Comparative Renal Effects of Midazolam and Thiopental in Humans

Lebowitz, Philip W.; Cote, Marc; Daniels, Alfred L.; Bonventre, Joseph V.

doi:10.1097/00000542-198311000-00003

Cited by 14 publications

(8 citation statements)

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“…In humans sedated with midazolam, a downward trend in renal blood flow and an upward trend in renal vascular resistance, estimated as mean arterial pressure and renal blood flow ratio, were observed. 23 In addition, the increase in RI and PI was associated with reduction of renal blood flow. 24 The midazolam effect on renal blood flow observed in this study may be the cause of the observed increase in renal and ocular PI and RI.…”

Section: Discussionmentioning

confidence: 98%

Effects of Sedation With Midazolam and Butorphanol on Resistive and Pulsatility Indices in Healthy Dogs

Novellas

Gopegui

Espada

2007

Vet Radiology Ultrasound

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Resistive index (RI) and pulsatility index (PI) are indirect measurements of blood flow resistance that may be measured by pulsed wave Doppler ultrasonography. Chemical restrain may potentially alter the indices although it is required to perform ultrasonography in some patients. The purpose of this study was to describe values for both intrarenal and ocular RI and PI within the same subject in clinically normal dogs sedated with a midazolam and butorphanol combination and evaluate if there are any significant changes between sedated and nonsedated dogs. Fifteen healthy Beagle dogs were studied by Duplex Doppler interrogation in interlobar or arcuate arteries of the kidney and long posterior ciliary artery. Pulse rate and systolic blood pressure were also determined. All measurements were recorded before and after the administration of a sedative combination of midazolam (0.2 mg/kg) and butorphanol (0.2 mg/kg). Mean comparison tests (paired t-tests or Wilcoxon's rank-sum test) were used to determine if any significant differences existed between right and left renal values or right and left ocular values. A correlation study (Pearson or Spearman) was applied between RI, PI, and systolic pressure, and pulse rate. RI and PI were significantly higher in sedated Beagles than in unsedated Beagles. There was neither correlation between index and systolic blood pressure nor pulse rate. In conclusion, provided that normal RI and PI increase in sedated animals, then reference ranges should be higher when sedated--healthy or ill--animals are evaluated.

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Section: Discussionmentioning

confidence: 98%

Effects of Sedation With Midazolam and Butorphanol on Resistive and Pulsatility Indices in Healthy Dogs

Novellas

Gopegui

Espada

2007

Vet Radiology Ultrasound

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“…It had been suggested that thiopentone induction of anaesthesia caused decreased glomerular filtration rate and renal blood flow secondary, at least in part, to decreased arterial pressure [19,20]. More recent data from studies in ASA class I and II patients have failed to confirm a decreased renal blood flow from thiopentone induction of anaesthesia [21]. Indeed, other data obtained from induction doses of thiopentone in dogs have shown a transient increase in renal blood flow in parallel with a transient increase in arterial presure [22].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Effects of Propofol and of Thiopentone Anaesthesia in the Sheep

Runciman

Mather

Selby

1990

British Journal of Anaesthesia

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We have examined the effects on the cardiovascular system and on regional blood flow of propofol and thiopentone when administered with IPPV (FIO2 0.4). A longitudinal study design was used in which 16 studies were performed in eight sheep for 30 min before, during the last 30 min of 70 min anaesthesia, and for 6 h after anaesthesia. During anaesthesia with propofol and thiopentone, mean total body oxygen consumption decreased, respectively, by 47% (P less than 0.001) and 24% (P less than 0.01) of pre-anaesthesia baseline values, mean heart rate increased by approximately 50% (P less than 0.05) with both agents, mean arterial pressures increased by approximately 50% (P less than 0.05) with both agents and the mean cardiac output was unaltered with propofol anaesthesia but was decreased by 20% (P less than 0.05) with thiopentone anaesthesia. The changes in arterial pressure and heart rate were unexpected and may have been a result of a species-specific effect. Mean hepatic blood flow decreased consistently by a mean of 17% (P less than 0.01) during propofol anaesthesia, and inconsistently during thiopentone anaesthesia so that it was not significantly different from baseline values. Mean renal blood flow decreased during propofol anaesthesia by 7% (P less than 0.05) and by 27% (P less than 0.001) during thiopentone anaesthesia. Whereas most variables returned to baseline values within 2 h after propofol anaesthesia, this took 5 h after thiopentone anaesthesia.

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“…Although it is possible that the renal effects of anaesthesia were mediated, at least in part, through competition for secretion between renally excreted metabolites of the anaesthetics and cefoxitin-as has been reported, for example, to occur in the presence of probenecid [8,9]-it is probable that propofol and thiopentone share the depressant effects of the volatile anaesthetic agents on renal function [10,11] which have also been observed for thiopentone in kidney slices in vitro [12]. Such effects on renal blood flow and renal function, it would seem, are common among general anaesthetic agents [10][11][12][13][14][15][16][17]; the differences between agents would seem to be mainly those of magnitude and time course. Although the clearance of propofol from the blood was much faster than that of thiopentone and the animals apparently recovered faster as judged by earlier extubation and standing, the effects of propofol on elimination of cefoxitin were not of a clearly shorter duration than thiopentone.…”

Section: Discussionmentioning

confidence: 99%

Effects of Propofol and of Thiopentone Anaesthesia on the Renal Clearance of Cefoxitin in the Sheep

Selby

Mather

Runciman

1990

British Journal of Anaesthesia

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We have examined the renal extraction ratios and clearances of cefoxitin in three groups of adult merino ewes. One group (n = 3) was studied for 12 h without perturbation; these were designated control studies. The other two groups (n = 4 each) were studied before (baseline values), during and after the induction and 70-min maintenance of anaesthesia with propofol or thiopentone. In the control studies, mean renal extraction ratio and clearance for cefoxitin were, respectively, 0.67-0.92 and 0.66-0.91 litre min-1 and were consistent throughout the entire study period in individual animals. Comparable values were obtained as baseline values in the anaesthesia groups. Compared with individual baseline values, blood concentrations of cefoxitin doubled during anaesthesia with each agent. At the same time, renal extraction ratio and clearance for cefoxitin each decreased significantly to about 50-60% of their control values. Recovery to control values of arterial blood concentrations and renal extraction ratio of cefoxitin took at least 5 h, but recovery of renal clearance was more rapid. The results indicate that renal elimination of an organic anion such as cefoxitin may be affected by changes in renal blood flow and in renal function produced by propofol and thiopentone; these effects may last for several hours after recovery of renal blood flow.

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Comparative Renal Effects of Midazolam and Thiopental in Humans

Cited by 14 publications

References 0 publications

Effects of Sedation With Midazolam and Butorphanol on Resistive and Pulsatility Indices in Healthy Dogs

Effects of Sedation With Midazolam and Butorphanol on Resistive and Pulsatility Indices in Healthy Dogs

Cardiovascular Effects of Propofol and of Thiopentone Anaesthesia in the Sheep

Effects of Propofol and of Thiopentone Anaesthesia on the Renal Clearance of Cefoxitin in the Sheep

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