the remifentanil group, and in three patients from the alfentanil group. The groups did not differ with regard to apnoea incidences. Times were recorded for orientation and Aldrete score > 8, and were similar between the two groups (13.20 +/- 3.64 min and 14.0 +/- 3.87 min in the remifentanil group, 14.7 +/- 3.64 min and 15.9 +/- 3.15 min in the alfentanil group, respectively). The sedative and analgesic combination of remifentanil-propofol does not offer any advantages compared with a combination of alfentanil-propofol with regards to respiration and recovery during sedation for outpatient endometrial biopsy.

Adult↗

PubMed1994

Changes in heart rate variability under propofol anesthesia: a possible explanation for propofol-induced bradycardia.

We propose to study the bradycardia associated with propofol anesthesia. Ten women undergoing laparoscopy for benign disease were studied using ambulatory electrocardiogram monitoring. Anesthesia was induced with an intravenous bolus of propofol and maintained with an infusion. After ventilation using positive pressure via a mask for 5 min, relaxants (succinylcholine or vecuronium) and opioids (alfentanil or fentanyl) were administered and the trachea was intubated. Approximately 15 min later, the laparoscopic trocar was placed and carbon dioxide insufflated. Heart rate variability spectra using a fast Fourier transformation technique were determined from the recordings in four separate time periods (preinduction, postinduction, postintubation, and posttrocar placement). Total, high-frequency, and low-frequency power in each time period was determined. Induction of anesthesia with propofol was associated with a significant reduction in total, low-frequency, and high-frequency power. Maintenance of anesthesia with propofol alone resulted in further reductions in total and low-frequency, but not high-frequency, power. Placement of the laparoscopic trocar and insufflation of carbon dioxide resulted in a decrease in heart rate and an increase in high-frequency power. We conclude that high-frequency variability reflects parasympathetic tone. Propofol anesthesia reduces parasympathetic tone to a lesser degree than sympathetic tone. This autonomic milieu predisposes the patient to developing bradycardia in response to parasympathetic stimuli.

Adult↗

PubMed1998

[Pharmacokinetics of propofol and ketamine during and after total intravenous anesthesia with propofol, fentanyl and ketamine for pediatric patients].

Pharmacokinetics of propofol and ketamine during propofol-fentanyl-ketamine (PFK) anesthesia for pediatric surgery was studied. Plasma levels of propofol (Pp) were maintained approximately at 2.5 micrograms.ml-1 during surgery. Fifteen minutes after the cessation of propofol infusion, Pp decreased to 1.5 micrograms.ml-1. Plasma levels of ketamine (Pk) were maintained at 150-200 ng.ml-1 during the surgery. After the cessation of ketamine infusion, Pk decreased as quickly as Pp. Pk values at 15 minutes and 120 minutes after the cessation of the infusion were 93 ng.ml-1, 24 ng.ml-1, respectively. On the other hand, plasma norketamine (Pn) levels increased gradually during surgery and stayed at 100-150 ng.ml-1 after the end of ketamine infusion to play an important role in post-operative sedation and pain relief. In conclusion, pharmacokinetics of propofol and ketamine in pediatric patients was similar to that in adult patients. PFK anesthesia can be used safely for pediatric as well as for adult patients.

Anesthesia, Intravenous↗

PubMed2000

Tracheal intubation after induction of anesthesia in children with propofol--remifentanil or propofol-rocuronium.

PURPOSE: To compare the intubating conditions after remifentanil-propofol with those after propofol-rocuronium combination with the aim of determining the optimal dose of remifentanil. METHODS: In a randomized, double-blind study 80 healthy children aged three to nine years were assigned to one of four groups (n=20): 2 or 4 microgxkg(-1) remifentanil (Re2 or Re4); 2 microgxkg(-1) remifentanil and 0.2 mgxkg(-1) rocuronium (Re2-Ro0.2); 0.4 mgxkg(-1) rocuronium (Ro0.4). After atropine, remifentanil was injected over 30 sec followed by 3.5 mgxkg(-1) propofol and rocuronium. After 60 sec, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor based on ease of ventilation, jaw relaxation, position of the vocal cords, and coughing to intubation. RESULTS: In all children intubation was successful. Overall intubating conditions were better (P < 0.01), and the frequency of excellent conditions, 85%, was higher (P < 0.01) in the Re4 group than in the Ro0.4 group. No child manifested signs of muscular rigidity. In the remifentanil groups, arterial pressure decreased 11-13% and heart rate 6-9% after anesthetic induction, and remained at that level throughout the study. CONCLUSION: The best intubating conditions were produced by the combination of 4 microgxkg(-1) remifentanil and 3.5 mgxkg(-1) propofol. It provided excellent or good intubating conditions in all children without causing undue cardiovascular depression.

