The haemodynamic effects of propofol in combination with ephedrine

Abstract

SummaryForty ASA 1 patients presenting for minor gynaecological surgery were randomly allocated into four study groups to compare the haemodynamic effects of adding diyerent doses of ephedrine to an induction dose of propofol. Heart rate, oxygen saturation and non-invasive arterial blood pressure were monitored before and for Smin after induction. In those patients who received propofol alone, there was a significant decrease in both systolic (p < 0.001) and diastolic (p = 0.003) blood pressure. The addition of ephedrine 15 mg or 20 mg to 1 % propofol20 ml was very effective in maintaining blood pressure at pre-induction values. There was a statistically significant increase from baseline in systolic @ = 0.004) and diastolic (j = 0.031) pressures, but this only occurred at 1 min postinduction. The addition of ephedrine 10 mg was insuficient to prevent hypotension. There was no signijcant effect on either heart rate or oxygen saturation in any group. We conclude that ephedrine may be safely employed to reduce the degree of hypotension during induction with propofol in this patient group. Key wordsAnaesthetics, intraveneous; propofol. Sympathetic nervous systems; pharmacology, ephedrine.Propofol has gained widespread popularity as an induction agent because of the ease and reliability of its use together with its short duration of action and minimal hangover effect. It can, however, cause hypotension and bradycardia [I, Ephedrine has been used for many years to counteract similar problems in spinal and epidural anaesthesia [lo]. In addition to its a vasoconstrictor and fl cardiac stimulant effects, ephedrine also has the advantage of being shortlived, so giving it a similar action profile to propofol. We assessed the haemodynamic effects of adding various doses of ephedrine to propofol to obtund this response and to determine the optimal dose. As propofol is known to have a hypotensive action even in young, fit individuals, we decided to assess the safety and efficacy of this combination in ASAl patients. MethodsAfter obtaining approval from the local ethics committee, and with informed consent, we studied 40 unpremedicated ASAl patients presenting for minor gynaecological surgery. Following insertion of an intravenous cannula, monitoring of arterial blood pressure (non-invasive), electrocardiograph (ECG), and peripheral oxygen saturation (Spo?) was instituted for up to 5 rnin before induction, or until the measured parameters were stable. Anaesthesia was induced with one of the study treatments shown in Table 1, allocated in random order. A dose sufficient to obtund the eyelash reflex was given over 40s and the amount recorded. Patients then breathed a mixture of 60% nitrous oxide in oxygen during the study period and before the start of surgery. The ECG and Spa? were monitored continuously and arterial blood pressures recorded at 1 min intervals for up to 5 min after injection of the induction agent. Two anaesthetists were present during the whole of the study period, and the administering anaesthetist was una...

Effects of Propofol and Sevoflurane on Hemodynamics during Laryngeal Mask Airway Insertion –A Prospective Comparative Study

“…There was an increase in the heart rate at twenty minutes after induction. These results are in consistent with other studies in the literature 15,16 . However, there are some contradictory reports as well 17,18 .…”

Propofol Compared to Etomidate Inductions and Attenuating Propofol Induced Hypotension

“…The control group had a hypotension incidence of 67.5%, while the ephedrine group that received 0.2 mg/kg showed 22.5% hypotension. Similar attenuation or complete prevention of hypotension were reported in eight other studies using ephedrine 0.1 mg/kg or 10-20 mg boluses [8][9][10]12,15,16]. El Tahan [6] also found that ephedrine improves ventricular contractility without causing relevant changes of left ventricular afterload.…”

“…Dosing of ephedrine varied from single bolus dosing to weight based dosing ranging from 10-15 mg to 0.07-0.2 mg/kg [6,[8][9][10][11][12][13][14][15][16]. Most trials had a timeframe for recording vitals ranging from 4-6 minutes with all trials showing similar results in this time frame.…”

Efeito da administração de solução salina na estabilidade da circulação durante a indução de anestesia geral com propofol em estudo randômico e controlado de procedimentos ginecológicos

“…Our data was consistent with Michelsen et al 1 study where induction of anesthesia with propofol was followed by a decrease in heart rate. In contrast, Gamlin et al 2 found no effect of propofol on heart rate, whereas Turner et al 4 found increase in heart rate. These confl icting results can be explained by the different methods of anesthesia maintenance performed in these studies.…”

“…Anesthesiologists have attempted different methods to prevent the hypotensive effect of propofol during GA induction, including administration of fl uids and prophylactic use of medications with vasoconstriction activity [1][2][3][4] .…”