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PubMed2002

[Effects of midazolam premedication on induction doses of propofol and hemodynamic changes during tumor patient induction].

BACKGROUND AND OBJECTIVE: Midazolam is a useful drug used preoperatively because it can produce anxiolysis and sedation. This study compared the propofol requirements and haemodynamic effects during anaesthetic induction using propofol with premedication of midazolam or luminal. METHODS: Thirty patients (aged 20-65, ASA I-II) undergoing tumor surgery were randomly assigned into 2 groups (group M and group L): group M, receiving 0.5 mg atropine and 0.05 mg/kg midazolam; group L, receiving atropine and 2 mg/kg phenobarbital sodium 30 min before induction as premedication. Anesthesia was induced with propofol at the rate of 30 mg.kg-1.h-1 to achieve enough depth of anesthesia to intubate. Induction time, total propofol dosage, blood pressure, heart rate were recorded before and after induction, and after intubation. Awaken time was also recorded. RESULTS: The time of induction and the propofol dosage in group M (2.8 +/- 0.37 min and 79.9 +/- 15.3 mg) were significantly (P < 0.05) less than that in group L (3.3 +/- 0.54 min and 98.9 +/- 17.4 mg). Blood pressure was unchanged in M group after propofol induction and after the intubation. Heart rate change was much less in group M (P < 0.05). CONCLUSIONS: The results indicate that midazolam compered to phenobarbital sodium as premedication could reduce the usage of propofol, and also provide stable cardiovascular state during propofol induction.

Adjuvants, Anesthesia↗
PubMed2002

[Effect of propofol on protecting Rhesus macaques from reperfusion lung injury during hemorrhagic shock and resuscitation].

OBJECTIVE: To investigate the protective efficacy of propofol against lung injury during hemorrhagic shock and resuscitation among Rhesus macaques. METHODS: Two healthy rhesus monkeys (Rhesus macaques) were killed and their lungs were taken out as samples of normal lung. Two healthy rhesus monkeys were made animal models of hemorrhagic shock and then were killed with their lungs taken out as samples of hemorrhagic shock lung. Another 12 healthy rhesus monkeys were randomly divided into two groups of six animals: propofol group (administered with propofol to a plasma concentration of 8 mg/L by target control infusion with computer before hemorrhagic shock) and control group. The monkeys were bled through the right femoral vein till the mean arterial pressure remained at the shock level of 40 mm Hg +/- 5 mm Hg. Two hours later, the total amount of bled blood and normal saline of the volume 2 times the volume of blood loss were reinfused into the animals quickly. Another 2 hours later hemodynamic parameters were measured, and blood samples were taken for measurement of malondialdehyde (MDA), superoxidedismutase (SOD) and lactate before bleeding, two hours after shock appeared, and 2 hours after resuscitation. The monkeys were killed 2 hours after resuscitation; their lungs were taken for pathologic examination and determination of water-to-dry weight ratio. RESULTS: The lungs of the 2 normal rhesus monkeys were normal with the W/D of 5.545 +/- 0.191. There is not remarkable change in the lung constitution of the 2 shock rhesus monkeys with a W/D ratio of 5.655 +/- 0.474. The mean pulmonary arterial pressure (MPA) and pulmonary vascular resistance index (PVRI) of the control group 2 hours after hemorrhagic shock and 2 hours after resuscitation were 17.00 +/- 4.42 and 22.83 +/- 5.11 respectively, both significantly higher than those of the propofol group (10.83 +/- 2.71 and 18.66 +/- 3.38, both P < 0.05). The pulmonary vascular resistance index (PVRI) of the control group 2 hours after hemorrhagic shock and 2 hours after resuscitation were 458.67 +/- 91.92 and 260.17 +/- 57.85 respectively, both significantly higher than those of the propofol group (258.67 +/- 63.02 and 159.17 +/- 47.98 respectively, both P < 0.05). The W/D ratio of the control group 2 hours after resuscitation was significantly higher than that of the propofol group (P < 0.05). The pulmonary edema of the control group was more serious than that of the propofol group by light microscopy and electron microscopy. CONCLUSION: Propofol remarkably relieves the lung injury occurring during hemorrhagic shock and resuscitation stage by ameliorating pulmonary circulation.