Androstanols↗

PubMed1996

[Comparison of sufentanil-propofol-anesthesia with fentanyl-propofol in major abdominal surgery].

UNLABELLED: Major abdominal surgery often leads to a marked sympathoadrenal stress response with high concentrations of plasma catecholomines, hypertension, and tachycardia. We compared the effects of sufentanil-propofol with fentanyl-propofol anaesthesia in a controlled, randomised, double-blind study of 18 ASA I-II patients aged 23-64 years undergoing major abdominal surgery. Study parameters were haemodynamics (heart rate [HR], arterial [ABP], central venous, and pulmonary arterial pressures, cardiac index [CI]), arterial catecholamine concentrations, and the median frequency of the electroencephalogram (EEG) power spectrum. METHODS: After premedication with flunitrazepam 1-2 mg, promethazine 25-50 mg, and piritramide 7.5-15 mg, a five-lead electrocardiograph and a Lifescan brain activity monitor were attached and indwelling cannulae were inserted into the radial artery and two forearm veins. A thermodilution catheter was placed in the pulmonary artery via the right internal jugular vein. Anaesthesia was induced with either fentanyl 7 micrograms/kg followed by 5 micrograms/kg.h or sufentanil 1 microgram/kg followed by 0.7 microgram/kg.h up to the end of surgery. Additional boli of the opioids were given according to set criteria, resulting in an average consumption of 9.03 micrograms/kg.h fentanyl or 1.22 micrograms/kg.h sufentanil. Propofol 2 mg/kg was given followed by 6 micrograms/kg.h up to the end of surgery. Relaxation was obtained with pancuronium 0.025-0.05 mg/kg before and after induction, after tracheal intubation, before and after skin incision, after opening of the peritoneum, and at the end of surgery. RESULTS: No significant differences were observed between the two groups with regard to the study parameters. The duration of surgery and blood loss were similar in both groups, as were patient characteristics. After induction 2 patients in each group developed thoracic rigidity, which was reversible after muscle relaxation. HR, ABP, and CI decreased significantly before skin incision; after surgical stimulation the baseline values were again reached. but not exceeded. No patient developed tachycardia (> 100/min) or hypertension (> 15% higher than baseline pressure) for longer than 10 min during the study period until the end of surgery. The plasma concentrations of epinephrine and norepinephrine decreased significantly during anaesthesia, and under maximum surgical stimulation did not increase higher than the physiological baseline concentrations. The EEG median frequencies decreased after induction, and during the entire anaesthetic period the main activity was in the delta and theta frequency bands. CONCLUSIONS: With both regimens, the sympathoadrenal stress response to major abdominal surgery was nearly completely suppressed, resulting in stable haemodynamics during the operations. Sufentanil and fentanyl were equally well suited as analgesic components of total i.v. anaesthesia with propofol.

Abdomen↗

PubMed1990

[Intubation in otorhinolaryngologic surgery: propofol versus propofol-suxamethonium].

This study was carried out to assess the conditions of intubation in head and neck surgery when using propofol alone or associated with suxamethonium. Sixty patients were randomly allocated in two groups of 30. Group I was given 3 mg.kg-1 propofol and Group II 3 mg.kg-1 propofol immediately followed by 1.5 mg.kg-1 suxamethonium. All patients were premedicated orally with midazolam 0.1 mg.kg-1, 0.5 to 1 mg atropine and 7 to 10 micrograms.kg-1 alfentanil, while a colloidal solute (Plasmion) up to 250-500 ml was infused. One minute after injection of propofol, lidocaine 5% was pulverized on the glottis and intubation performed. The mean time required for intubation was similar in both groups: 128 +/- 10 sec in group I vs 132 +/- 9.7 sec in group II. Thirty-five % of patients had to be considered as difficult to intube but the mean times in these cases were not statistically different: 169 +/- 14 sec in group I vs 175 +/- 13 sec in group II. Opening of the glottis was found to be better in group II than in group I (p less than 0.01) and bucking was more frequent in group I (p less than 0.01). Successful intubation was obtained after one attempt at a similar rate in the two groups. The haemodynamic variations consisted in a significant decrease of systolic blood pressure compared to the initial value but these variations were similar in the two groups at each time (2.3 and 5 min) from induction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Recovery after propofol infusion anaesthesia in children: comparison with propofol, thiopentone or halothane induction followed by halothane maintenance.

