Propofol Versus Midazolam/Ketamine for Procedural Sedation in Pediatric Oncology

Gottschling, Sven; Meyer, Sascha; Krenn, Thomas; Reinhard, Harald; Lothschuetz, Daniela; Nunold, Holger; Graf, Norbert

doi:10.1097/01.mph.0000179238.37647.91

Cited by 57 publications

(80 citation statements)

References 35 publications

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“…that propofol administration at standard doses might have a signiˆcant eŠect on serum TRG levels. 3,17) In the present study, we observed a signiˆcant increase in TRG and VLDL levels at P 4th in the Gp-P. This was almost certainly because of the low dose of intraoperative propofol infusion (1.5 mg kg -1 h -1 ) which are su‹cient for the maintenance of general anesthesia in our patients with stable hemodynamic status.…”

Section: Discussionsupporting

confidence: 45%

“…There are some published reports showing signiˆcant increases in serum triglyceride (TRG) concentrations secondary to long-term propofol infusion while using a formulation containing long-chain triglycerides (LCT) from soybean oil in the postoperative intensive care unit (ICU). [1][2][3][4] However, some research did not support thisˆnding of hypertriglyceridemia. 5) In recent years, propofol infusion has increasingly been recognized as the anesthetic agent of choice in cardiac surgery for patients with normal ventricular function.…”

mentioning

confidence: 99%

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Effects of Propofol and Midazolam on Lipids, Glucose, and Plasma Osmolality during and in the Early Postoperative Period Following Coronary Artery Bypass Graft Surgery: A Randomized Trial

et al. 2007

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It is not clear how levels of serum lipids and glucose and plasma osmolality change during propofol infusion in the pre-and postoperative period of coronary artery bypass graft surgery (CABG). This prospective, randomized, controlled trial evaluated changes in these parameters during propofol or midazolam infusion during and in the early postoperative period following surgery. Twenty patients undergoing CABG were randomized preoperatively into two groups: 10 patients received propofol (induction 1.5 mg/kg, maintenance 1.5 mg kg -1 h -1 ) and 10 patients received midazolam (induction 0.5 mg/kg, maintenance 0.1 mg kg -1 h -1 ). Both groups also received fentanyl (induction 20 mg/ kg, maintenance 10 mg kg -1 ). Serum lipids, glucose, and plasma osmolality were measured preinduction, precardiopulmonary bypass, at the end of cardiopulmonary bypass, at the end of surgery, and 4 and 24 h postoperatively. In the propofol group, we observed a signiˆcant increase in triglycerides and very low-density lipoprotein levels 4 h postoperatively. In the midazolam group, we observed a signiˆcant decrease in low-density lipoprotein, cholesterol at the end of cardiopulmonary bypass, end of surgery, and 4 and 24 h postoperatively and signiˆcant increase in osmolality at the end of cardiovascular bypass. Changes in glucose levels did not diŠer signiˆcantly diŠerent between the two groups. In patients with normal serum lipids, glucose, and plasma osmolality undergoing CABG, propofol infusion for maintenance anesthesia is not associated with dangerous changes in serum lipids, glucose, and plasma osmolality compared with midazolam. A propofol infusion technique for maintenance of anesthesia for cardiac surgery where serum lipids and glucose may be of concern could be recommended as an alternative to midazolam.

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Section: Discussionsupporting

confidence: 45%

mentioning

confidence: 99%

Effects of Propofol and Midazolam on Lipids, Glucose, and Plasma Osmolality during and in the Early Postoperative Period Following Coronary Artery Bypass Graft Surgery: A Randomized Trial

et al. 2007

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“…Patients wake up very soon after administration of the medicine is discontinued. It is broadly used for sedation in the pediatric intensive care unit (Gottschling et al, 2005;Leino et al, 2009;Kearns et al, 2011;Rebel et al, 2011) and it is also used in adults for anesthesia. It is also reportedly used in the removal of tracheal foreign bodies among children and many types of superficial operations.…”

Section: Discussionmentioning

confidence: 99%

Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children

et al. 2015

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ABSTRACT. This study explored the sedative and analgesic effects of fentanyl combined with propofol via an intrathecal chemotherapy injection for acute leukemia (acute lymphocytic leukemia or acute myelocytic leukemia) among children, to relieve pain and difficulty during intrathecal injection, improve treatment compliance, increase the success rate of single puncture, and reduce procedure failure, with the aim of developing a painless procedure for children with acute leukemia. Fifty person-times received fentanyl combined with propofol via an intrathecal chemotherapy injection among the hospitalized children with leukemia. The patients' cooperation with the procedure, response to the medication, dosages of fentanyl and propofol, reaction to the procedures, wake-up time, and changes in oxygen saturation (SpO 2 ), heart rate (HR), respiration, and blood pressure (BP) before, during, and after the procedures were observed. The doctors who performed the procedures assessed the quality of sedation and analgesia. In the treatment group, the patients were quiet during the lumbar puncture and intrathecal injection, showing good sedation and analgesia. HR and respiration decreased slightly. There were no changes in SpO 2 and BP. No obvious respiratory depression occurred with proper dosages. Only a few patients showed stertorous respiration, which stopped soon after the procedures. In the control group, the patients were agitated, crying, and not cooperative before and during the procedures, which made the procedures very difficult. During intrathecal injection, pain obviously reduced and the success rate of single lumbar puncture increased. It is safe and effective to apply fentanyl combined with propofol for sedation and analgesia.