Animals↗
PubMed2003

Antioxidative and anti-endotoxin effects of propofol on endothelial cells.

OBJECTIVE: To investigate the antioxidant and anti-endotoxin effects of propofol on endothelial cells and the possible mechanisms. METHODS: Cultured endothelial cells were treated with hydrogen peroxide (H(2)O(2)), propofol + H(2)O(2), lipopolysaccharide (LPS) and propofol + LPS, respectively. Endothelial cell damage was monitored for possible lactic dehydrogenase (LDH) release. The transcription and the protein expression levels of endothelial nitric oxide synthase (eNOS) were measured. RESULTS: LDH release was higher in groups treated with H(2)O(2) or LPS than in the control group. After pretreatment with propofol, the effects induced by H(2)O(2) were attenuated, but propofol did not decrease the LDH release induced by LPS. Both H(2)O(2) and LPS significantly increased the eNOS transcript levels and the increases were significantly attenuated after pretreatment with propofol. Both H(2)O(2) and LPS significantly increased the eNOS protein expression and the increase was attenuated after pretreatment with propofol. CONCLUSION: Propofol could protect endothelial cells against oxidative stress by inhibiting eNOS transcription and protein expression, but could not antagonise endotoxin induced cell injuries.

Antioxidants↗
PubMed2003

[Effect of body fat percentage on estimated propofol concentrations at awakening from anesthesia using target controlled infusion].

BACKGROUND: Target controlled infusion (TCI) for propofol allows anesthesiologists to target constant blood concentrations of propofol. However, the pharmacokinetic parameters in TCI system do not take account of the patient's age, make up and gender. We evaluated the relationship between body fat percentage and the estimated effect site propofol concentrations at awakening. METHODS: Anesthesia was induced in 37 patients with fentanyl and propofol by TCI. Patients's percentage of fat was evaluated by measuring the thickness of the three parts of the skin fat with Skyndex (Caldwell Justiss, USA). After surgery and discontinuation of anesthesia, the estimated effect site propofol concentrations (EPEC) were determined when the patient could respond to verbal command. RESULTS: The EPECs at awakening were 1.5 +/- 0.2 micrograms.ml-1 in male and 1.5 +/- 0.3 micrograms.ml-1 in female. In male, the percentage of fat and body mass index (BMI) correlated significantly with EPEC (r = 0.79 and 0.49 respectively). In female, the percentage of fat and BMI did not correlate with EPEC. The estimated fentanyl effect site concentrations at awakening did not correlate with the EPEC. CONCLUSIONS: Male patients who have high percentage of fat have a tendency to delayed of awakening from propofol anesthesia. In female, however, no correlation was seen between percentage of fat and awakening time from propofol anesthesia. Measuring the percentage of fat might bring a new insight into pharmacokinetics of propofol.

Anesthesia Recovery Period↗
PubMed1992

Total intravenous anesthesia with a continuous propofol-alfentanil infusion.

