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1.
Semina cienc. biol. saude ; 43(1): 167-176, jan./jun. 2022. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1354480

ABSTRACT

Animais presentes em zoológicos frequentemente necessitam de captura e anestesia para a realização de procedimentos clínicos e cirúrgicos. A anestesia total intravenosa apresenta vantagens como redução do estresse cirúrgico e menor depressão cardiovascular e respiratória. Entretanto, ainda são escassas as pesquisas dedicadas dentro deste contexto. Nesse sentido, o objetivo deste relato foi avaliar o protocolo anestésico empregado, visando um procedimento seguro e passível de reversão para a espécie silvestre selecionada. Acompanhou-se a anestesia de um leão (Panthera leo), macho, adulto, proveniente do Zoológico Municipal de Curitiba, submetido a procedimento endodôntico. A medicação pré-anestésica constituiu-se de dexmedetomidina (6 µg/kg), metadona (0,2 mg/kg), midazolam (0,1 mg/kg) e tiletamina-zolazepam (1,2 mg/kg). A indução foi realizada com propofol (1,5 mg/kg) e o animal foi intubado. Visando promover analgesia local, foi realizado bloqueio infraorbitário esquerdo com 5 mL de lidocaína a 2%. A manutenção foi realizada por meio do fornecimento de propofol (0,02-0,1 mg/kg/h), dexmedetomidina (0,5 µg/kg/h) e remifentanil (5 µg/kg/h). O paciente apresentou sedação profunda e foi mantido em plano anestésico cirúrgico; todos os parâmetros fisiológicos monitorados permaneceram estáveis durante todo o procedimento. Após 55 minutos de anestesia o paciente apresentava sustentação espontânea da cabeça, quando foi novamente transportado ao zoológico para soltura no recinto. A ambulação foi considerada normal pelos observadores no zoológico seis horas após a anestesia. Pôde-se concluir que o protocolo realizado se mostrou tanto eficaz quanto seguro para a referida espécie encaminhada ao procedimento em questão.


Zoo animals often require capture and anesthesia in order to undergo clinical and surgical procedures. Total intravenous anesthesia has advantages such as reduced surgical stress and less cardiovascular and respiratory depression. However, specific research on this matter is still scarce. Therefore, the present report aims to evaluate the anesthetic protocol employed, seeking a safe and reversible procedure for the selected wild species. A male adult lion (Panthera leo), from the Zoológico Municipal de Curitiba, was subjected to an endodontic anesthesia, under close monitoring. The pre-anesthetic medication consisted of dexmedetomidine (6 µg/kg), methadone (0.2 mg/kg), midazolam (0.1 mg/kg) and tiletamine-zolazepam (12 mg/kg). Induction was performed with propofol (1 mg/kg) and the animal was intubated. In order to promote local analgesia, a left infraorbital block was implemented with 5 mL of 2% lidocaine. Maintenance was undertaken by supplying propofol (0.02-0.1 mg/kg/min), dexmedetomidine (0.5 µg/kg/h) and remifentanil (5 µg/kg/h). The patient exhibited deep sedation and followed the surgical anesthetic plan; all the monitored physiological parameters remained stable throughout the procedure. After 55 minutes of anesthesia the patient showed spontaneous head support, when it was transported back to the zoo. The ambulation was considered normal by the zoo observers 6 hours after the anesthesia. It was concluded that the protocol was both effective and safe for the referred species undergone the procedure reported.


