PubMed · 1853704
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J S Patterson, K J Hopkins, R Albanese. 1991. Propofol handling techniques.. https://doi.org/10.1111/j.1399-6576.1991.tb03311.x
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Remifentanil and propofol infusions were used to provide neuroleptanalgesia during an awake craniotomy to resect a left frontoparietal glioblastoma near the motor speech center. This operation presented anesthetic requirements ranging from adequate analgesia during bone flap removal to an appropriate level of consciousness during cortical speech mapping. We performed pharmacokinetic simulations to estimate the effect site concentrations of propofol and remifentanil as the infusion rates were modulated to meet the dynamic sedation and analgesic needs of the operation. Simulations revealed that changes in infusion rates were quickly followed by changes in the effect site concentrations which corresponded well with the desired changes in patient sedation and analgesia. We propose that remifentanil and propofol in combination may be a useful technique for awake craniotomy.
OBJECTIVE: To determine the median effective dose (ED50) of propofol required for induction of anesthesia in goats and the frequency of myoclonic activity and apnea associated with propofol administration. DESIGN: Clinical trial. ANIMALS: 28 healthy mature goats. PROCEDURE: ED50 was determined by use of the up-and-down method. The first goat was given 4 mg of propofol/kg (1.8 mg/lb) of body weight, i.v. Dose was increased by 25% for the next goat if endotracheal intubation was not possible and decreased by 20% if it was. For each subsequent goat, dose was determined on the basis of response of the previous goat. The ED50 was calculated by use of probit analysis. Induction time, frequency and duration of apnea, frequency of myoclonus, and other adverse effects were recorded. RESULTS: ED50 was determined to be 5.1 mg/kg (2.3 mg/lb). Mean (+/- SD) induction time was 23.2 +/- 4.7 seconds. Apnea was observed in 27 of 28 goats; mean (+/- SD) duration of apnea was 72.9 +/- 38.3 seconds. dose did not correlate without duration of apnea. Myoclonic activity was observed in 16 of 28 goats; frequency of myoclonus was not associated with dose. Cyanosis, regurgitation, and signs of pain during injection were not observed. CLINICAL IMPLICATIONS: Administration of propofol at 5.1 mg/kg (2.3 mg/lb), i.v., should permit endotracheal intubation in half of unpremedicated, healthy, mature goats. Myoclonus and apnea were associated with propofol administration.
A 1-year-old Standardbred gelding had received xylazine hydrochloride (0.75 to 1.00 mg/kg [0.34 to 0.45 mg/lb] of body weight, IV) during 2 surgeries for debridement of a wound. The horse was given chloramphenicol (55 mg/kg [25 mg/lb], PO, q 6 h) for 5 days, and was anesthetized a third time with xylazine (0.75 mg/kg, IM). Five hours after administration of xylazine, the horse remained markedly sedated and had clinical signs of gaseous distention of the large bowel (bloat) requiring trocharization. Administration of yohimbine (0.03 mg/kg [0.01 mg/lb], i.v.) eliminated signs of sedation within 5 minutes. Moderate flatulence developed, and gastrointestinal sounds could be heard within all 4 abdominal quadrants within 15 minutes of yohimbine administration. The remainder of recovery was unremarkable. Xylazine induces bradycardia and decreases gastrointestinal motility in addition to causing sedation, muscle relaxation, and analgesia. Chloramphenicol can inhibit oxidase activity of cytochrome P-450 and inhibit metabolism and elimination of drugs such as xylazine.