Induction characteristics of 2% propofol in children

Borgeat, Alain; Fuchs, Thomas; Tassonyi, E.

doi:10.1093/bja/78.4.433

Cited by 18 publications

(11 citation statements)

References 7 publications

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“…The primary outcome was the number of patients reporting any pain Studies excluded (n=106): Reviews (n=7) 1 3 4 14-17 Animal studies (n=2) 18 19 Not randomised controlled trials (n=15) [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Improper assessment of pain (n=7) [35][36][37][38][39][40][41] Duplicate publication (n=2) 42 43 Methodological concerns (n=15) [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] Did not measure pain from propofol injection (n=20) [60][61][62][63][64][65][66][67][68]…”

Section: Discussionmentioning

confidence: 99%

Prevention of pain on injection of propofol: systematic review and meta-analysis

Jalota

Kalira

George

et al. 2011

BMJ

270

227

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Objective To systematically determine the most efficacious approach for preventing pain on injection of propofol. Design Systematic review and meta-analysis. Data sources PubMed, Embase, Cochrane Library, www.clinicaltrials.gov, and hand searching from the reference lists of identified papers. Study selection Randomised controlled trials comparing drug and non-drug interventions with placebo or another intervention to alleviate pain on injection of propofol in adults. Results Data were analysed from 177 randomised controlled trials totalling 25 260 adults. The overall risk of pain from propofol injection alone was about 60%. Using an antecubital vein instead of a hand vein was the most effective single intervention (relative risk 0.14, 95% confidence interval 0.07 to 0.30). Pretreatment using lidocaine (lignocaine) in conjunction with venous occlusion was similarly effective (0.29, 0.22 to 0.38). Other effective interventions were a lidocaine-propofol admixture (0.40, 0.33 to 0.48); pretreatment with lidocaine (0.47, 0.40 to 0.56), opioids (0.49, 0.41 to 0.59), ketamine (0.52, 0.46 to 0.57), or non-steroidal anti-inflammatory drugs (0.67, 0.49 to 0.91); and propofol emulsions containing medium and long chain triglycerides (0.75, 0.67 to 0.84). Statistical testing of indirect comparisons showed that use of the antecubital vein and pretreatment using lidocaine along with venous occlusion to be more efficacious than the other interventions. Conclusions The two most efficacious interventions to reduce pain on injection of propofol were use of the antecubital vein, or pretreatment using lidocaine in conjunction with venous occlusion when the hand vein was chosen. Under the assumption of independent efficacy a third practical alternative could be pretreatment of the hand vein with lidocaine or ketamine and use of a propofol emulsion containing medium and long chain triglycerides. Although not the most effective intervention on its own, a small dose of opioids before induction halved the risk of pain from the injection and thus can generally be recommended unless contraindicated.

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Section: Discussionmentioning

confidence: 99%

Prevention of pain on injection of propofol: systematic review and meta-analysis

Jalota

Kalira

George

et al. 2011

BMJ

270

227

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“…This state, referred to as paradoxical excitation, is encountered with many sedative and general anesthetic drugs (Gibbs et al, 1937). A common general anesthetic induction agent, propofol (2,6-diisopropylphenol), which potentiates GABAa currents (Bai et al, 1999), is one such drug that induces paradoxical excitation at low doses (Borgeat et al, 1997). A cohesive representation of brain activity requires integration of the paradoxical coexistence of cellular level inhibition with systems level excitation.…”

Section: Introductionmentioning

confidence: 99%

Potential Network Mechanisms Mediating Electroencephalographic Beta Rhythm Changes during Propofol-Induced Paradoxical Excitation

McCarthy¹,

Brown²,

Kopell³

2008

J. Neurosci.

154

151

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Propofol, like most general anesthetic drugs, can induce both behavioral and electroencephalographic (EEG) manifestations of excitation, rather than sedation, at low doses. Neuronal excitation is unexpected in the presence of this GABAa-potentiating drug. We construct a series of network models to understand this paradox. Individual neurons have ion channel conductances with HodgkinHuxley-type formulations. Propofol increases the maximal conductance and time-constant of decay of the synaptic GABAa current. Networks range in size from 2-230 neurons. Population output is measured as a function of pyramidal cell activity, with the EEG approximated by the sum of population AMPA activity between pyramidal cells.These model networks suggest propofol-induced paradoxical excitation may result from a membrane level interaction between the GABAa-current and an intrinsic membrane slow potassium current (Mcurrent). This membrane level interaction has consequences at the level of multi-cellular networks enabling a switch from baseline interneuron synchrony to propofol-induced interneuron antisynchrony. Large network models reproduce the clinical EEG changes characteristic of propofolinduced paradoxical excitation. The EEG changes coincide with the emergence of anti-synchronous interneuron clusters in the model networks. Our findings suggest interneuron anti-synchrony as a potential network mechanism underlying the generation of propofol-induced paradoxical excitation. As correlates of behavioral phenomenology, these networks may refine our understanding of the specific behavioral states associated with general anesthesia.

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“…Borgeat et al ., suggested that coughing was produced by sudden high propofol brain concentrations when high doses of 2% propofol (5 mg/kg) were used. [3] However, it is unlikely that these concentrations could be reached by low dose propofol treatment. Mitra et al ., hypothesized an alternative explanation of violent coughing when lower doses of propofol (2 mg/kg of 1% propofol) are used.…”

Section: Discussionmentioning

confidence: 99%

“…However, severe coughing following sedative doses of 1% propofol has not been reported so far. [34] We report a rare case of violent coughing following low-dose propofol infusion in a patient with Becker's muscular dystrophy.…”

Section: Introductionmentioning

confidence: 99%

Propofol-induced violent coughing in a patient with Becker′s muscular dystrophy

Jain

2011

Indian J Pharmacol

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Propofol anesthesia is often associated with decreased incidence of gagging, coughing or laryngospasm, and provides intense suppression on airway reflex during tracheal intubation and laryngeal mask airway insertion. Propofol pretreatment is also effective in reducing the occurrence of opioid-induced coughing. These benefits are often attributed to bronchodilator and sedative effects of propofol. However, severe coughing following sedative doses of 1% propofol has not been reported so far. We report a rare case of violent coughing following low-dose propofol infusion in a patient with Becker's muscular dystrophy.

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Induction characteristics of 2% propofol in children

Cited by 18 publications

References 7 publications

Prevention of pain on injection of propofol: systematic review and meta-analysis

Prevention of pain on injection of propofol: systematic review and meta-analysis

Potential Network Mechanisms Mediating Electroencephalographic Beta Rhythm Changes during Propofol-Induced Paradoxical Excitation

Propofol-induced violent coughing in a patient with Becker′s muscular dystrophy

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