Subject(s)
Animals , Preanesthetic Medication , Tiletamine , Zolazepam , Propofol , Dexmedetomidine , Analgesia , Anesthesia , Anesthesia, Intravenous , Anesthetics , Animals, Zoo
2.
Braz. J. Pharm. Sci. (Online) ; 58: e18807, 2022. graf
Article in English | LILACS | ID: biblio-1364413

ABSTRACT

Abstract This study aimed to investigate possible changes in the spatial memory of rats and the expression or activity of EGR-1, c-Fos, PKA, and PKC after propofol anesthesia. Thirty-six Sprague-Dawley rats aged 20 months and 36 Sprague-Dawley rats aged three months were each randomly divided into three groups: the control group, the Morris Water Maze (MWM) group, and the propofol group. In the propofol groups of both young and aged rats, the rats were anesthetized by propofol for two or four hours and then performed the MWM test two days or two weeks after anesthesia to assess cognitive function. EGR-1, c-Fos, PKA, and PKC expressions in the rat hippocampus were determined via immunohistochemistry. For the older rats, the escape latency in the P4h/2d group was significantly prolonged (P < 0.05), and the learning curve was right-shifted in the P4h/2w group (P < 0.05). The expression levels of EGR-1, c-Fos, PKA, and PKC in the MWM groups were significantly higher than those in the control groups (P < 0.05). In the P4h/2d group of aged rats, the expression levels of both PKA and PKC were decreased compared with those of the MWM groups. The decreased expression of both protein kinases may be responsible for the observed impairment after propofol anesthesia


Subject(s)
Animals , Male , Female , Rats , Propofol/pharmacology , Rats, Sprague-Dawley/classification , Morris Water Maze Test , Anesthesia/adverse effects , Cognition/classification , Cognitive Dysfunction/pathology , Spatial Memory , Hippocampus
3.
Article in Chinese | WPRIM | ID: wpr-936352

ABSTRACT

OBJECTIVE@#To evaluate the impact of a history of vaginal delivery on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation.@*METHODS@#Ninety-nine patients undergoing hysteroscopic surgery under intravenous general anesthesia were enrolled in this study, including 43 patients with (VD group) and 56 patients without a history of vaginal delivery (NVD group). For all the patients, blood pressure, heart rate (HR), blood oxygen saturation (SpO2) and bispectral index (BIS) were recorded before anesthesia (T1), after anesthesia (T2), after cervical dilation (T3), and at 3 min after cervical dilation (T4). Propofol and etomidate doses during anesthesia induction, the total dose of propofol administered, additional intraoperative bolus dose and times of propofol, intraoperative body movement, total operation time and surgeons' satisfaction feedback scores were compared between the two groups. The postoperative awake time, recovery time, VAS score at 30 min after operation, and postoperative nausea and vomiting (PONV) were also compared.@*RESULTS@#There was no significant differences in SBP, DBP, HR, SpO2, or BIS between the two groups at T1 and T2, but at T3 and T4, SBP and DBP were significantly higher in NVD group than in VD group (P < 0.01); HR was significantly higher in NVD group only at T3 (P < 0.01). The application of vasoactive drugs did not differ significantly between the two groups. The total dose of propofol, additional intraoperative dose and times of propofol were all greater in NVD group than in VD group (P < 0.01). More body movements of the patients were observed in NVD group (P < 0.01), which also had lower surgeons' satisfaction score for anesthesia (P < 0.01), higher postoperative VAS score (P < 0.05), and shorter postoperative awake time (P < 0.05) and recovery time (P < 0.01).@*CONCLUSION@#A history of vaginal delivery has a significant impact on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation in terms of hemodynamic changes, anesthetic medication, and postoperative recovery quality, suggesting the necessity of individualized anesthesia management for these patients.


Subject(s)
Anesthesia, General , Anesthesia, Intravenous , Anesthetics, Intravenous , Cohort Studies , Delivery, Obstetric , Female , Humans , Hysteroscopy , Pregnancy , Propofol
4.
Article in Chinese | WPRIM | ID: wpr-936149

