Effects of propofol on intracranial pressure and prognosis in patients with severe brain diseases undergoing endotracheal suctioning

Abstract

Background To investigate whether the administration of intravenous propofol before endotracheal suctioning (ES) in patients with severe brain disease can reduce the sputum suction response, improve prognosis, and accelerate recovery. Methods A total of 208 severe brain disease patients after craniocerebral surgery were enrolled in the study. The subjects were randomly assigned to the experimental group (n = 104) and the control group (n = 104). The experimental group was given intravenous propofol (10 ml propofol with 1 ml 2% lidocaine), 0.5–1 mg/kg, before ES, while the control group was subjected to ES only. Changes in vital signs, sputum suction effect, the fluctuation range of intracranial pressure (ICP) before and after ES, choking cough response, short-term complications, length of stay, and hospitalization cost were evaluated. Additionally, the Glasgow Outcome Scale (GOS) prognosis score was obtained at 6 months after the operation. Results At the baseline, the characteristics of the two groups were comparable (P > 0.05). The increase of systolic blood pressure after ES was higher in the control group than in the experimental group (P < 0.05). The average peak value of ICP in the experimental group during the suctioning (15.57 ± 12.31 mmHg) was lower than in the control group (18.24 ± 8.99 mmHg; P < 0.05). The percentage of patients experiencing cough reaction- during suctioning in the experimental group was lower than in the control group (P < 0.05), and the fluctuation range of ICP was increased (P < 0.0001). The effect of ES was achieved in both groups. The incidence of short-term complications in the two groups was comparable (P > 0.05). At 6 months after the surgery, the GOS scores were significantly higher in the experimental than in the control group (4–5 points, 51.54% vs. 32.64%; 1–3 points, 48.46% vs. 67.36%; P < 0.05). There was no significant difference in the length of stay and hospitalization cost between the two groups. Conclusions Propofol sedation before ES could reduce choking cough response and intracranial hypertension response. The use of propofol was safe and improved the long-term prognosis. The study was registered in the Chinese Clinical Trial Registry on May 16, 2015 (ChiCTR-IOR-15006441).

[Retracted] Meta‐Analysis of Anesthetic Efficacy and Safety of Propofol in Craniotomy Patients

“…Propofol can inhibit the extracellular voltage dependent calcium channel from entering calcium ions, playing the role of calcium ion flow and reducing calcium overload. In this way, brain tissue and brain cell functions can be effectively protected, and a large amount of sodium and water can be effectively prevented from remaining in cells, thus effectively reducing brain edema and improving brain oxygen metabolism and intracranial pressure [ 7 ].…”

Propofol effects over intracranial pressure waveform and cerebral hemodynamics: A case report

“…Therefore, keeping these patients adequately sedated can reduce brain metabolism, avoid ventilator asynchrony and venous congestion, preventing elevation of thoracic pressure, contributing to the intracranial compartment compliance. In many studies, propofol has shown to reduce ICP and cerebral metabolic rate of oxygen (CMRO2) (Wu et al, 2020). Side effects of propofol are dose-dependent hypotension which can decrease cerebral perfusion pressure even if it induces a decrease in ICP and dose-dependent respiratory depression (Peluso et al, 2019).…”

The nurse's quick guide to I.V. drug calculations

“…5 In addition to the fast-acting sedative effects of the drug 30-60 seconds typically, propofol is also metabolized by the body quickly. 6 The sedative properties of the drug increase patient comfort and assist with better ventilator compliance. Additionally, propofol can also lower ICP by decreasing cerebral blood flow.…”

“…Propofol is a short-acting sedative/anesthetic drug that's commonly used in the ICU setting with ventilated patients 5. In addition to the fast-acting sedative effects of the drug 30–60 seconds typically, propofol is also metabolized by the body quickly 6. The sedative properties of the drug increase patient comfort and assist with better ventilator compliance.…”