Comparison of the Potency of Different Propofol Formulations

Guen, Morgan Le; Grassin-Delyle, Stanislas; Cornet, Camille; Genty, Antoine; Chazot, Thierry; Dardelle, Dominique; Liu, Ngai; Dreyfus, Jean François; Mazoit, Jean Xavier; Devillier, Philippe; Alvarez, Jean‐Claude; Sessler, Daniel I.; Fischler, Marc

doi:10.1097/01.anes.0000435741.97234.04

Cited by 20 publications

(4 citation statements)

References 42 publications

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“…A multicenter double blinded trial compared the dose of propofol for induction (using a closed loop infusion guided by Bispectral Index (BIS)) and patient discomfort with and without lidocaine and found that the different formulations were not equipotent - Propoven ® required a higher dose for induction (2.2 ± 0.1 mg/kg) than Diprivan ® (1.8 ± 0.1 mg/kg) or Lipuro ® (1.7 ± 0.1 mg/kg; P = 0.02); however, induction doses were similar when propofol formulations were mixed with lidocaine [18]. …”

Section: ) Commercially Available Formulationsmentioning

confidence: 99%

Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

2015

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Propofol is an intravenous agent used commonly for induction and maintenance of anesthesia, procedural and critical care sedation in children. The mechanisms of action on the central nervous system involve interactions at various neurotransmitter receptors, especially gamma-aminobutyric acid A receptor. Approved for use in the United States by the Federal Drugs and Administration (FDA) in 1989, its use for induction of anesthesia in children less than 3 years of age still remains off-label. Despite its wide use in pediatric anesthesia, there is conflicting literature about its safety and serious adverse effects in particular subsets of children. Particularly as children are not “little adults”, in this review, we emphasize the maturational aspects of propofol pharmacokinetics. Despite the myriad of propofol pharmacokinetic-pharmacodynamic studies and the ability to use allometrical scaling to smooth out differences due to size and age, there is no optimal model that can be used in target controlled infusion pumps for providing closed loop total intravenous anesthesia in children. As the commercial formulation of propofol is a nutrient-rich emulsion, the risk for bacterial contamination exist despite the FDA mandating addition of antimicrobial preservative, calling for manufacturers’ directions to discard open vials after six hours. While propofol has advantages over inhalation anesthesia like less postoperative nausea and emergence delirium in children, pain on injection remains a problem even with newer formulations. Propofol is known to depress mitochondrial function by its action as an uncoupling agent in oxidative phosphorylation. This has implications for children with mitochondrial diseases and the occurrence of propofol-related infusion syndrome, a rare but seriously life-threatening complication of propofol. At the time of this review, there is no direct evidence in humans for propofol induced neurotoxicity to the infant brain; however, current concerns of neuroapoptosis in developing brains induced by propofol persist and continue to be a focus of research.

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Section: ) Commercially Available Formulationsmentioning

confidence: 99%

Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

2015

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“…Finally, propofol was used without lidocaine, although lidocaine can reduce pain during injection. [13] Hypothetically, the lack of an observed effect might have been due to a loss of focus and hypnotic state during this painful stimulus and before induction, thus “resetting” the patient, as suggested by the reactions observed during injection in some patients.…”

Section: Discussionmentioning

confidence: 99%

“…On the basis of a previous study on the potency of various propofol formulations, [13] the mean propofol dose required to obtain anesthesia induction (BIS < 60 for at least 30 seconds) was 2.2 mg/kg (standard deviation 0.6). Considering a statistical power of 90% and an alpha risk of 5% to detect a dose reduction of 25%, the number of patients needed in each group was 40.…”

Section: Methodsmentioning

confidence: 99%

Impact of a preoperative conversational hypnotic session on propofol consumption using closed-loop anesthetic induction guided by the bispectral index

et al. 2017

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Objective:The automated administration of propofol in a closed loop could be used to objectively evaluate the nonpharmacological anesthetic action of hypnotherapy. The objective of this study was to evaluate the impact of a conversational hypnosis session on the consumption of propofol for anesthetic induction.Design:A randomized, usual care-controlled, single-center, patient-blind trial.Setting:Tertiary care center in France from November 2012 to December 2013.Participants:Adult patients scheduled for a surgical procedure under general anesthesia.Interventions:Before surgery, patients were randomized with a computer-generated random list for a preoperative conversational hypnosis session or for usual care. The conversational hypnosis session was conducted and individualized by the therapist with an academic degree in hypnosis in a quiet environment. Anesthetic induction was automatically performed by propofol without opioids and was assisted by the bispectral index in a closed loop.Outcome:Primary endpoint was the propofol dose required for anesthesia induction, defined as a Bispectral index less than 60 for at least 30 seconds.Results:The study included 48 patients in the hypnosis group and 49 patients in the control group. No difference in propofol consumption to obtain anesthesia induction was observed between the groups (total dose: 138.6 [67.5] and 130 [47.9] mg, P = .47; adjusted dose: 2.15 [1.09] and 1.95 [0.66] mg/kg, P = .28, for the hypnosis and control groups, respectively). Hetero-evaluation of arm movement during propofol injection (no reaction: 98% and 74%; P = .004, in the hypnosis and control groups, respectively) and face reaction at venous access placement (no reaction 59% and 30%; P = .017, in the hypnosis and control groups, respectively) were lower in the hypnosis group. No adverse event was reported.Conclusions:No difference in propofol consumption was observed in this study designed to evaluate the effect of a hypnotic conversational session on anesthesia induction using an automated tool for propofol administration.

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“…The use of lidocaine to reduce propofol injection pain can lead to adverse effects, such as cardiovascular and hemodynamic influence and swelling at the intravenous access site, and can cause confusion regarding the required propofol dose for induction (Ahmad et al, 2013;Kim et al, 2011;Le Guen et al, 2014). Few studies have compared propofol injection pain between lidocaine administration and local warming.…”

Section: Introductionmentioning

confidence: 99%