Some Ventilatory Effects of Propofol as Sole Anaesthetic Agent

Goodman, Neville W.; Black, Andy; Carter, J.A.

doi:10.1093/bja/59.12.1497

Cited by 154 publications

(85 citation statements)

References 15 publications

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“…Although opioids are frequently used with propofol to improve LMA insertion conditions in clinical practice, 17 co-administration of both agents may increase the incidence and duration of apnea due to their synergistic effect on respiratory depression. 18,19 The incidence of apnea may reach 70% following the use of propofol 2.5 mgÁkg -1 alone and 83.3% following the use of propofol 2.5 mgÁkg -1 plus fentanyl 1 lgÁkg -1 . 20 Apnea is probably of little consequence when the airway is protected with the LMA.…”

mentioning

confidence: 99%

Topical lidocaine improves conditions for laryngeal mask airway insertion

Changchien¹,

Chen²,

Hsieh³

et al. 2010

Can J Anesth/J Can Anesth

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Purpose We hypothesized that optimal laryngeal mask airway (LMA TM ) insertion conditions might be achieved with topical lidocaine and a smaller dose of propofol. In this study, insertion conditions after topical lidocaine 40 mg followed by propofol 2 mgÁkg -1 were compared with propofol 2 mgÁkg -1 or propofol 3 mgÁkg -1 alone. Methods Ninety patients were recruited for this randomized prospective double-blind study. One group received four sprays of topical lidocaine (40 mg) over the posterior pharyngeal wall followed by propofol 2 mgÁkg -1 (Group 2PL; n = 30). The other two groups received four sprays of 0.9% normal saline followed by propofol 2 mgÁkg -1 (Group 2P; n = 30) or by propofol 3 mgÁkg -1(Group 3P; n = 30). The frequency of optimal insertion conditions (successful insertion at the first attempt without adverse responses) and side effects were recorded. Results The frequency of optimal insertion conditions was greater in Group 2PL (20/30, 67%) and Group 3P (22/ 30, 73%) than in Group 2P (11/20, 37%) (P = 0.009). In Group 3P, the mean blood pressure was lower than in the other groups prior to LMA-Classic TM insertion (P = 0.003) but was similar after insertion. The incidence of apnea was greater in Group 3P patients (17/30, 57%) than in Group 2P (2/30, 7%) or Group 2PL patients (1/30, 3%) (P \ 0.001). Conclusion Topical lidocaine 40 mg followed by propofol 2 mgÁkg -1 can provide optimal insertion conditions of the LMA-Classic comparable to those of propofol 3 mgÁkg -1 , with fewer hemodynamic changes and a lower incidence of apnea. RésuméObjectif Nous avons e´mis l'hypothe`se que des conditions optimales d'insertion du masque larynge( LMA TM ) pourraient eˆtre cre´e´es graˆce a`l'utilisation de lidocaı¨ne topique et une dose moindre de propofol. Dans cette e´tude, nous avons compare´les conditions d'insertion apre`s 40 mg de lidocaı¨ne topique puis 2 mgÁkg -1 de propofol, avec 2 mgÁkg -1 de propofol ou 3 mgÁkg -1 de propofol sans lidocaı¨ne topique. Méthode Quatre-vingt-dix patients ont e´te´recrute´s dans cette e´tude prospective randomise´e à double insu. Un groupe a reçu quatre pulve´risations de lidocaı¨ne topique (40 mg) sur la paroi pharynge´e poste´rieure, puis 2 mgÁkg -1 de propofol (groupe 2PL; n = 30). Les deux autres groupes ont reçu quatre pulve´risations de se´rum physiologique a`0,9 %, puis 2 mgÁkg -1 de propofol (groupe 2P; n = 30) ou 3 mgÁkg -1 de propofol (groupe 3P; n = 30). La fre´quence de conditions d'insertion optimales (insertion re´ussie a`la premie`re tentative sans re´action ne´gative) et les effets secondaires ont e´te´enregistre´s. Résultats La fre´quence de conditions d'insertion optimales e´tait plus e´leve´e dans le groupe 2PL (20/30, 67 %) et le groupe 3P (22/30, 73 %) que dans le groupe 2P (11/30, 37 %) (P = 0,009). Dans le groupe 3P, la tension