A total intravenous anesthetic using propofol and alfentanil was evaluated to determine if it would provide a shorter recovery-room stay than a more traditional balanced anesthetic using isoflurane and alfentanil. Forty-three ASA I or II patients between 17 and 50 years of age undergoing major abdominal or orthopedic procedures were studied. The propofol group received alfentanil 50 mg/kg followed by propofol 1 mg/kg for anesthesia induction. Continuous propofol infusion was initiated at induction using 170 mg/kg/min for 10 minutes, followed by 130 mg/kg/min for 10 minutes, then maintained at 100 mg/kg/min until 10 minutes before the end of surgery. Ventilation was supported with an air-oxygen mixture. The group receiving balanced anesthesia received alfentanil 1 mg/kg, and anesthesia was induced with sodium thiopental 4 mg/kg. A 1% isoflurane inhalation with air-oxygen was initiated immediately upon induction. Both groups received a continuous infusion of alfentanil titrated to maintain heart rate within 10% of preinduction levels. Recovery from anesthesia was measured using a subjective pain assessment, a verbal fluency test, and a short-term memory test. No differences were detected in the rate of recovery at 30 minutes or 60 minutes postextubation. Hemodynamic stability during induction and intubation was slightly better in the propofol group than in the isoflurane group. One episode each of intraoperative awareness and delayed eye opening occurred in the propofol group. Total intravenous anesthesia using propofol and alfentanil is just as effective as a balanced inhalation anesthetic and provides equally rapid recovery. However, practitioners are cautioned to include an amnestic adjuvant when using propofol as the sole anesthetic agent.

Adolescent↗
PubMed2004

[Fentanyl or remifentanil to potentiate a single dose of rocuronium in patients anesthetized with propofol with evaluation by accelerometry].

OBJECTIVE: To compare the increase in potency of a single dose of rocuronium during anesthesia with propofol combined with either fentanyl or remifentanil. PATIENTS AND METHODS: Forty patients scheduled for plastic surgery were distributed in 2 groups of 20 according to the opioid drug assigned: fentanyl or remifentanil. Induction with propofol was accomplished by computer-controlled infusion, with response measured in the adductor pollicis muscle. After calibration, a dose of 0.6 mg/Kg of rocuronium was infused. Anesthesia was maintained with propofol, oxygen in air, and an equipotent dose of either fentanyl or remifentanil, which was modified to maintain heart rate and systolic arterial pressure within 30% above or below baseline levels. Patient characteristics recorded were age, sex, height, weight, ASA class, type of surgery, and the propofol and opioid doses consumed. Intubation conditions and time to onset of action of rocuronium (T1), of recovery of the first response in a train of four (RT1), and of recovery of 25% of the first response or clinical duration. RESULTS: The groups were statistically similar in terms of demographic variables, type of surgery, propofol and opioid consumption, intubation conditions, and rocuronium T1 and RT1. Clinical duration of anesthesia was longer (p<0.05) in the remifentanil group (33.1 +/- 10 minutes) than in the fentanyl group (27.1 +/- 7.4 minutes). CONCLUSIONS: Remifentanil administered in combination with propofol for anesthesia does not affect time of onset of a single dose of 0.6 mg/Kg dose of rocuronium, but clinical duration of anesthesia is longer with remifentanil and propofol than with the fentanyl and propofol combination. The surgical and intubation conditions achieved with both combinations are adequate and similar.

Adjuvants, Anesthesia↗
PubMed2004

[The influence of intermittent hemodialysis (HD) on bispectral index (scale) (BIS) and serum propofol concentration under postoperative intravenous sedation].

We experienced a case of postoperative intravenous sedation with propofol during intermittent hemodialysis (HD), and investigated the correlation between the clinical sedation level based on bispectral index scale (BIS) together with Ramsay score, and the serum concentration of propofol. One adult oral cancer patient (carcinoma of the lower gingiva) with end-stage renal dysfunction needing HD was selected for this study. The day after operation, HD was commenced under intravenous sedation with propofol. Clinical sedation level was assessed using BIS and Ramsay score, and serum propofol concentrations were determined in arterial blood samples. Serum concentrations were measured every 15 times until 51 hours after operation. The initial dose of propofol was set at 3.5 mg x kg(-1) x h(-1) on the basis of clinical symptoms. According to BIS and Ramsay score, sedation level decreased lineally for 1 hour after commencement of HD. In contrast, serum propofol concentration incresed from 1.71 microg x ml(-1) to 2.21 microg x ml(-1). Total serum concentration of propofol was enhanced during HD because of dialytic dehydration, but, according to BIS and Ramsay scores, the possibility was suggested that the fraction of albmin-unbound propofol with pharmacological activities was eliminated or absorbed by membrane during HD.

