Inotropic Effects of Propofol, Thiopental, Midazolam, Etomidate, and Ketamine on Isolated Human Atrial Muscle

Gelissen, H.P.M.M.; Epema, Anne H.; Henning, Robert H.; Krijnen, H. John; Hennis, P. J.; Hertog, Adriaan den

doi:10.1097/00000542-199602000-00019

Cited by 217 publications

(95 citation statements)

References 38 publications

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“…The discrepancy between the change in heart rate and cardiac autonomic activity in our study showed that propofol had direct effects on the heart. The inotropic effect of propofol was shown to depend on the concentration of the drug in human cardiac muscle experiments [30]. The absence of any changes in the heart rate or decrease of the SI after propofol induction in either our study or other studies [5] supported these negative chronotropic and inotropic effects.…”

Section: Discussionsupporting

confidence: 74%

“…Previous reports and our own results suggest that at very high doses [13] midazolam induces the dominance of parasympathetic activity, but that at lower doses it induces dominance of sympathetic activity [11,12,20], whether used alone or in combination. Midazolam also has a negative inotropic effect on the heart [30], which can explain the decrease of the SI after bolus infusion in our study, depending on the concentration, but midazolam maintained SI from T3 to T5.…”

Section: Discussionmentioning

confidence: 48%

See 1 more Smart Citation

Haemodynamic changes and heart rate variability during midazolam‐propofol co‐induction*

Win¹,

Kohase

Yoshikawa

et al. 2007

Anaesthesia

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SummaryIn a prospective, blind, randomised study, we examined the effects of midazolam-propofol co-induction on haemodynamic (blood pressure, heart rate and stroke volume) and heart rate variability. The latter was measured by spectral analysis using the maximum-entropy method to calculate the following: the low frequency component (LF), which reflects both the cardiac sympathetic and parasympathetic activity, the high frequency component (HF) and entropy, which reflects the cardiac parasympathetic activity, the total power (TP), calculated by the addition of LF and HF, and the LF ⁄ HF ratio, which reflects the balance between the cardiac sympathetic and parasympathetic nervous activity. Forty patients were randomly allocated to the propofol group and the midazolam-propofol group, and the parameters described above were calculated at baseline (T1), post induction (T2), after tracheal intubation (T3), and 3 min (T4) and 5 min after intubation (T5). Propofol was administered at 2.5 mg.kg )1 in the propofol group and midazolam at 0.1 mg.kg )1 followed by propofol at 1.5 mg.kg )1 in the midazolam-propofol group for anaesthesia induction. Then, propofol was administered at 4-6 mg.kg )1 propofol for maintenance in both groups. The midazolam-propofol group showed compensated haemodynamic changes, which were related to significant increases in the LF ⁄ HF ratio at T2, T4 and T5 (p = 0.011, 0.038 and 0.034). These results suggest that the midazolam-propofol combination yielded compensated modulatory effects on the cardiovascular system, including preserved baroreflex activity. Combined induction (co-induction) refers to the administration of a small dose of a sedative or anaesthetic agent prior to the induction of anaesthesia, with the aim of achieving more specific 'target' responses, while minimising side-effects. Co-induction with midazolam and propofol has been mainly studied in relation to the drugs' synergistic hypnotic actions of the drugs and haemodynamic changes [1-4] during induction of anaesthesia, but there are no reports to date of the haemodynamic changes occurring during tracheal intubation. Propofol decreases the arterial blood pressure, associated with a decrease of the cardiac output ⁄ index, stroke volume index, and systemic vascular resistance [5]; on the other hand, the cardiac output ⁄ index and ventricular filling pressures are maintained after the administration of midazolam [5,6]. The autonomic nervous system exerts important neural control on the heart for maintaining cardiovascular stability. Previous studies have evaluated the effects of propofol [7][8][9][10] and midazolam [11][12][13] on the cardiac autonomic nervous system by means of heart rate variability (HRV) analysis, a non-invasive technique [14][15][16]. There are, however, no reports on simultaneous analysis of the changes of the stroke volume and HRV during midazolam-propofol co-induction. The aim of this study was to investigate the haemodynamic changes and heart rate variability during midazolam co-induction with propofol as comp...

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 48%

Haemodynamic changes and heart rate variability during midazolam‐propofol co‐induction*

Win¹,

Kohase

Yoshikawa

et al. 2007

Anaesthesia

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“…were from the nonfailing hearts of patients undergoing coronary artery bypass surgery, propofol produced a significant decrease in developed tension in all muscles at concentrations exceeding 56 μM (37). Furthermore, another study has shown that the IC 50 value for propofol in human atrial tissue contractility is 235 -246 μM (15). Clinically, the relevant blood concentrations during intravenous infusion of propofol are less than 23 μM (38, 39), and free fractions of propofol in plasma, which are active, appear to be much lower because of its high protein-binding property, which exceeds 95% (40).…”