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confidence: 99%

Topical lidocaine improves conditions for laryngeal mask airway insertion

Changchien¹,

Chen²,

Hsieh³

et al. 2010

Can J Anesth/J Can Anesth

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“…This combination aims to capitalise on the primarily hypnotic and analgesic properties of each drug, respectively. Propofol, at the recommended induction dose (2.0±2.5 mg.kg 21 ), can cause cardiovascular and respiratory depression [5,6]. The extent of hypotension, degree of bradycardia and the duration of apnoea are dose related but can be unpredictable even in fit young patients.…”

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confidence: 99%

Effect of midazolam pretreatment on induction dose requirements of propofol in combination with fentanyl in younger and older adults

Cressey¹,

Claydon²,

Bhaskaran

et al. 2001

Anaesthesia

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SummaryIn a double-blind, randomised trial, we compared the effects of pretreatment with midazolam at two different doses (0.025 and 0.05 mg.kg 21 ), with placebo, on the induction dose requirements of propofol in two different age groups. We enrolled 120 patients: 60 younger patients (aged 18± 35 years) and 60 older patients (aged over 60 years). All patients received 0.75 m g.kg 21 of fentanyl, plus a blinded pretreatment with either saline or one of two doses of midazolam. Induction continued with a fixed rate infusion of propofol. Propofol dose requirement was recorded, as were cardiovascular parameters and the occurrence of significant apnoea (. 60 s). Midazolam pretreatment was associated with a significant reduction in propofol dose requirement in both younger and older patients. The reduction in older patients was significantly greater than the equivalent response in younger groups. There was no demonstrable benefit in terms of improved cardiovascular stability or reduction in the incidence of apnoea. Caution is advised in the use of midazolam as an agent for co-induction with propofol in the elderly.

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“…Goodman et al found that the HCVR decreases to 58 % of its baseline after a 2.5 mg kg -1 bolus of propofol followed by an infusion of 100 mcg kg -1 min -1 [64]. Blouin et al [67] demonstrated that the slope of the CO 2 response curve decreases by 56 % after a 2.5 mg kg -1 bolus of propofol.…”

Section: Propofolmentioning

confidence: 99%

“…Two separate groups demonstrated that the decreased minute ventilation observed after a propofol bolus is more attributable to decreased tidal volume than to decreased respiratory rate [59,60]. After induction of anesthesia with propofol (2.0-2.5 mg kg -1 ) alone, periods of apnea more than 30 s occur in at least 60 % of patients [61][62][63][64]. These episodes may extend to 60 s or more in 33-50 % of patients receiving the same dose of propofol after pretreatment with an opioid [59,65,66].…”

Section: Propofolmentioning

confidence: 99%

Sources of Inspiration: A Neurophysiologic Framework for Understanding Anesthetic Effects on Ventilatory Control

Czick

Waldman

Gross

2013

Curr Anesthesiol Rep

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Almost every medication that is presently available to provide sedation, analgesia, or general anesthesia significantly depresses one or more ventilatory control mechanisms. This places patients at risk of developing hypoventilation and hypoxemia during moderate or deep sedation as well as general anesthesia. As the neurophysiologic processes underlying normal ventilatory drive are discovered, new insights into the influence of anesthetics on ventilation have been recognized. More importantly, research into ways to circumvent these effects is underway. For example, drugs such as serotonin agonists and ampakines have been shown to counteract opioidinduced ventilatory depression without reversing the analgesic effect. On the other hand, efforts to identify agents that reverse the respiratory depression associated with propofol and the inhalation anesthetics have been less promising. Until reliable means for reversing drug-induced ventilatory depression are developed, prompt recognition of ventilatory insufficiency and initiation of resuscitative measures remain the keys to patient safety.

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Some Ventilatory Effects of Propofol as Sole Anaesthetic Agent

Cited by 154 publications

References 15 publications

Topical lidocaine improves conditions for laryngeal mask airway insertion

Topical lidocaine improves conditions for laryngeal mask airway insertion

Effect of midazolam pretreatment on induction dose requirements of propofol in combination with fentanyl in younger and older adults

Sources of Inspiration: A Neurophysiologic Framework for Understanding Anesthetic Effects on Ventilatory Control

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