Prophylaxis against the systemic hypotension induced by propofol during rapid-sequence intubation

El‐Beheiry, Hossam; Kim, Jarmila; Milne, Brian; Seegobin, R.D.

doi:10.1007/bf03011034

Cited by 60 publications

(30 citation statements)

References 8 publications

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“…Interestingly, we were unable to demonstrate any medications that were associated with the development of PIHI, although we were again limited in our ability to do so because of the manner in which the data were reported in the studies. Even medications such as propofol, which is widely considered a prominent factor in hemodynamic instability when rapidly administered during EETI, 36,37 was not associated with PIHI, nor was etomidate associated with a reduced incidence of PIHI. The available data did not allow for analysis of dosing regimens or the impact of certain medication combinations.…”

Section: Discussionmentioning

confidence: 89%

Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Green

Hutton

Lorette

et al. 2014

CJEM

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Objective: Hemodynamic instability following emergent endotracheal intubation (EETI) is a potentially life-threatening adverse event. The objectives of this systematic literature review were to document the incidence of postintubation hemodynamic instability (PIHI), to determine the definitions for PIHI used in the available literature, and to examine factors associated with PIHI in adult patients who require EETI. Data Source: Articles published in Medline (1966-August 2012. Study Selection: This systematic review included adult, inhospital studies of EETIs. Studies with nonemergent or pediatric patient populations were excluded. Data Extraction: Two authors independently performed data abstraction. Disagreements were resolved by a third party. The methodological quality of included studies was assessed with the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies. Data Synthesis: We estimated the pooled prevalence of PIHI across studies using a random effects meta-analysis. Subgroups analyzed included study design, intubation setting, geographic location of the study, physician experience, medications used for sedation, neuromuscular blockade, and definition of PIHI. Eighteen studies were analyzed, with sample sizes from 84 to 2,833 patients. The incidence of PIHI ranged from 5 to 440 cases per 1,000 intubations, with a pooled estimate of 110 cases per 1,000 intubations (95% CI 65-167). Conclusions: PIHI was found to occur in 110 cases per 1,000 in-hospital, emergent intubations. However, heterogeneity among the included studies limits the reliability of this summary estimate. Further investigation is warranted. RÉ SUMÉObjectifs: L'instabilité hé modynamique consé cutive à une intubation endotraché ale trè s urgente (IETU) est un é vé nement indé sirable potentiellement mortel. L'examen mé thodique de la documentation avait pour objectifs d'é tablir la fré quence de l'instabilité hé modynamique aprè s intubation (IHAI), de dé terminer les dé finitions de l'IHAI utilisé es dans la documentation et d'examiner les facteurs associé s à l'IHAI chez les adultes. Source de donné es: Les articles publié s dans Medline (1966-aoû t 2012) ont constitué la source de donné es. Sé lection des é tudes: L'examen mé thodique portait sur les é tudes ayant pour objet les IETU effectué es chez les adultes, en milieu hospitalier; les é tudes portant sur les intubations non considé ré es comme trè s urgentes ou effectué es chez les enfants é taient é carté es. Extraction des donné es: Deux auteurs ont procé dé , chacun de leur cô té , aux ré sumé s analytiques des donné es. Les divergences de point de vue ont é té ré solues par une tierce partie. La qualité mé thodologique des é tudes retenues a é té é valué e selon l'é chelle de NewcastleOttawa, qui permet d'é valuer la qualité des é tudes de cohortes. Synthè se des donné es: L'estimation de la pré valence globale de l'IHAI, tiré e des é tudes retenues repose sur une mé taanalyse à effets alé atoires. Ont é té analysé s le type d'é tude, le service où ont é té eff...

