Commonly used intravenous anesthetics decrease bladder contractility: An in vitro study of the effects of propofol, ketamine, and midazolam on the rat bladder

Abstract

Aim:This study was designed to test the hypothesis that propofol, ketamine, and midazolam could alter the contractile activity of detrusor smooth muscle.Materials and Methods:Four detrusor muscle strips isolated from each rat bladder (n = 12) were placed in 4 tissue baths containing Krebs-Henseleit solution. The carbachol (10 −8to 10−4mol/L)-induced contractile responses as well as 5, 10, 20, 30, 40, 50 Hz electrical field stimulation (EFS)-evoked contractile responses of the detrusor muscles were recorded using isometric contraction measurements. After obtaining basal responses, the in vitro effects of propofol, ketamine, midazolam (10−5 to 10−3 mol/L), and saline on the contractile responses of the detrusor muscle strips were recorded and evaluated.Results:All the 3 drugs reduced the carbachol-induced and/or EFS-evoked contractile responses of rat detrusor smooth muscles in different degrees. Midazolam (10−4 to 10−3 mol/L) caused a significant decrease in the contractile responses elicited by either EFS or carbachol (P=0.000−0.013). Propofol (10−3mol/L) caused a decrease only in EFS-evoked contractile responses (P=0.001−0.004) and ketamine (10−3mol/L) caused a decrease only in carbachol-induced contractile responses (P=0.001−0.034).Conclusion:We evaluated the effects of the 3 different intravenous anesthetics on detrusor contractile responses in vitro and found that there are possible interactions between anesthetic agents and detrusor contractile activity. The depressant effects of midazolam on the contractile activity were found to be more significant than ketamine and propofol. Despite the necessity of further studies, it could be a piece of wise advice to clinicians to keep the probable alterations due to intravenous anesthetics in mind, while evaluating the results of urodynamic studies in children under sedation.

Anesthetic protocols for urodynamic studies of the lower urinary tract in small rodents—A systematic review

“…Ceran and colleagues evaluated the effects of 3 different intravenous anesthetics: propofol, ketamine, and midazolam on detrusor contractile responses in vitro . Results demonstrated that depressant effects of midazolam on the contractile activity were found to be more significant than ketamine and propofol [ 66 ].…”

Evaluation of the effects of sedation administered via three different routes on the procedure, child and parent satisfaction during cystometry

“…Malinovski et al reported from their study investigating the effects of intravenous opioids and ketoprofen on urodynamic parameters in male adults that opioids change urodynamic results in contrast to ketoprofen but the opioid nalbuphine has no effect on detrusor contraction (Malinovsky et al 1998 ). Ceran et al reported that midazolam depressed detrusor contraction at moderate and high concentrations in the study that they conducted to determine the effects of the commonly used anesthetic agents of ketamine, propofol and midazolam on rat detrusor smooth muscle in vitro (Ceran et al 2010 ). Another study investigated the effects of ketamine, propofol, midazolam and ether on cystometric parameters in rats and reported that the urination reflex disappears under ketamine anesthesia while propofol prolongs the urination period but ether inhalation and midazolam make no change in urodynamic parameters (Ozkurkcugil and Ozkan 2010 ).…”