We have compared the recovery profiles of 163 healthy Chinese children after general anaesthesia for minor surgical procedures. Patients were allocated randomly to receive one of four anaesthetic techniques: propofol infusion for induction and maintenance using a pharmacokinetic model-controlled syringe pump set initially at a target concentration of 8 micrograms ml-1 and then adjusted according to clinical requirements; propofol 2.5-3.5 mg kg-1, thiopentone 4-5 mg kg-1 or 2-3% halothane for induction of anaesthesia followed by 1-2% halothane for maintenance of anaesthesia. All patients breathed a mixture of 70% nitrous oxide in oxygen through a laryngeal mask airway and received an appropriate regional anaesthetic block. Recovery was assessed using the time to achieve full Steward score, open eyes on command, orientation and the time required to complete a simple puzzle. Recovery was slowest with the propofol infusion (mean 39.8 (SD 12.9) min when eyes opened on command). The recovery times were significantly shorter with the three other techniques (propofol bolus 21.9 (9.9) min, thiopentone 23.4 (11.3) min, halothane 20.1 (8.9) min), and the choice among these three methods had no significant influence on the recovery profile.

Anesthesia Recovery Period↗

PubMed2003

Closed-loop control of propofol anaesthesia using bispectral index: performance assessment in patients receiving computer-controlled propofol and manually controlled remifentanil infusions for minor surgery.

BACKGROUND: In a previous study we used the bispectral index (BIS) for automatic control of propofol anaesthesia, using a proportional-integral-differential control algorithm. As control was less than optimal in some patients, we revised the constants of the control algorithm. The aim of the current study was to measure the performance of the revised system in patients undergoing minor surgery under propofol and remifentanil anaesthesia. METHODS: Twenty adult patients scheduled for body surface surgery were enrolled. Anaesthesia was manually induced with target-controlled infusions (TCI) of propofol and remifentanil. After the start of surgery, when anaesthesia was clinically adequate, automatic control of the propofol TCI was commenced using the revised closed-loop system. For patients 11-20, effect-site steering was also incorporated into the closed-loop control algorithm. Adequacy of anaesthesia during closed-loop control was assessed clinically, and by calculating the median performance error (MDPE), the median absolute performance error (MDAPE) and the mean offset of the control variable. RESULTS: The system provided adequate operating conditions and stable cardiovascular values in all patients during closed-loop control. The mean MDPE and MDAPE were -0.42% and 5.63%, respectively. Mean offset of the BIS from setpoint was -0.2. No patients reported awareness or recall of intraoperative events. CONCLUSIONS: The system was able to provide clinically adequate anaesthesia in all patients, with better accuracy of control than in the previous study. There was a tendency for more accurate control in those patients in whom the control algorithm incorporated effect-site steering.

Adult↗

PubMed1991

Propofol in short gynaecological procedures. Comparison of recovery over 2 days after anaesthesia with propofol or thiopentone as sole anaesthetic agent.

Recovery was assessed over 48 hours after anaesthesia with propofol or thiopentone as sole anaesthetic agent in 36 unpremedicated gynaecological patients. Immediate recovery, as measured by the Steward scale, was shown to be quicker for the patients given propofol. At one hour postoperatively the thiopentone group showed impaired visual-motor coordination on the aiming test (p less than 0.01) and dexterity task (p less than 0.05), and a slowing of reaction time (p less than 0.01). Patients given propofol showed only an increase in reaction time (p less than 0.05). By 2 hours the thiopentone group showed impairment only in the aiming task (p less than 0.05). No further significant impairment was detected at 4, 24 or 48 hours. However, patients reported symptoms throughout the 48 hours indicative of residual drug effects. There was a substantial practice effect with some tests which may have obscured impairment. It can be argued therefore that the better recovery profile after propofol is still evident at 24 hours.

Adolescent↗

PubMed1994

The subjective effects of low-dose propofol. A double-blind study to evaluate dimensions of sedation and consciousness with low-dose propofol.

In this study the subjective effects (sedation and mood) of subanaesthetic doses of propofol were examined in 28 healthy male volunteers. A computer model was used to predict the infusion profiles necessary to obtain steady state propofol plasma concentrations of 0.3 microgram.ml-1, 0.6 microgram.ml-1, 0.9 microgram.ml-1. Objective measures of sedation from saccadic eye movement and choice reaction time gave significant dose responses at each level but a battery of psychometric tests failed to show dose-related subjective responses. Of particular note in the subjective data is the lack of a difference between groups or even of a consistent trend within the data. This suggests that a low concentration of propofol in plasma does not induce euphoria or a sense of well-being. The anecdotal evidence available for mood changes with propofol therefore remains unsubstantiated.