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Section: Discussionmentioning

confidence: 89%

Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Green

Hutton

Lorette

et al. 2014

CJEM

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“…They found that prophylactic IV ephedrine 0.2 mg/kg significantly attenuated, but did not abolish the decrease in blood pressure during propofol and fentanyl induction. Similarly, El-Beheiry et al [15] found that ephedrine 0.07 mg/kg given just before propofol induction and subsequent tracheal intubation maintained blood pressure at preinduction values for up to 6 min after induction. The reason that a smaller dose of ephedrine is effective depends on the sympathoadrenal-stimulating effect of intubation.…”

Section: Discussionmentioning

confidence: 86%

A Comparative Study of Uses of Ephedrine by Different Doses on Prevention of Hemodynamic Changes Accompanied with Induction of General Anesthesia through Propofol and Fentanyl without Adverse Effects

Eldemrdash¹,

Al-Azhary²

2017

OJAnes

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“…31 Other authors have shown that fluid pre-loading, pre-induction ephedrine sulphate and reduced infusion rates minimize propofol-induced hypotension. [32][33][34][35][36] In the studies reviewed, propofol's hypotensive effects were significant and were not overcome by the hypertensive responses related to cardioversion and intubation. In most cases, propofol caused more marked hypotension than thiopental 19,20,26,27 or etomidate.…”

Section: Adverse Effectsmentioning

confidence: 99%

Is propofol an optimal agent for procedural sedation and rapid sequence intubation in the emergency department?

Wilbur

Zed

2001

CJEM

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Objective:We conducted a qualitative systematic review to evaluate the efficacy and safety of propofol for direct current cardioversion (DCC), rapid sequence intubation (RSI) and procedural sedation in adult emergency department (ED) patients. Data source: MEDLINE (1966 to September 2000, PubMed (to September 2000), EMBASE (1988 to September 2000, Database of Systematic Reviews (to September 2000), Best Evidence (1991 to September 2000) and Current Contents (1996 to September 2000) databases. Study selection: English-language, randomized, comparative evaluations of propofol for procedures routinely conducted in adults (>18 years) were included. Direct current cardioversion, RSI and procedural sedation were considered. Data extraction: Efficacy and safety endpoints were evaluated for all trials. For DCC and procedural sedation trials, efficacy measures included induction and recovery times, as well as the association for successful procedure. For the RSI trials, optimal intubating conditions were evaluated as the primary efficacy endpoint. Safety measures included hemodynamic changes, apnea rates and adverse effects. Data synthesis: In the setting of DCC, efficacy and safety outcomes were similar for propofol, thiopental, etomidate and methohexital. All of these agents provided markedly shorter induction and recovery times than midazolam. Patients who were pre-medicated with fentanyl exhibited prolonged recovery times and greater decreases in blood pressure. When used for RSI, propofol administration was associated with satisfactory intubating conditions that were comparable to those seen with thiopental and etomidate. Blood pressure reductions were seen in both DCC and RSI studies. Apneic episodes (>30 seconds) occurred in 23% of propofol recipients, 28% of thiopental recipients and 7% of etomidate and midazolam recipients. Apart from the DCC studies described, no procedural sedation studies met our predefined review eligibility criteria. Conclusion:The body of literature evaluating propofol for DCC and RSI in the ED is limited. There is evidence to support the use of propofol for DCC and RSI, but this evidence comes from stable patients in non-ED settings. Further ED-based randomized comparative trials should be conducted before propofol is adopted for widespread use in the ED. RÉSUMÉObjectif : Nous avons mené une revue qualitative méthodique afin d'évaluer l'efficacité et l'innocuité du propofol pour la cardioversion, l'intubation à séquence rapide (ISR) et la sédation

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Prophylaxis against the systemic hypotension induced by propofol during rapid-sequence intubation

Abstract: Rapid-sequence induction of anaesthesia is a challenging situation for the anaesthetist. The major considerations are rapid protection of the airway by a cuffed cndo-CAN J ANAESTH 1995 / 42:10 / pp 875-8

Cited by 60 publications

References 8 publications

Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

A Comparative Study of Uses of Ephedrine by Different Doses on Prevention of Hemodynamic Changes Accompanied with Induction of General Anesthesia through Propofol and Fentanyl without Adverse Effects

Is propofol an optimal agent for procedural sedation and rapid sequence intubation in the emergency department?

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