ABSTRACT

OBJECTIVE@#To explore the effectiveness and feasibility of dexamethasone combined with oxybuprocaine hydrochloride gel on the prevention of postoperative sore throat after nasal endoscopy.@*METHODS@#In the study, 60 patients with American Society of Anesthesiologist (ASA) physical statuses Ⅰ to Ⅱ, aged 18 to 72 years, scheduled for elective nasal endoscope surgery under general anesthesia requiring endotracheal intubation were randomly divided into dexamethasone combined with oxybuprocaine hydrochloride gel group (G group, n=30) and control group (C group, n=30). The patients in the G group received dexamethasone 0.1 mg/kg before induction and the oxybuprocaine gel was applied to the endotracheal catheter cuff and the front end within 15 cm. The patients in the C group received the same dose of saline and the saline was applied to the endotracheal catheter cuff and the front end within 15 cm. Then, all the patients in the two groups received the same induction and anesthesia maintainance. The operation time, anesthesia time, emergence time, extubation time and departure time were recorded. The intraoperative infusion volume, blood loss volume, propofol, remifentanil, rocuronium dosage were also recorded. The adverse reactions such as intraoperative hypotension, bradycardia and postoperative agitation were recorded. The postoperative sore throat score was recorded at the end of operation and 4 h, 8 h, 12 h, and 24 h after operation.@*RESULTS@#Compared with the C group, the emergence time [(8.4±3.9) min vs. (10.8±4.7) min], extubation time [(8.8±3.7) min vs. (11.9±4.8) min], and departure time [(20.0±5.3) min vs. (23.0±5.8) min] were significantly shorter, and the propofol dosage [(11.8±1.8) mg/kg vs. (15.9±4.6) mg/kg], remifentanil dosage [(10.9±4.7) μg/kg vs. (14.1±3.6) μg/kg] were significantly less in the G group, and there was no difference of rocuronium dosage in the two groups. Compared with the C group the incidence of intraoperative hypotension [10%(3/30) vs. 30%(9/30)], bradycardia [16.7%(5/30) vs. 20%(6/30)] and postoperative agitation [6.7%(2/30) vs. 23.3%(7/30)] were significantly lower in the C group. The postoperative sore throat score at the end of operation, 4 h, 8 h, 12 h and 24 h after operation in the G group were significantly lower than in the C group respectively [0 (0, 1) vs. 1 (1, 2), 0 (0, 0) vs. 1 (1, 2), 0 (0, 0) vs. 1 (1, 2), 0 (0, 0) vs. 1 (0.75, 1), 0 (0, 0) vs. 1 (0, 1)].@*CONCLUSION@#Dexamethasone combined with oxybuprocaine hydrochloride gel was effective and feasible on the prevention of postoperative sore throat after nasal endoscopy.


Subject(s)
Adolescent , Adult , Aged , Bradycardia/drug therapy , Dexamethasone/therapeutic use , Endoscopy/adverse effects , Humans , Hypotension/drug therapy , Intubation, Intratracheal/adverse effects , Middle Aged , Pain/drug therapy , Pharyngitis/prevention & control , Postoperative Complications/prevention & control , Procaine/analogs & derivatives , Propofol , Remifentanil , Rocuronium , Young Adult
5.
Article in English | WPRIM | ID: wpr-927665

ABSTRACT

Objective@#Neonatal exposure to propofol has been reported to cause neurotoxicity and neurocognitive decline in adulthood; however, the underlying mechanism has not been established.@*Methods@#SD rats were exposed to propofol on postnatal day 7 (PND-7). Double-immunofluorescence staining was used to assess neurogenesis in the hippocampal dentate gyrus (DG). The expression of p-Akt and p27 were measured by western blotting. The Morris water maze, novel object recognition test, and object location test were used to evaluate neurocognitive function 2-month-old rats.@*Results@#Phosphorylation of Akt was inhibited, while p27 expression was enhanced after neonatal exposure to propofol. Propofol also inhibited proliferation of neural stem cells (NSCs) and decreased differentiation to neurons and astroglia. Moreover, the neurocognitive function in 2-month-old rats was weakened. Of significance, intra-hippocampal injection of the Akt activator, SC79, attenuated the inhibition of p-AKT and increase of p27 expression. SC79 also rescued the propofol-induced inhibition of NSC proliferation and differentiation. The propofol-induced neurocognition deficit was also partially reversed by SC79.@*Conclusion@#Taken together, these results suggest that neurogenesis is hindered by neonatal propofol exposure. Specifically, neonatal propofol exposure was shown to suppress the proliferation and differentiation of NSCs by inhibiting Akt/p27 signaling pathway.


