The cardioprotective effect of microemulsion propofol against ischemia and reperfusion injury in isolated rat heart / 대한마취과학회지

BACKGROUND: Lipid-emulsion propofol (LP) has cardioprotective effects against ischemia-reperfusion injury, but it has lipid-related side effects. Microemulsion propofol (MP) is a lipid-free propofol emulsified with 10% purified poloxamer 188 (PP188). PP188 is a nonionic surfactant and has cardioprotective effects. However, some reports have suggested that reduced cardioprotective effects were observed when the cardioprotective agents were used in combination even though each cardioprotective agent has cardioprotective effects. The aims of this study were to examine and compare the cardioprotective effects of MP and LP. METHODS: 50 isolated rat hearts were perfused with modified Kreb's solution. They were divided into 4 groups and underwent 30 minutes of ischemia and 60 minutes of reperfusion. Control group: ischemia-reperfusion was performed without treatment. LP, MP and PP groups: LP, MP and PP188 were infused during the pre-ischemic and reperfusion period, respectively. Hemodynamic parameters and coronary effluent flow rate (CEFR) were measured. Infarct size was determined using triphenyl-tetrazolium staining. RESULTS: In the MP group, systolic pressure was maintained near baseline, the systolic pressure was higher than that in the other groups and HR was lower than that in the other groups during reperfusion. Diastolic pressure was transiently increased in the PP group after treatment and at 5 minutes after reperfusion compared with that in the control group and in the the LP group. There were no differences in dP/dtmax and CEFR between groups. Infarct size in the LP, MP and PP groups was smaller than that in the control group, but there were no significant differences between these three groups. CONCLUSIONS: MP has cardioprotective effects similar to those of LP. MP can be used for cardiac anesthesia in cases with ischemia-reperfusion injury to avoid the lipid-related side effects of LP.

Suspected Anaphylactic Reaction Associated with Microemulsion Propofol during Anesthesia Induction

Although rare, intraoperative anaphylaxis can lead to significant morbidity and mortality. Aquafol(R) (Daewon Pharmaceutical Co. Ltd., Seoul, Korea), a microemulsion propofol, was developed to eliminate lipid solvent-related adverse events, and was used in clinical anesthesia since 2009 with little data about severe side effects such as anaphylaxis. A healthy 16-yr-old male patient who had past medical history with two previous operations of no complications developed cardiovascular shock with generalized erythema following administration of microemulsion propofol during anesthesia induction. Intravenous injection of epinephrine and steroid rescued him. He remained in a stable state without any problems postoperatively and was discharged. Clinicians should consider this rare but serious complication during induction of anesthesia with propofol.

Comparison among the effect of ondansetron, lidocaine and combination of ondansetron and lidocaine on microemulsion propofol injection pain

BACKGROUND: The pain caused by injection of propofol is known to be related to the concentration of aqueous free propofol. Microemulsion propofol can cause a serious pain because it has 7 times higher concentration of aqueous free propofol. We used ondansetron, lidocaine, ondansetron lidocaine as pretreatment to compare the effect for injection pain of microemulsion propofol. METHODS: 75 patients, ASA physical status I or II were enrolled. We randomly allocated into Group L (n = 25) received 2% lidocaine 40 mg, group O (n = 25) received ondansetron 4 mg and group M (n = 25) received ondansetron 4 mg plus 2% lidocaine 40 mg as pretreatment. After instituting standard monitoring, the venous drainage was occluded using a pneumatic tourniquet at 25 cm proximal to venous line. The patients were pretreated over a period of 15 seconds with one of the pretreatment drug. After releasing the tourniquet, microemulsion propofol was injected. We asked the patient about degree of injection pain until loss of consciousness, by using 0-100 point pain intensity numerical rating scale (PI-NRS). In the recovery room, we asked the patient whether they recall injection pain. RESULTS: There were significant differences in the group L and the group M compared with group O on PI-NRS (P < 0.05). The incidence of injection pain was significantly lower in group L and group M than group O. CONCLUSIONS: Pretreatment of lidocaine and lidocaine + ondansetron is more effective than ondansetron alone for reducing pain on injection of microemulsion propofol.

The effect of priming injection of different doses of remifentanil on injection pain of microemulsion propofol premixed with lidocaine / 대한마취과학회지

BACKGROUND: The injection pain of microemulsion propofol is frequent and difficult to prevent. This study examined the prevention of pain during microemulsion propofol injection by pretreatment with different doses of remifentanil or saline, and premixing of lidocaine. METHODS: One hundred sixty ASA physical status 1-2 adult patients scheduled for elective surgery were enrolled into one of four groups (n = 40, in each). The patients received saline (group LS), remifentanil 0.3 microg/kg (group LR 0.3), remifentanil 0.5 microg/kg (group LR 0.5), or remifentanil 1.0 microg/kg (group LR 1.0), and after 90 seconds received an injection of 2 mg/kg microemulsion propofol premixed with lidocaine 40 mg. Pain was assessed on a four-point scale during microemulsion propofol injection. RESULTS: The incidence of microemulsion propofol-induced pain was significantly lower in the LR 0.3, LR 0.5 and LR 1.0 groups than in the LS group (37.5%, 12.5% and 10% vs 65%, respectively). The LR 0.5 and LR 1.0 groups showed significantly less frequent and intense pain than the LR 0.3 group. However, both incidence and severity of pain were not different between LR 0.5 and LR 1.0 groups. CONCLUSIONS: The combination of remifentanil and lidocaine is effective in alleviating pain associated with a microemulsion propofol injection compared with just lidocaine. Remifentanil 0.5 microg/kg had a similar analgesic effect compared to the 1.0 microg/kg dose.