Anesthesia, General↗
PubMed1992

[The effect of halothane, alfentanil and propofol on blood flow velocity, blood vessel cross section and blood volume flow in the middle cerebral artery].

Transcranial Doppler sonography (TCD) has gained in relevance for noninvasive monitoring of the cerebral circulation during the perioperative period. As long as the diameters of the investigated vessels remain unknown, however, flow velocities alone are not really informative. Exact vessel diameter determination in humans under the influence of different anesthetic drugs has not yet been performed due to ethical and methodological restrictions. A new modification of TCD allows analysis of the reflected "Doppler power", which is proportional to the cross-sectional area of the insonated vessel. METHODS. Three groups of 15-16 patients each (ASA I) were investigated after informed consent. Anesthesia was induced with droperidol, alfentanil, thiopental, and vecuronium bromide. After intubation patients were normoventilated with N2O:O2 = 3:2 and additional doses of alfentanil were injected until the transcranial ultrasound probe was fixed to the temporal bone and focused on the middle cerebral artery. Baseline values of heart rate (HR), mean arterial pressure (MAP), expiratory minute volume (EMV), end-expiratory CO2 (FeCO2), and TCD were measured. Then 1.5 vol% halothane, 25-50 micrograms/kg alfentanil, or propofol (1.5 mg/kg iv., 10 mg/kg.min) was administered. Further measurements (HR, MAP, EMV, FeCO2 and TCD) were performed at 3, 6, 10, and 20 min after the start in the halothane and propofol groups and after 3 and 6 min in the alfentanil group. The following transcranial parameters were derived from the TCD device: mean maximal flow velocity (vmmax), pulsatility index, time-averaged mean velocity (vmmen), "vessel area (VA)", and "volume flow (VF)". The mean +/- standard deviation of each parameter was calculated. Statistical evaluation was performed by paired t-tests (level of significance P less than 0.05). RESULTS. HR showed a tendency to increase after halothane and to decline after alfentanil. Alfentanil induced a short-term decline in MAP. End-expiratory minute volume and FeCO2 showed only minor alterations in all three groups. The vmmax was nearly doubled by halothane. Alfentanil induced a transitory decline in vmmax while Propofol decreased it markedly. The pulsatility index showed a decrease after halothane; alfentanil caused a short-term increase. Propofol induced a strong increase after 3 min; in the following period a return to baseline values was observed. The vmmean was increased by halothane and reduced by 32% propofol. VA was found to be unaltered by alfentanil and propofol but was more than doubled by halothane. Accordingly, the relative value for VF increased by 148% under halothane. VF appeared to decline after propofol. DISCUSSION. The described method allows only the determination of relative values: it is not possible to quantify exactly how much the VA changed. Halothane caused significant increases of VA measured in the middle cerebral artery, whereas alfentanil and propofol did not influence this parameter. This is in accordance with previous experiments in dogs in which halothane decreased the resistance of large basal cerebral arteries (LAR). LAR remained unaltered after alfentanil administration. The site of action of some anesthetic agents on cerebral vessels does not seem to be restricted to cerebral arterioles: at least for halothane, a vasodilating effect on large cerebral arteries could be demonstrated. This should be kept in mind when transcranial Doppler is applied during the perioperative period.

Alfentanil↗
PubMed2004

[The influences of nitrous oxide and ketamine on electroencephalogram during propofol-anesthesia].