Adult↗

PubMed1994

Intra-operative patient-controlled sedation and patient attitude to control. A crossover comparison of patient preference for patient-controlled propofol and propofol by continuous infusion.

Intra-operative patient controlled sedation with propofol (bolus dose 18 mg over 5.4 s; lockout period 1 min) has been compared to continuous propofol infusion (3.6 mg.kg-1.h-1) in a randomised crossover study of 38 ASA 1 or 2 day surgery patients undergoing two-stage bilateral extraction of third molar teeth under local anaesthesia (76 procedures). Mean (SD) propofol used (mg.kg-1) was less with patient-controlled sedation (2.39 (1.28) than with the infusion (2.58 (0.84)) but the difference was not statistically significant. There were only minor differences between the methods in postoperative recovery of cognitive function and no differences for patient cooperation and surgeon's satisfaction with sedation. Patient-controlled sedation was preferred by 19 patients, continuous infusion by 10, with nine indifferent. Preferences, expressed as mild, moderate or strong, were significantly stronger for patient-controlled sedation (p < 0.05). Sedation was no deeper than eyelid closure with response to command in all 76 procedures. This level was reached in all 38 infusion cases but in only 26 cases with patient-controlled sedation, where 12 patients remained less sedated (p < 0.01). Patient-controlled sedation with propofol provided safe sedation and was strongly preferred over the infusion by a large proportion of patients.

Adult↗

PubMed1991

Does propofol have an anti-emetic effect? A prospective study of the anti-emetic effect of propofol following laparoscopy.

In order to investigate the putative anti-emetic effect of propofol, 53 patients undergoing gynaecological laparoscopy were given a standard anaesthetic including induction with thiopentone. At the end of surgery, the patients received either a sub-anaesthetic does of propofol or an equivalent volume of normal saline. There was no difference in the incidence of nausea and vomiting between the propofol and control group. It is concluded that low-dose propofol does not have an anti-emetic effect.

Adult↗

PubMed1999

[Changes of arterial blood pressure and heart rate during induction of anesthesia with propofol--efficacy of propofol titration using bispectral index as an indicator].

Bispectral index (BIS) is a processed EEG parameter that measures the hypnotic effects of anesthetic and sedative agents on the brain. We studied whether propofol titration using BIS allows us to prevent hemodynamic changes during induction of anesthesia and endotracheal intubation. Thirty patients without hypertension and obesity were studied. In the titration group (n = 15), BIS was maintained at 40 during induction of anesthesia with propofol. In the bolus group, anesthesia was induced with a bolus infusion of propofol 2 mg.kg-1 (n = 15). Arterial blood pressure and heart rate were recorded before induction of anesthesia, during induction of anesthesia, immediately after, and 1 min, 2 min, and 3 min after intubation. Diastolic blood pressure and heart rate increased significantly after endotracheal intubation in both groups. Systolic blood pressure significantly increased immediately after intubation in the bolus group, but was unchanged in the titration group. These results suggest that BIS is useful to prevent significant increases in systolic blood pressure associated with endotracheal intubation during induction of anesthesia with propofol.

Adolescent↗

PubMed1999

[Premixing of 5% dextrose in Ringer's acetate solution with propofol reduces incidence and severity of pain on propofol injection].

The purpose of this study was to compare the effect of premixed 5% dextrose in Ringer's acetate solution and premixed lidocaine with propofpl on the reduction of pain during injection of propofol in adult patients. We conducted a prospective, randomized, double-blinded trial. Ninety-six patients were randomly allocated to one of three groups according to the agents added to 1% propofol 20 ml; Group C, normal saline 2 ml, Group L, 2% lidocaine 2 ml, and Group A, 5% dextrose in Ringer's acetate solution 2 ml. The pain on injection was rated as none, mild, moderate, or severe. Seventy percent of patients in the C group experienced pain, while 33% and 25% of patients experienced pain in the A group and the L group, respectively. Forty-two percent of patients in the C group complained moderate to severe pain but only one patient in both A group and L group. In conclusion, 5% dextrose in Ringer's acetate solution premixed with 200 mg propofol significantly reduces incidence and severity of pain associated with propofol injection and is easier to use than premixed lidocaine.

Adult↗