Comparison of the effects of propofol and midazolam on the cardiovascular autonomic nervous system during combined spinal and epidural anesthesia

Hidaka, Syozo; Kawamoto, Masashi; Kurita, Seiichiro; Yuge, Osafumi

doi:10.1016/j.jclinane.2004.03.012

Cited by 26 publications

(13 citation statements)

References 26 publications

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“…Propofol could protect the heart from serious ventricular arrhythmias during acute coronary occlusion, but the effect was absolutely blocked by atropine, indicating that the antiarrhythmic effect of propofol was due to a reduction in sympathetic tone leading to a dominance of parasympathetic tone [27] . Research showed that propofol suppressed both sympathetic and parasympathetic tone, but the suppression of sympathetic tone was more than that of parasympathetic tone [62, 63] .…”

Section: Propofol and The Autonomic Nervous Systemmentioning

confidence: 99%

Propofol and arrhythmias: two sides of the coin

et al. 2011

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The hypnotic agent propofol is effective for the induction and maintenance of anesthesia. However, recent studies have shown that propofol administration is related to arrhythmias. Propofol displays both pro- and anti-arrhythmic effects in a concentration-dependent manner. Data indicate that propofol can convert supraventricular tachycardia and ventricular tachycardia and may inhibit the conduction system of the heart. The mechanism of the cardiac effects remains poorly defined and may involve ion channels, the autonomic nervous system and cardiac gap junctions. Specifically, sodium, calcium and potassium currents in cardiac cells are suppressed by clinically relevant concentrations of propofol. Propofol shortens the action potential duration (APD) but lessens the ischemia-induced decrease in the APD. Furthermore, propofol suppresses both sympathetic and parasympathetic tone and preserves gap junctions during ischemia. All of these effects cumulatively contribute to the antiarrhythmic and proarrhythmic properties of propofol.

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Section: Propofol and The Autonomic Nervous Systemmentioning

confidence: 99%

Propofol and arrhythmias: two sides of the coin

et al. 2011

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“…Due to the reasons mentioned above, arterial hypotension late during the operation may occur in TIVA rather than in inhalative narcosis, and may urge to be corrected by the administration of colloids or additional amounts of crystalloid solutions during the course of anaesthesia. Furthermore, the susceptibility to anaesthesia-related hypotension is age-dependent, which also applies to middle-aged patients [5,6]. Possibly, uncorrected hypovolaemia due to starving has been reported to be another factor contributing to anaesthesia-related hypotension [7], a factor that was not elucidated in this study though.…”

Section: Discussionmentioning

confidence: 74%

Perioperative risk factors for haematoma after breast augmentation

Richard

Huesler

Banič

et al. 2013

Journal of Plastic Surgery and Hand Surgery

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Postoperative bleeding is the most frequent early complication after breast augmentation. The aim of this retrospective analysis was to assess possible risk factors originating in the perioperative management. All primary, bilateral breast augmentation procedures including augmentation mastopexy performed over an 8-year period were reviewed. Nine cases of postoperative bleeding could be identified in the 132 patients included in the study (6.8%). Univariate statistical analysis revealed age (p < 0.01), the amount of administered fluid intraoperatively (p < 0.05) and within the first 24 hours from the onset of anaesthesia (p < 0.01), the use of colloids (p < 0.01), total intravenous anaesthesia (p < 0.05), and systolic hypotension during the last 30 minutes of the operation (p < 0.05) as risk factors, whereas none of them could be identified as independent risk factor in multivariate analysis. In conclusion, this study was able to identify risk factors originating in the perioperative management that may lead to haematoma formation after breast augmentation.

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“…Hypotension is also caused by propofol, which dilates venous and arterial vessels, inhibits the sympathetic system and reflexes from baroreceptors and exerts depressive effects on the myocardium [11,12]. The median systolic and diastolic arterial pressures were lower in the PROP group when compared with the MID group.…”

Section: Discussionmentioning

confidence: 99%

A comparison of subhypnotic doses of propofol and midazolam during spinal anaesthesia for elective Caesarean section

Danielak-Nowak¹,

Musioł²,

Arct-Danielak³

et al. 2016

Anaesthesiol Intensive Ther

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Background: This study compared two types of sedation in pregnant women receiving subarachnoid anaesthesia for elective Caesarean section. Methods: This prospective randomised study included 56 women. Patients were sedated with propofol (PROP group, n = 27) or midazolam (MID group, n = 29) via intravenous infusion after extraction of the foetus. The following parameters were assessed at five-minute intervals: degree of sedation, heart rate, arterial pressure, ECG recording and arterial haemoglobin oxygen saturation. Moreover, we recorded drug doses, changes in infusion rates to ensure a desirable degree of sedation and adverse side effects. The maternal recall of delivery and satisfaction with sedation were also evaluated. Results: The incidence of increased sedative infusion rates was higher in the PROP group (59.3% vs. 37.9%). In contrast, decreased infusion rates were observed in the MID group (41.4% vs. 29.6%). After the initial dose, a desirable level of sedation was easier to obtain in the PROP group (77.7% vs. 55.1%), whereas excessive sedation was noted more frequently in the MID group (34.5% vs. 11.5%). The deepest degree of sedation was found in 2 PROP patients and 1 MID patient. In the PROP group, excessive sedation was rapidly alleviated by reducing the infusion rate. In the MID group, excessive sedation was observed throughout the examination, despite reduced infusion rates. No significant intergroup differences were found for desired sedation levels. The mean heart rate and arterial pressure were lower in the PROP group. In the MID group, only 5% of patients developed an elevated systolic RR. No ECG alterations were observed in any patient. A haemoglobin oxygen saturation level below 92% was found in 1 patient from each group. Logorrhoea was characteristic in the PROP group (44.4%). The incidence of nausea and vomiting were higher in the MID group. Other side effects (e.g., headache, backache, erythema and chills) were observed in a subset of patients from both groups. In the MID group, birth recall was significantly lower (82.8% vs. 96.3%). Full satisfaction with sedation was declared by 89.6% of MID patients and 92.6% of PROP patients. Conclusions: Midazolam and propofol induce effective and safe sedation in patients receiving subarachnoid anaesthesia for Caesarean section. Propofol appears to be more useful for Caesarean section sedation when compared with midazolam because of its shorter action, antiemetic effects and better maternal recall of foetal delivery.

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Comparison of the effects of propofol and midazolam on the cardiovascular autonomic nervous system during combined spinal and epidural anesthesia

Cited by 26 publications

References 26 publications

Propofol and arrhythmias: two sides of the coin

Propofol and arrhythmias: two sides of the coin

Perioperative risk factors for haematoma after breast augmentation

A comparison of subhypnotic doses of propofol and midazolam during spinal anaesthesia for elective Caesarean section

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