BACKGROUND: The influence of nitrous oxide and ketamine on electroencephalogram (EEG) during the induction of general anesthesia with propofol was quantitatively analyzed. METHODS: Anesthesia was induced with propofol using TCI (target controlled infusion) system. Twenty-five adult patients (ASA I-II) were randomly divided into three groups: 1. anesthesia induced with propofol alone [Group-P (n=7)], 2. anesthesia induced with inhalation of nitrous oxide in addition to propofol [Group-PN (n= 10)] and 3. anesthesia induced with intravenous injection of ketamine in addition to propofol [Group-PK (n= 8)]. We studied the influence of nitrous oxide and ketamine on EEG by analyzing the relations between effect-site concentration of propofol and EEG-indices. RESULTS: Additional injection of ketamine (Group-PK) increased BIS index during the maintenance of anesthesia from 43.4 +/- 8.2 to 71.8 +/- 6.5 in comparison with the contrasting group (Group-P). Nitrous oxide also increased the high frequency component in EEG. CONCLUSIONS: When anesthesia is induced with nitrous oxide and/or ketamine together with propofol, and BIS is taken as an index of depth of anesthesia, the intracerebral concentration of propofol becomes excess.

Adult↗
PubMed2005

[Effect of propofol on visual evoked potentials during neurosurgery].

BACKGROUND: Evoked potentials are used to monitor the central nervous system during neurosurgery and it is well known that they are affected by the depth of anesthesia. Many studies on the evoked potential like somatosensory evoked potential (SEP) and auditory brain stem response (ABR) are reported, but studies on visual evoked potential (VEP) are few. We investigated the influence of the propofol concentration on VEP in neurosurgical patients. METHODS: Seven patients scheduled for neurosurgery, three with cranial aneurysm and four with brain tumor, were studied. Anesthesia was maintained with intravenous propofol using target controlled infusion (TCI). We measured the change of amplitude and latency of VEP at three propofol concentrations (effect site concentrations of 1.5, 2.0 and 3.0 microg x ml(-1)), and also evaluated bispectral index (BIS) at each propofol concentration. RESULTS: Amplitude of VEP at 3.0 microg x ml(-1) propofol concentration decreased significantly compared with the amplitude at 1.5 microg x ml(-1) concentration. No significant change was observed with the latency of VEP. The value of BIS at 3.0 microg x ml(-1) propofol concentration also decreased significantly compared with 2.0 microg x ml(-1) concentration. CONCLUSIONS: Amplitude of VEP is strongly affected by the concentration of propofol. Caution should be taken in evaluating VEP in patients undergoing propofol anesthesia.

Aged↗
PubMed2005

Effects of propofol and fentanyl on duodenal motility activity in pigs.

To investigate the effects of propofol and fentanyl on the postprandial duodenal motility the intraluminal impedance technique was used. Six pigs were instrumented with a central venous catheter, a percutaneous enterogastrostomy (PEG), and an impedance catheter, which was introduced via the PEG into the duodenum through endoscopy. Over the following 3 d, duodenal motility was measured for 8-hour periods. Measurements were taken on each subject under 3 different sets of conditions: in the conscious unrestrained pig, during propofol sedation, and during sedation with propofol-fentanyl. Both, after morning feeding and during gastric nutrition via the PEG, duodenal feeding patterns and duodenal phase II of the migrating motor cycle were shortened during propofol and propofol-fentanyl sedation. In contrast, the duration of phase I was prolonged by propofol and propofol-fentanyl. In conclusion, either propofol or propofolfentanyl sedation shortens duodenal feeding patterns, as well as phase II of the migrating motor cycle.

Animals↗
PubMed2006

[Effects of sevoflurane and propofol on evoked potentials during neurosurgical anesthesia].

