Subhypnotic Doses of Thiopentone and Propofol Cause Analgesia to Experimentally Induced Acute Pain

Anker‐Møller, E.; Spangsberg, N; Arendt‐Nielsen, Lars; Schultz, P.; Kristensen, Michael Seltz; Bjerring, Peter

doi:10.1093/bja/66.2.185

Cited by 89 publications

(29 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While few studies observed analgesic effect and reduction of postoperative opioid requirement after propofol anesthesia when compared to volatile anesthetic anesthesia [197], others showed no effects on analgesia [198] or even enhanced pain sensitivity [199]. Patients who had general anesthesia with isoflurane or sevoflurane were found to report more postoperative pain and require more morphine than those anesthetized with propofol [200, 201].…”

Section: ) Propofol and Pain Modulationmentioning

confidence: 99%

“…Patients who had general anesthesia with isoflurane or sevoflurane were found to report more postoperative pain and require more morphine than those anesthetized with propofol [200, 201]. Also, sub-hypnotic doses of propofol were found to increase the pain threshold in human pain models to laser stimulation and decreased the amplitude of pain-evoked potential significantly [197]. In contrast, prospective blind randomized trial reported no difference or even less analgesia among patients anesthetized with propofol compared with volatile anesthetics [202, 203].…”

Section: ) Propofol and Pain Modulationmentioning

confidence: 99%

See 1 more Smart Citation

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

2015

View full text Add to dashboard Cite

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.

show abstract

Section: ) Propofol and Pain Modulationmentioning

confidence: 99%

Section: ) Propofol and Pain Modulationmentioning

confidence: 99%

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

2015

View full text Add to dashboard Cite

show abstract

“…Quite naturally, investigators studied its effects on pain perception and, just like early reports on barbiturates, noted hyperalgesic action associated with propofol both in preclinical, experimental as well as clinical studies. 12,14,16,42,43 However, despite these reports, the use of propofol as analgesic drug remained a topic of discussion. The notion that propofol was used to treat inadequate analgesia in a scientific report in 1999 44 prompted the following commentary: “Too often, in our opinion, patients receive propofol, at a time when an analgesic would serve them better.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sedation on Pain Perception

Frölich

Zhang

Ness³

2013

Anesthesiology

View full text Add to dashboard Cite

Background Sedation or anesthesia is used to facilitate many cases of an estimated 45 million diagnostic and therapeutic medical procedures in the United States. Preclinical studies have called attention to the possibility that sedative hypnotic drugs can increase pain perception but it remains unclear whether this observation holds true in humans and whether pain-modulating effects are agent specific or characteristic of intravenous sedation in general. Methods To study this important clinical question, we recruited 86 healthy volunteers and randomly assigned them to receive one of three sedative drugs; midazolam, propofol or dexmedetomidine. We asked participants to rate their pain in response to four experimental pain tasks (cold, heat, ischemic or electrical pain) before and during moderate sedation. Results Midazolam increased cold, heat and electrical pain perception significantly (10-point pain rating scale change = 0.82 ± 0.29, mean ± SEM). Propofol reduced ischemic pain and dexmedetomidine reduced both cold and ischemic pain significantly (−1.58 ± 0.28, mean ± SEM). We observed a gender-by-race interaction for dexmedetomidine. In addition to these drug specific effects, we observed gender effects on pain perception; females rated identical experimental pain stimuli higher than males. We also noted racedrug interaction effects for dexmedetomidine with higher doses of drug needed to sedate Caucasians when compared to African-Americans. Conclusions The results of our study call attention to the fact that intravenous sedatives may increase pain perception. The effect of sedation on pain perception is agent and pain type specific. Knowledge of these effects provides a rational basis for analgesia and sedation to facilitate medical procedures.

show abstract

“… ++ sehr ausgeprägt, + vorhanden, o kein Effekt. a Sanders et al [41] konnten einen antinozizeptiven Effekt an Ratten feststellen. b Anker-Møller et al [4] konnten einen analgetischen Effekt bei Probanden aufzeigen. …”

Section: Figures and Tablesunclassified

Was wissen wir über Narkosemechanismen?

Hucklenbruch

2009

Anaesthesist

View full text Add to dashboard Cite

Despite the increase of molecular knowledge in anesthesia research over the past decades there is still ongoing discussion about the mechanisms of anesthesia. This article focuses on presenting anesthetic sensitive ligand and voltage gated ion channels. The impact on anesthetic modulated ion channels is summarized for clinically commonly used anesthetics isoflurane, propofol and ketamine. Furthermore, the anesthetic features hypnosis, unresponsiveness to surgical incision and amnesia and their putative relevant anatomical sites in the central nervous system are briefly introduced. KeywordsMechanisms of anesthesia; Ion channels; Isoflurane; Propofol; Ketamine Molekulare MechanismenNarkose kann durch eine breite Vielfalt unterschiedlicher Stoffklassen hervorgerufen werden. Narkosemittel modulieren auf zellulärer Ebene selektiv Ionenkanäle und haben teilweise mehrere molekulare Angriffspunkte in unterschiedlichen anatomischen Strukturen [16,24,28] Klinische EigenschaftenDie klinischen Eigenschaften dieser Narkosemittel sind in Tab. 4 zusammengefasst. Exkurs in die PraxisIm Vergleich zum intraoperativen Schmerzniveau ist der Schmerzreiz gegen Ende einer Operation (Hautnaht, Verbände etc.) zumeist deutlich reduziert. Dies ermöglicht eine

show abstract

Subhypnotic Doses of Thiopentone and Propofol Cause Analgesia to Experimentally Induced Acute Pain

Cited by 89 publications

References 0 publications

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

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

Effect of Sedation on Pain Perception

Was wissen wir über Narkosemechanismen?

Contact Info

Product

Resources

About