Section: Shortening Effect Of Propofol On Action Potentialsmentioning

confidence: 99%

Pharmacological Significance of the Blocking Action of the Intravenous General Anesthetic Propofol on the Slow Component of Cardiac Delayed Rectifier K+ Current

et al. 2009

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Abstract. Propofol is a widely used intravenous general anesthetic. The negative inotropic effect of propofol has been best explained by inhibition of the L-type Ca 2+ current (I Ca ). Using guinea-pig cardiac preparations, however, we found that the propofol concentration producing a 50% decrease in force of contraction was more than 10 times higher than that producing a 50% inhibition of I Ca , implying that a compensatory mechanism may be present to counteract the negative inotropic effect associated with the I Ca inhibition. Consistent with I Ca inhibition, propofol produced a shortening of action potential duration (APD) in single cardiomyocytes. Yet, the concentrations necessary to shorten APD were greater than that for 50% inhibition of I Ca . This was associated with the potent and effective inhibition of the slowly activating component of the delayed rectifier K + current (I Ks ). Thus, the I Ks blockade with propofol may counterbalance the APD shortening evoked by its I Ca inhibition. Taken together, the negative inotropic effect of propofol is detectable only at supratherapeutic concentrations. At clinically relevant concentrations, the action potential prolongation mechanism due to I Ks inhibition appears to alleviate the reduction in transsarcolemmal Ca 2+ influx through L-type Ca 2+ channels, which may help to counteract the net negative inotropism of propofol.

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Section: Introductionmentioning

confidence: 99%

“…Today, the drugs most frequently used for sedation in transesophageal echocardiography are the benzodiazepines (diazepam and midazolam), and for analgesia, the opioids (meperidine and fentanyl) and propofol. Adequate levels of sedation based on the use of low doses of sedatives are preferred because of the higher tolerability to the procedure and minimum incidence of side effects [3][4][5][6] .Because of the importance of standardizing the amount of sedatives and analgesic drugs necessary for an adequate sedation in groups of patients with specific characteristics 7 , we studied the correlation between the mean doses of midazolam and meperidine solution required to achieve a level of sedation between 3 and 4 of the Ramsay scale (Table 1) in individuals from different age ranges, in those with different body surface areas, and in patients diagnosed with or without left ventricular systolic dysfunction. …”

mentioning

confidence: 99%

Dose efetiva de sedação em ecocardiograma transesofágico: relação com idade, área de superfície e função do ventrículo esquerdo

José¹,

Silva²,

Ferreira³

et al. 2009

Arq. Bras. Cardiol.

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Background: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case.Objective: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction.Methods: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml), meperidine 1 mg (1 ml) and distilled water (7.5 ml). Four age groups were analyzed: G1: ≤ 24 years; G2: 25 to 44 years; G3: 45 to 64 years; and G4: ≥ 65 years. Body surface area was calculated using the formula {[(height x 100) 0.725 ] x (weight 0.425 ) x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: < 55%; and GB: ≥ 55%. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area.Results: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01). The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01). The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null). Conclusion Effective Dose of Sedation in Transesophageal EchocardiographyRelation to Age, Body Surface Area and Left Ventricle FunctionGuilherme Moreira José, Carlos Eduardo Suaide Silva, Luiz Darcy Cortez Ferreira, Yara Prosdossini Soares de Novaes, Claudia Gianini Monaco, Manuel Adán Gil, Renata Rejane Linhares, Marcelo Sgrott Rodrigues, Antônio S. S. de Moraes, Juarez Ortiz. OMNI-CCNI Medicina Diagnóstica de São Paulo, São Paulo, SP -Brazil IntroductionTransesophageal echocardiography is performed via esophageal intubation, using a probe with one or more transducers at its tip. An approximately 5-hour fast is required for all patients undergoing the procedure whether using anesthesia or sedation 1 .The use of a local anesthetic agent (lidocaine hydrochloride 10% spray) and peripheral venipuncture are also recommended; usually, sedatives and analgesic agents are preferably administered intravenously 1 . The tolerance to the procedure, which is almost always uncomfortable, is increased with the use of sedation and analgesia by blocking the response to stress (quite useful in patients with heart diseases), and by reducing the laryngeal activity (very useful in patients with asthma, chronic bronchitis and heart diseases), discomfort and pain. It is also very useful for excessively anxious patients and those with neurological diseases or psychiatric disorders who are unable to cooperate. It can also be performed as per patient . Today, the drugs most frequently used for sedation in transesophageal echocardiography are the benzodiazepines (diazepam and midazolam), and for analgesia, the opioids (meperidine and fentanyl) and propofo...

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Inotropic Effects of Propofol, Thiopental, Midazolam, Etomidate, and Ketamine on Isolated Human Atrial Muscle

Cited by 217 publications

References 38 publications

Haemodynamic changes and heart rate variability during midazolam‐propofol co‐induction*

Haemodynamic changes and heart rate variability during midazolam‐propofol co‐induction*

Pharmacological Significance of the Blocking Action of the Intravenous General Anesthetic Propofol on the Slow Component of Cardiac Delayed Rectifier K+ Current

Dose efetiva de sedação em ecocardiograma transesofágico: relação com idade, área de superfície e função do ventrículo esquerdo

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