Antiemetische Wirkung von Propofol

Borgeat, Alain; Stirnemann, H

doi:10.1007/s001010050643

Cited by 26 publications

(11 citation statements)

References 38 publications

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“…The antiemetic action of propofol is well known and has been extensively described [ 118 , 119 ]. Patients receiving anaesthesia with propofol experience significantly less PONV compared with that associated with other hypnotic drugs, irrespective of the use of adjunct drugs, patient characteristics or opiate use.…”

Section: Pharmacodynamics (Pd)mentioning

confidence: 99%

Clinical Pharmacokinetics and Pharmacodynamics of Propofol

2018

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Propofol is an intravenous hypnotic drug that is used for induction and maintenance of sedation and general anaesthesia. It exerts its effects through potentiation of the inhibitory neurotransmitter γ-aminobutyric acid (GABA) at the GABAA receptor, and has gained widespread use due to its favourable drug effect profile. The main adverse effects are disturbances in cardiopulmonary physiology. Due to its narrow therapeutic margin, propofol should only be administered by practitioners trained and experienced in providing general anaesthesia. Many pharmacokinetic (PK) and pharmacodynamic (PD) models for propofol exist. Some are used to inform drug dosing guidelines, and some are also implemented in so-called target-controlled infusion devices, to calculate the infusion rates required for user-defined target plasma or effect-site concentrations. Most of the models were designed for use in a specific and well-defined patient category. However, models applicable in a more general population have recently been developed and published. The most recent example is the general purpose propofol model developed by Eleveld and colleagues. Retrospective predictive performance evaluations show that this model performs as well as, or even better than, PK models developed for specific populations, such as adults, children or the obese; however, prospective evaluation of the model is still required. Propofol undergoes extensive PK and PD interactions with both other hypnotic drugs and opioids. PD interactions are the most clinically significant, and, with other hypnotics, tend to be additive, whereas interactions with opioids tend to be highly synergistic. Response surface modelling provides a tool to gain understanding and explore these complex interactions. Visual displays illustrating the effect of these interactions in real time can aid clinicians in optimal drug dosing while minimizing adverse effects. In this review, we provide an overview of the PK and PD of propofol in order to refresh readers’ knowledge of its clinical applications, while discussing the main avenues of research where significant recent advances have been made.

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Section: Pharmacodynamics (Pd)mentioning

confidence: 99%

Clinical Pharmacokinetics and Pharmacodynamics of Propofol

2018

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“…Der zu Grunde liegende Wirkungsmechanismus ist zwar nicht genau bekannt, allerdings wird vermutet, dass die dämpfende Wirkung von Propofol auf kortikale bzw. subkortikale Afferenzen, die unspezifische Wirkung auf den 5HT 3 -Rezeptor und die verminderte Serotoninfreisetzung in diesem Zusammenhang wesentliche Rollen spielen [3].…”

Section: Materials Und Methoden Patientenunclassified

Vergleich der Prämedikationsqualität unterschiedlicher Clonidinkonzentrationen und Midazolam im Rahmen einer TCI bei orthopädischen Schulteroperationen

Grottke

Müller²,

Pj³

et al. 2003

Anasthesiol Intensivmed Notfal

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“…OffLabelUse von Propofol ▼ Geringere PONV-Inzidenz Die direkte antiemetische Wirkung von Propofol ist seit langer Zeit bekannt [9]. Im Vergleich zu anderen Anästhesiemedikamenten oder -techniken verursacht der Einsatz von Propofol bei Anästhesieeinleitung und -aufrechterhaltung im Rahmen einer total intra venösen Anästhesie (TIVA) eine verminderte Inzidenz von PONV [10]. Allerdings wurden bei den hierzu durchgeführten Studien unterschiedliche Dosierungen verwendet und das Medikament teils als Bolus, teils kontinuierlich über eine Spritzen pumpe appliziert.…”

Section: N Fachwissenunclassified

Antiemetische Therapie in der präklinischen Notfallmedizin – Aktuelle Studienlage

Luxen¹,

Trentzsch²,

Urban³

et al. 2015

Anästhesiol Intensivmed Notfallmed Schmerzther

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Nausea and vomiting are frequent symptoms in emergency medicine and require a targeted drug intervention. Despite known disadvantages in terms of efficacy and side effects, metoclopramide is still often used in the emergency medical service to treat nausea and vomiting. Recent studies show that, especially in the therapy of opioid-triggered vomiting, metoclopramide is not significantly effective when compared to placebo. Dimenhydrinate seems to be an effective drug for various forms of nausea, but can often be relatively or absolutely contraindicated in emergency medicine due to its sedative effect. Based on a literature review, 5-HT3-antagonists appear to be a good alternative for the treatment of emesis in the emergency service. However, as for all antiemetics, the maximum dosage and potential side effects need to be paid attention to. In addition, neither of the 5-HT3-antagonists are approved for therapy of non-chemotherapy-induced vomiting or PONV. In conclusion, it may be considered to include 5-HT3-antagonists in addition to dimenhydrinate in the ambulance medical equipment. The routine use of a specific antiemetic is not recommended.

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Antiemetische Wirkung von Propofol

Cited by 26 publications

References 38 publications

Clinical Pharmacokinetics and Pharmacodynamics of Propofol

Clinical Pharmacokinetics and Pharmacodynamics of Propofol

Vergleich der Prämedikationsqualität unterschiedlicher Clonidinkonzentrationen und Midazolam im Rahmen einer TCI bei orthopädischen Schulteroperationen

Antiemetische Therapie in der präklinischen Notfallmedizin – Aktuelle Studienlage

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