Subject(s)
Animals , Cell Proliferation , Hippocampus/metabolism , Neural Stem Cells , Propofol/toxicity , Proto-Oncogene Proteins c-akt/metabolism , Rats , Rats, Sprague-Dawley , Signal Transduction
6.
Medisan ; 25(6)2021. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1356478

ABSTRACT

Se describe el caso clínico de un adolescente de 18 años de edad, con antecedente de salud aparente, atendido en el cuerpo de guardia del Hospital General Docente Roberto Rodríguez Fernández de Morón, provincia de Ciego de Ávila, con síntomas sugestivos de apendicitis aguda, por lo que fue intervenido quirúrgicamente. Una vez terminado el proceder tuvo parada cardíaca, lo cual se interpretó como un síndrome por propofol. Se decidió transferirlo a la Unidad de Cuidados Intensivos, donde fue evolucionando favorablemente, con mejoría de todos los parámetros. A los 6 días lo trasladaron a la Unidad de Cuidados Intermedios y posteriormente egresó de la institución hospitalaria sin complicaciones.


The case report of an 18 years adolescent with history of apparent health is described. He was assisted in the emergency service of Roberto Rodríguez Fernández Teaching General Hospital from Morón, Ciego de Ávila, with suggestive symptoms of acute appendicitis, reason why he was surgically intervened. Once finished the procedure he had a cardiac arrest, which was interpreted as a syndrome due to propofol. It was decided to referred him to the Intensive Cares Unit, where he had a favorable clinical course, with improvement of all parameters. Six days later he was transferred to the Intermediate Cares Unit and later on he was discharged from the hospital institution without complications.


Subject(s)
Propofol , Propofol Infusion Syndrome , Anesthesia, General , Surgical Procedures, Operative , Adolescent
7.
Lima; Instituto Nacional de Salud; oct. 2021.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-1354502