BACKGROUND: The effect of anesthetics on somatosensory evoked potential (SEP) and auditory brain stem response (ABR) has been a subject of intense reseach over the last two decades. In fact, volatile anesthetics have been repeatedly shown to decrease cortical amplitude in a dose-dependent fashion but the information regarding the effect of propofol is incomplete. The purpose of this study was to compare the effects of sevoflurane and propofol on evoked potentials during comparable depth of anesthesia guided by bispectral index (BIS). METHODS: Forty four patients scheduled for neurosurgery were studied. Anesthesia was maintained with intravenous propofol using target controlled infusion (TCI). We measured the change of amplitude and latency of SEP(N20-P25), ABR (V wave) and visual evoked potential (VEP: P100) at three sets of sevoflurane (0%, 1%, 2%) or propofol concentrations (effect site concentration of 1.5, 2.0, 3.0 microug x ml(-1)). BIS monitor was used to measure relative depth of hypnosis. RESULTS: With increasing concentrations of sevoflurane (0, 1% and 2%), SEP showed dose-related reduction in its amplitude, ABR produced less marked changes and VEP showed a significant reduction at 1%. VEP at the propofol concentration of 3.0 microg x ml(-1) was decreased significantly compared with the amplitude at 1.5 microg x ml(-1) concentration. No significant change was observed with SEP and ABR during the change of propofol dosages. BIS values were almost the same with each anesthetics. CONCLUSIONS: VEP was most strongly affected with anesthetics, and ABR showed less marked influence of sevoflurane and propofol. Propofol based TIVA technique would induce less change in evoked potentials than sevoflurane.

Aged↗
PubMed2006

Venous occlusion with lidocaine for preventing propofol induced pain. A prospective double-blind randomized study.

OBJECTIVE: Pain is a well-known complication of intravenous administration of propofol, and to find out the optimal method to decrease this pain, we studied 4 methods of delivering propofol. METHODS: The study took place at Jordan University Hospital, Amman, Jordan between November 2004 and March 2005 on 200 patients. The patients were divided into 4 groups, group I (n=50), the control group, propofol 1% was given alone. Group II (n=50), patients received propofol 1% premixed with 40 mg of lidocaine. Group III (n=50), patients received propofol 1% 60 seconds after giving 40 mg of lidocaine. Group IV (n=50), patients had venous occlusion for 60 seconds with the use of lidocaine 1% (40 mg), followed by release of the occlusion and administration of the propofol. Pain was assessed during injection and categorized into: no pain, pain, and pain with behavioral changes. RESULTS: In group I (control), 35 patient complained of pain, compared to 26 in group II, 23 in group III, and 7 patients in group IV, with a significant reduction in the incidence and intensity of pain in group II, III, and IV compared with the control (p<0.005). The best reduction of intensity and incidence was achieved in group VI, when compared with groups I, II and III (p<0.005), with no statistical difference between group II and III when compared with each other. CONCLUSION: Of the 4 methods studied, the optimal method to decrease the incidence and intensity of pain resulting from propofol injection is to inject lidocaine while applying venous occlusion for 60 seconds prior to administering propofol.

Adolescent↗
PubMedDate not supplied

[Hemodynamic effects of propofol in patients undergoing pulmonary excision and in patients undergoing closed heart mitral valve surgery].

The effects of propofol on cardiovascular dynamics were studied, by means of SO2 Swan-Ganz catheter, in 12 patients scheduled for elective pulmonary resection and in 10 patients undergoing closed heart mitral valve commissurotomy. Myocardial contractility was also investigated in 10 patients (5 pulmonary and 5 mitral valve patients) by means of transthoracic echocardiography. The patients were premedicated with morphine (0.1 mg/kg i.m.), scopolamine (0.005 mg/kg i.m.) and diazepam (0.1 mg/kg p.o.). Anaesthesia was induced with propofol (2 mg/kg i.v.) and fentanyl (0.005 mg/kg i.v.) and maintained with propofol (6 mg/kg/h) plus fentanyl (0.005 mg/kg/h) infusion. Muscle relaxation was assured by pancuronium bromide (0.1 mg/kg). Ventilation (O2-N2O 50%) was controlled to maintain ETCO2 between 30 and 40 mmHg. All the patients undergoing pulmonary resection were intubated with double lumen endotracheal tube. Measurements were performed with the patients awake, after induction, during steady state anaesthesia, before and after thoracotomy. Propofol together with fentanyl significantly decreased arterial pressure (more than 35%) and cardiac index (more than 40%) in both groups of patients; heart rate showed no significant changes even after intubation. Right atrial pressure didn't change meanwhile wedge pressure showed a reduction, with statistical significance only in pulmonary patients. Total systemic resistances didn't show any variation in both groups of patients. The echocardiographic data revealed an important impairment of myocardial contractility after bolus of propofol, mainly in cardiac patients, as evidenced by decrease of ejection fraction values (20%) and by increase of left ventricle end systolic volume index (10%) from baseline. SVO2 and DO2/VO2 ratio values were stable, according with deep anaesthesia level and adequate metabolic balance. In pulmonary patients, during one lung ventilation, the intrapulmonary shunt values did not differed either during or without propofol infusion, thus suggesting that propofol doesn't interfere with pulmonary hypoxic vasoconstrictor response. In conclusion an aware use of propofol and a careful haemodynamic monitoring would be advisable primarily in patients with a well known or supposed cardiovascular disease.