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“…Propofol is a hypnotic and amnestic agent, used for both induction and maintenance of general anesthesia TIVA, and short procedures [76,77]. Dexmedetomidine is a α2 -adrenoceptor agonist, which induces sedative state similar to physiological sleep [78,79].…”

Section: Intravenous Anestheticsmentioning

confidence: 99%

“…Ketamine acts on NMDA receptors, and differs from other anesthetics because of its strong analgesic effect with minimal respiratory depression [71,72]. Etomidate is a GABA agonist used for induction of general anesthesia and sedation, and presents peculiar characteristics, such as adrenocortical suppression [73][74][75].Propofol is a hypnotic and amnestic agent, used for both induction and maintenance of general anesthesia TIVA, and short procedures [76,77]. Dexmedetomidine is a α2 -adrenoceptor agonist, which induces sedative state similar to physiological sleep [78,79].…”

mentioning

confidence: 99%

Anesthesia, cytokines and cancer recurrence

Kitamura¹,

Biaso²,

Ingelmo

et al. 2015

Glob Anesth Perioper Med

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Cytokines are essential mediators for the regulation of both innate and acquired immunity and hematopoiesis. They modulate immune cell signaling, activation, adhesion and functioning. They regulate the individual response to several insults such as infection, inflammation, trauma, and pain. Moreover, the balance between pro-inflammatory and anti-inflammatory cytokines is critical for the evolution of surgical complications and tumor progression.Several drugs, including anesthetic agents, influence cytokines secretion. Opioids, inhalational agents, intravenous and local anesthetics have shown different effects on immune system and cytokine expression. Therefore, anesthesia may play an important role in postoperative recovery and outcome of cancer patients.The aim of the present article is to review the main role of some important cytokines and the effect of anesthesia techniques and drugs on their secretion. Furthermore, current clinical evidence regarding the effects of anesthesia on cancer recurrence will be discussed. Cytokines and immune systemCytokines are proteins expressed in both innate and acquired immune system and are often named according to the secreting cells (i.e., lymphocytes, interleukins, etc.). They are essential mediators of the natural (non-specific, innate) immunity, which is the initial step of the inflammatory response. They also play a pivotal role during the specific immunity, which occurs after exposure to antigens, as they regulate lymphocyte and leukocyte activation, growth and differentiation, and the immune-mediated inflammation [1].The cytokines have different structures, but also common aspects, which are summarized in Table 1.The aim of the present article is to review the main role of some important cytokines and the effect of anesthesia techniques and drugs on their secretion. Cytokines receptorsThe cytokines receptors are formed by one or more transmembrane proteins: the extracellular portion binds the cytokine, whereas the cytoplasmic part starts the signal cascade. Based on the extracellular portion, they are divided in five categories. 1) Type I receptors, which have four α-helical stands and contain four cysteine residues and the amino acid motif tryptophanserine-X-tryptophan-serine (WSXWS).2) Type II receptors, structurally similar to Type I receptors, but without the sequence WSXWS. Cytokines functionProvided that the same cytokine may be produced during both innate and acquired immunity response, cytokines can be classified according to their functions: 1)Cytokines regulating the innate immunity and secreted by stimulated macrophages; 2)Cytokines regulating the acquired immunity and secreted by lymphocytes; 3)Cytokines stimulating the hematopoiesiss and secreted by bone marrow, leucocytes and other cells. Common aspects of CytokineTheir secretion is brief and limited in time Cytokine expressed during the innate immunity response Tumor necrosis factor (TNF-α, TNF-β)The TNF is responsible for the initial phase of acute inflammatory response, especially against ...

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Propofol Versus Midazolam/Ketamine for Procedural Sedation in Pediatric Oncology

Cited by 57 publications

References 35 publications

Effects of Propofol and Midazolam on Lipids, Glucose, and Plasma Osmolality during and in the Early Postoperative Period Following Coronary Artery Bypass Graft Surgery: A Randomized Trial

Effects of Propofol and Midazolam on Lipids, Glucose, and Plasma Osmolality during and in the Early Postoperative Period Following Coronary Artery Bypass Graft Surgery: A Randomized Trial

Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children

Anesthesia, cytokines and cancer recurrence

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