ABSTRACT

ANTECEDENTES: El objetivo del presente informe es: Describir el proceso para la elaboración de recomendaciones por el grupo de trabajo designado por el Ministerio de Salud, en adelante denominado grupo de trabajo. Trasladar las Recomendaciones efectuadas por dicho grupo de trabajo en atención al uso de sedación endovenosa en pacientes con COVID-19 crítico en ventilación mecánica invasiva, según la pregunta PICO (P: Población, I: Intervención, C: Comparador, O: Outcome o desenlaces) priorizada por el grupo de trabajo. La metodología considerada para arribar a la recomendación fue el Marco de Evidencia a la Decisión/Recomendación (EtD) desarrollado por el Grupo de Trabajo GRADE (1,2). ANALISIS: Formulación de la pregunta: En personas con COVID-19 crítico en ventilación mecánica invasiva, ¿cuál es el medicamento que debe administrarse para la sedación endovenosa? Y ¿Cuál pauta de dosificación? Identificación de la evidencia para la pregunta PICO: Se siguieron las orientaciones establecidas en el documento interno de UNAGESP: Orientaciones para el soporte metodológico otorgado al grupo de trabajo designado por el MINSA. Se describe a continuación los resultados del proceso: Se efectuó la búsqueda de guías de práctica clínica (GPC) que incluyeran recomendaciones respecto al uso de sedación endovenosa en la población de interés, con fecha de búsqueda 22 de octubre de 2021 en las siguientes plataformas: eCOVID-19 living map of recommendations (eCovid-19 RecMap), Base internacional de Guías GRADE (BIGG) , Guidelines International Network (GIN), COVID-19 Guidelines Dashboard, National Institute for Health and Care Excellence - UK (NICE) y Trip database, identificándose 7 guías de práctica clínica (Ver Anexo 1). En base a criterios como fecha de búsqueda de la evidencia, uso de metodología GRADE para evaluar la certeza de la evidencia, disponibilidad de la tabla Perfil de evidencia o Resumen de hallazgos, disponibilidad de los criterios o Tabla EtD y tipo de recomendación. Se identificaron tres guías de la Organización Panamericana de la Salud y una de la Society of Critical Care Medicine (SCCM)(3­6), sin embargo, las guías de OPS no brindan recomendaciones especificas para responder directamente a todas las alternativas de intervenciones planteadas por SOPEMI. Por otro lado, las guías de SCCM contienen recomendaciones respecto al uso de todas las alternativas de intervenciones planteadas en pacientes no COVID. La búsqueda se realizó en MEDLINE/ vía PubMed, plataforma L·OVE de Epistemonikos (7) y en MedRxiv, con fecha 22 de octubre de 2021. Los criterios de selección de los estudios fueron: ensayos clínicos aleatorizados, cohortes o casos y control que evalúen la PICO planteada y reportaran al menos uno de los desenlaces de interés. La certeza de la evidencia fue realizada según el enfoque GRADE que toma en cuenta los siguientes criterios: diseño del estudio, riesgo de sesgo, inconsistencia en los resultados, ausencia de evidencia directa, imprecisión, sesgo de publicación, tamaño de efecto, gradiente dosis-respuesta, y efecto de los potenciales factores de confusión residual (los tres últimos aplicables en estudios observacionales) (8,9). Los resultados fueron presentados utilizando la Tablas de Resumen de Hallazgos (SOF, por sus siglas en inglés) construidas a partir del software en línea GRADEpro (https://gradepro.org/)(10) a partir de la adaptación de tablas SoF de la guía de SCCM (6) para pacientes no críticos. Metodología considerada para la elaboración de las recomendaciones: Marco de Evidencia a la Decisión/Recomendación (EtD: Evidence to decisión framework): Los marcos EtD (1,2) son una herramienta del Enfoque GRADE, que tiene como finalidad fomentar el uso de la evidencia de una manera estructurada y transparente para informar decisiones relacionadas al manejo clínico de una enfermedad, salud pública, políticas del sistema de salud o en situaciones como el contexto actual de pandemia acerca de acciones con repercusión socio-económica entre otras. Se aplicaron los principios del enfoque "GRADE-ADOLOPMENT" para identificar guías de práctica clínica orientadas a las preguntas PICO propuestas por el grupo de trabajo de MINSA, además que tener disponibles los perfiles de evidencia GRADE o Tablas de resumen de hallazgos y los marcos EtD. Dependiendo de la evaluación, estas pueden ser consideradas para la adaptación con contextualización o para la adopción (11). Los siguientes criterios del marco EtD fueron seleccionados para la discusión y juicio por el grupo de trabajo: Efectos deseables, Efectos indeseables, Certeza de la evidencia, Valores y preferencias de los pacientes, Balance de efectos, Recursos necesarios, Equidad, Aceptabilidad y Factibilidad. En caso de no haber consenso en la valoración del juicio, se efectuó una votación, determinándose la valoración por mayoría simple. La perspectiva fue del sistema de