Adult↗
PubMed1990

[Anesthesia induction in children: propofol in comparison with thiopental following premedication with midazolam].

Propofol provides smooth and rapid induction of anesthesia in adults and guarantees rapid recovery. The use of propofol in adults is frequently associated with pain on injection, but this can be reduced by: (1) injection into the relatively large veins in the forearm or the antecubital fossa: (2) addition of lignocaine to the propofol; or (3) injection of an opioid (alfentanil) before propofol. Compared with experience in adults, there is very little experience with propofol in pediatric anesthesia. The aim of this random prospective study was to compare the induction characteristics of propofol and thiopentone in pediatric anesthesia. Vigilance and behavior in the postoperative period were also compared. METHOD. A total of 75 healthy children aged 3-12 years who were undergoing elective operations were studied. All the children received premedication with 0.5 mg/kg midazolam with 0.02 mg/kg atropine by the rectal route. The children were divided randomly into 3 groups and received: group A, thiopentone 3-6 mg/kg; group B, propofol 1-3 mg/kg mixed with lignocaine (10/200 mg); group C, propofol 1-3 mg/kg, followed 1 min later by alfentanil 0.01 mg/kg. The induction agent was injected over 30 s, if possible into the vein in the forearm or the antecubital fossa. The immediate reaction on vein puncture and any discomfort during the injection were noted. After intubation the anesthesia was maintained with 1 vol% halothane, nitrous oxide and oxygen (2:1). Arterial pressure was measured on arrival in the induction room, immediately after the induction of anesthesia, immediately after intubation and thereafter at 5-min intervals throughout the anesthesia. Heart rate (ECG) and arterial oxygen saturation (saO2) were measured continuously. The existence of any anterograde amnesia was tested (age over 4 years) by means of one of 6 pictures shown to each before operation. The ability to recall the picture shown was recorded 2-5 h postoperatively. The completeness of recovery was assessed at 10-min intervals up to 1 h, and thereafter at 1-h intervals. In the postoperative period a recovery test (postbox test) was performed. The incidence of side effects during the induction of anesthesia and also during recovery and the postoperative period (for 5 h) was recorded. RESULTS. There was no significant difference between the children in the 3 different groups with regard to age, body weight, type of operation, or duration of anesthesia. Among the total of 75 children, 66.7% accepted the vein puncture very well, and 24% well. In some children in each group we observed obstruction of the respiratory tract (group A, 36%; group B, 48%; group C, 64%). Apnea for 20 s was observed only in groups B and C (2 and 3 children respectively). During spontaneous respiration with room air there was a significant decrease of the arterial oxygen saturation about 1 min after induction in all groups. In children ventilated with oxygen by mask, the SaO2 remained nearly constant...

Administration, Rectal↗
PubMed1986

Comparison of propofol with methohexital for outpatient anesthesia.

