Injektionsschmerz durch Propofol-MCT/LCT bei Kindern

Larsen, Reinhard; Beerhalter, U.; Erdkönig, R.; Larsen, Brianna

doi:10.1007/s001010100213

Cited by 27 publications

(13 citation statements)

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“…1% (B-Braun, Melshungen AG, Germany) contains a mixture of long- and medium-chain triglycerides (LCT/MCTs) and is reported to reduce injection pain [16, 17]. …”

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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“…1% (B-Braun, Melshungen AG, Germany) contains a mixture of long- and medium-chain triglycerides (LCT/MCTs) and is reported to reduce injection pain [16, 17]. …”

Section: ) Commercially Available Formulationsmentioning

confidence: 99%

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

2015

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“…The incidence of pain on injection of propofol in children has been reported to be 30–90%. [89] In order to improve this, a number of strategies, including the addition of local anesthetics and cooling the propofol solution, have been tested in children, but the incidence still remains at 10–30%. [79]…”

Section: Discussionmentioning

confidence: 99%

“…[2] Recently, a medium-chain triglyceride/long-chain triglyceride (MCT/LCT) emulsion has been advocated to reduce injection pain compared with propofol LCT in adults and teenagers. [810] We compared the injection pain of two propofol emulsions to show their effectiveness on two pain scales in children of different age groups.…”

Section: Introductionmentioning

confidence: 99%

Injection pain of propofol in children: A comparison of two formulations without added lidocaine

Beyaz¹,

Eman²

2012

J Anaesthesiol Clin Pharmacol

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Background:Propofol emulsion in medium and long-chain triglycerides (MCT/LCT) has been reported to cause less injection pain than other propofol solutions in adult studies. The aim of this study was to compare the injection pain of two different propofol emulsions using two different pain scales on the pediatric population.Materials and Methods:100 children scheduled for general anesthesia were divided into two groups. Patients were randomly assigned to receive propofol LCT or propofol MCT/LCT. Assessment and evaluation of the Ontario Children's Hospital Pain Scale (mCHEOPS) and the Wong-Baker Faces Scale (WBFS) were performed at the start of the injection until the patients lose consciousness.Results:There were no significant differences between groups in terms of demographic data. According to the mCHEOPS scale, the pain incidence of propofol LCT was 5%, whereas for propofol MCT/LCT it was 15% (P < 0.05). According to the WBFS Pain Scale, the pain incidence of propofol LCT was 17%, whereas for propofol MCT/LCT it was 21% (P > 0.05).Conclusions:Propofol MCT/LCT does not decrease injection pain; contrary to the general assumption, it causes more pain than propofol LCT in children.

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“…The emulsion did not affect the pharmacokinetics or pharmacodynamics of propofol, caused less pain upon injection, and increased speed of triglyceride elimination. [2526] This agent has been available outside of the United States since 1999. It is not available in the US because of the lack of EDTA in the solvent.…”

Section: Emulsion Modificationsmentioning

confidence: 99%

Novel propofol derivatives and implications for anesthesia practice

Feng

Kaye

et al. 2017

J Anaesthesiol Clin Pharmacol

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Propofol (2,6-diisopropylphenol) is the most commonly used intravenous agent for induction of anesthesia. It is also used for maintenance of anesthesia and sedation in both Intensive Care Units and outpatient procedural settings. Its success in the clinical setting has been a result of its rapid onset, short duration of action, and minimal side effects despite disadvantages associated with its oil emulsion formulation. Early attempts to alter the standard emulsion or to develop new formulations with cyclodextrins and micelles to resolve issues with pain upon injection, the need for antimicrobial agents, and possible hyperlipidemia have mostly failed. With these challenges in the foreground, attention has now shifted to the use of more prodrugs and exogenous alternatives, the success of which is yet to be determined. These new agents must offer significant clinical advantages over the well-entrenched, generic propofol oil emulsion to justify higher costs and to be well received in the increasingly cost-conscious healthcare marketplace.

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Injektionsschmerz durch Propofol-MCT/LCT bei Kindern

Cited by 27 publications

References 1 publication

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

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

Injection pain of propofol in children: A comparison of two formulations without added lidocaine

Novel propofol derivatives and implications for anesthesia practice

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