The effect and optimal dose of sufentanil in reducing injection pain of microemulsion propofol / 대한마취과학회지

BACKGROUND: Propofol is used as an induction and maintenance agent for general anesthesia but it can cause adverse reactions like hyperlipidemia, growth of microorganisms, and pulmonary embolisms. Microemulsion propofol was developed to avoid these side effects but incidence and severity of pain on injection is higher than with lipid emulsion propofol. We aimed to compare the effects of sufentanil in analgesic doses for reducing the injection pain of microemulsion propofol. METHODS: The candidates included eighty patients, 19-60 years old and ASA I-II. They were randomly classified into four groups and pretreated with normal saline, sufentanil 0.1 microg/kg, 0.2 microg/kg or 0.3 microg/kg before injection of microemulsion propofol. Five minutes after receiving pretreatment drug, 2 mg/kg of microemulsion propofol was injected and VAS was recorded. RESULTS: There were no significant differences in the incidence of injection pain among the groups. Severity of injection pain was significantly lower in the sufentanil 0.3 microg/kg group than normal saline and sufentanil 0.1 microg/kg group. Significant differences in blood pressure and heart rate were observed in sufentanil groups only after endotracheal intubation. One patient each in sufentanil 0.1 microg/kg and 0.3 microg/kg group experienced mild cough, one from sufentanil 0.3 microg/kg group experienced dizziness and another showed signs of hypoxia. One patient each in normal saline and sufentanil 0.1 microg/kg group showed clinical symptoms of phlebitis in the injection area. CONCLUSIONS: Pretreatment with sufentanil 0.3 microg/kg reduced the severity of microemulsion propofol injection pain without increasing arterial blood pressure and heart rate after endotracheal intubation.

Pain reduction on injection of microemulsion propofol via combination of remifentanil and lidocaine / 대한마취과학회지

BACKGROUND: Microemulsion propofol produces more frequent and severe pain upon injection than lipid emulsion propofol. This study examined the analgesic effect of lidocaine-premixed microemulsion propofol in patients pretreated with remifentanil. The induction of anesthesia with this combination was compared with microemulsion propofol accompanied with either remifentanil or lidocaine. METHODS: One hundred twenty patients aged between 20-65 years old were allocated randomly into one of three groups (n = 40, in each). The patients in the remifentanil group received remifentanil 0.5 microgram/kg IV for 30 seconds before a microemulsion propofol injection. The patients in the lidocaine group received propofol 2 mg/kg premixed with 40 mg lidocaine over a 60 second period. The patients in the combination group received both remifentanil and lidocaine. RESULTS: There was a significantly lower incidence of microemulsion propofol injection pain (severity 2 or more) in the combination group (12.5%) than in the remifentanil and lidocaine groups (90% and 65%, respectively, P < 0.05). The incidence of moderate pain disappeared completely in the combination group (0%) compared to that in the remifentanil and lidocaine group (32.5% and 20%, respectively, P < 0.05). Severe pain did not appear in any of the three groups. There were no complications on the injection site in the lidocaine alone and combination groups. CONCLUSIONS: The combination of microemulsion propofol premixed with lidocaine after a pretreatment with remifentanil was more effective in reducing the incidence of pain upon the injection of microemulsion propofol than either treatment alone.

Prevention of pain during injection of microemulsion propofol: application of lidocaine mixture and the optimal dose of lidocaine / 대한마취과학회지

BACKGROUND: Similar to lipid emulsion propofol, microemulsion propofol also causes a high incidence of pain during intravenous injection. Various methods have been used to minimize the incidence and severity of pain on injection of lipid emulsion propofol. In this study, we investigated the effect of a lidocaine mixture on pain induced by microemulsion propofol injection, and sought to determine the optimal dose of lidocaine that could reduce pain on injecting a propofol-lidocaine mixture. METHODS: One hundred sixty (n = 160) patients of American Society of Anesthesiologists physical status class I or II were randomly allocated to four groups: Group A, control; Group B, 20 mg lidocaine; Group C, 30 mg lidocaine; Group D, 40 mg lidocaine. In each patient, pain on microemulsion propofol solution injection was graded as none, mild, moderate, or severe. RESULTS: The incidence of pain in groups A, B, C, and D was 97.5%, 80%, 65%, and 50%, respectively. Increasing the lidocaine dose significantly reduced pain (P < 0.05). One patient in Group D (2.5%) had moderate to severe pain, which was significantly lower than groups B (42.5%) and C (32.5%) (P < 0.05). CONCLUSIONS: The lidocaine and propofol mixture is effective in alleviating pain associated with microemulsion propofol injection. Within this dose range and in this patients population, increasing lidocaine dosage significantly reduced pain during injection of microemulsion propofol.