Propofol is an intravenous anesthetic currently available for clinical investigative use. The intraoperative and postoperative effects of propofol were compared to methohexital when used as an adjuvant to nitrous oxide for outpatient anesthesia. Sixty healthy young women were randomly assigned to receive either methohexital, 1.5 mg/kg intravenously (IV), or propofol, 2.5 mg/kg IV, for induction of anesthesia. Both drugs produced transient cardiovascular and respiratory depression after induction. Maintenance of anesthesia consisted of either methohexital, 6 +/- 2 mg/min, or propofol, 7 +/- 2 mg/min (mean +/- SD) by continuous infusion in combination with nitrous oxide, 70% in oxygen. Use of a propofol infusion was associated with lower blood pressures and heart rates during maintenance. Propofol was associated with fewer side effects (e.g., hiccoughing, nausea, and vomiting) intra- and postoperatively. Recovery times for awakening, orientation, and ambulation were consistently shorter with propofol. We conclude that propofol is a useful alternative to methohexital for induction and maintenance of outpatient anesthesia.

Adult↗
PubMed1987

[Peridural anesthesia in thoraco-abdominal surgery. Propofol-methohexital comparison for complementary anesthesia].

Two groups of 20 patients scheduled for major abdominal surgery or thoracic surgery received analgesia by thoracic peridural route: 850 and 837 micrograms.kg-1 of bupivacaine, plus 4.30 and 4.20 micrograms.kg-1 of fentanyl. Anaesthesia was induced and maintained with either infusion of propofol 0.2% or infusion of methohexital 0.1% and patients were intubated and ventilated. The quality of induction was good in the two groups (3.48 mg.kg-1 in 4 min with propofol and 2.76 mg.kg-1 in 5 min with methohexital). But only 4 of propofol group needed vecuronium for intubation; they were 19 in the other group. Maintenance was extremely smooth with propofol (0.088 mg.kg-1.min-1) in 18 cases. In contrast, poor anaesthetic control was obtained with 14 methohexital patients and had to be abandoned. Hemodynamic data show fc, Pa and Ppa decreased with propofol but increased with methohexital in response to laryngoscopy and intubation. In this study, the onset of 5 sinusal bradycardias was noted with propofol. Two of them were severe 39 and 38 b.min-1 with major decrease of LVSWI to 32.45 and 24.47 g.mm-2. The role of hypovolemia (Bainbridge reflex) or vagomimetic effect of propofol is discussed. Nevertheless, this study shows that propofol given by infusion can better achieve adequate anaesthesia than methohexital.

Abdomen↗
PubMed1987

[Hemodynamic action profile of propofol in comparison with midazolam. A study in coronary surgical patients].

Propofol, a rapid and short-acting i.v. anesthetic, was associated with the risk of anaphylactic reactions in its original cremophor-EL formulation. It has been reformulated in a soybean emulsion with satisfactory anesthetic properties. A former study of hemodynamic changes after i.v. induction with propofol, thiopental, methohexital, etomidate, and midazolam in patients with coronary artery disease demonstrated that in comparison to other induction agents propofol depressed systolic and diastolic arterial pressures more severely, compromising coronary perfusion. In the present investigation left ventricular parameters as well as hemodynamic effects during extracorporeal circulation (ECC) were studied in comparison to midazolam during opiate analgesia. Methods. Hemodynamic effects of 2 mg/kg body weight propofol as compared to 0.15 mg/kg midazolam were studied in 34 patients during coronary artery surgery before cannulation of the large vessels (measurement of left ventricular parameters) or during ECC (measurement of arterial perfusion pressure and oxygenator volume). Results (see Table 1, Figs. 1 and 2). Propofol decreased systolic and diastolic pressures (-27%, -22%) more than midazolam (-10%, -9%). Cardiac index and stroke volume index were diminished following both drugs (propofol: -14%, -9%; midazolam: -15%, -11%); total systemic resistance was reduced significantly by propofol (-22%). Dp/dtmax was compromised more markedly by propofol (-24%) than by midazolam (-18%), but there was no significant difference.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