salud. Elaboración de las Recomendaciones: La metodología EtD considera determinar la fuerza y dirección de una recomendación (12). Ambas, como resultado del juicio acerca del balance beneficio-riesgo, calidad global de la evidencia, confianza en los valores y preferencias de los pacientes, uso de recursos, equidad en salud, aceptabilidad, y factibilidad. En este sentido, existirán recomendaciones "a favor de la intervención" o "en contra de la intervención" (a favor de la alternativa u opción). Asimismo, las recomendaciones fueron determinadas como fuertes o condicionales. Una recomendación será fuerte si existe una clara diferencia entre los efectos deseables e indeseables de la intervención, la certeza global de la evidencia alta o moderada, todos o casi todos los pacientes informados toman la misma decisión, el costo de la intervención está plenamente justificado, existe un impacto favorable en la equidad en salud, la intervención es aceptable para los usuarios interesados (pacientes y personal de salud) y la implementación de dicha intervención es viable. Una recomendación será condicional si alguna de las consideraciones siguientes está presente: Exista poca diferencia entre los efectos deseables e indeseables de la intervención, la calidad de la evidencia es baja o muy baja, existe variabilidad o incertidumbre respecto de lo que decidirán los pacientes informados o el costo de la intervención pudiera no estar justificado en algunas circunstancias. Diálogo Deliberativo para la valoración de los criterios del Marco EtD y elaboración de las recomendaciones: El Diálogo deliberativo se llevó a cabo el día 27 de octubre de 2021, reunión virtual a través de la herramienta Zoom, con la participación de: 1. Profesionales del Grupo de trabajo designado por el Ministerio de Salud: integrantes de la Sociedad Peruana de Medicina Intensiva y Representantes del Ministerio de Salud, en su calidad de panel de expertos, habilitados para emitir los juicios para cada criterio, votar en caso de ser necesario y elaborar la recomendación. 2. Representantes de la Unidad de Análisis y Generación de Evidencias en Salud Pública (UNAGESP) del INS, quienes efectuaron la identificación de la evidencia presentada ante los expertos, en calidad de facilitadores y conductores de los aspectos metodológicos de la reunión. RECOMENDACIÓN: Se sugiere el uso de Propofol sobre benzodiazepinas para la sedación en pacientes con COVID 19 críticos en ventilación mecánica invasiva. Recomendación condicional, basada en evidencia de muy baja calidad: Consideraciones adicionales: La sedación en pacientes COVID 19 críticos en ventilación mecánica invasiva debe ser precedida por una adecuada analgesia. En los pacientes COVID 19 críticos en ventilación mecánica invasiva que no se alcance el objetivo de sedación con las dosis adecuadas de Propofol, o se tenga efectos colaterales, se podría considerar el uso de otro sedante. No se ha establecido la seguridad de Propofol en el embarazo, porque atraviesa la barrera placentaria y puede causar depresión neonatal. Se sugiere usar dexmedetomidina sobre benzodiazepinas para la sedación en pacientes COVID 19 críticos en ventilación mecánica durante la fase de destete. Recomendación condicional, calidad de la evidencia muy baja: Consideraciones adicionales: Tener precaución sobre los efectos adversos como bradicardia e hipotensión. Evitar su uso en pacientes inestables hemodinámicamente. No se recomienda dar dosis de carga de dexmedetomidina. Se sugiere el uso de dexmedetomidina sobre Propofol para la sedación en pacientes COVID 19 críticos en ventilación mecánica durante la fase de destete.


Subject(s)
Humans , Respiration, Artificial , Midazolam/administration & dosage , Propofol/administration & dosage , Dexmedetomidine/administration & dosage , SARS-CoV-2/drug effects , COVID-19/complications , COVID-19/drug therapy , Lorazepam/administration & dosage , Efficacy , Cost-Benefit Analysis
8.
Rev. bras. ter. intensiva ; 33(3): 428-433, jul.-set. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1347287

ABSTRACT

RESUMO Objetivo: Construir um modelo de custo-efetividade para comparar o uso de propofol com o de midazolam em pacientes críticos adultos sob uso de ventilação mecânica. Métodos: Foi construído um modelo de árvore decisória para pacientes críticos submetidos à ventilação mecânica, o qual foi analisado sob a perspectiva do sistema privado de saúde no Brasil. O horizonte temporal foi o da internação na unidade de terapia intensiva. Os desfechos foram custo-efetividade por hora de permanência na unidade de terapia intensiva evitada e custo-efetividade por hora de ventilação mecânica evitada. Foram obtidos os dados do modelo a partir de metanálise prévia. Assumiu-se que o custo da medicação estava incluído nos custos da unidade de terapia intensiva. Conduziram-se análises univariada e de sensibilidade probabilística. Resultados: Pacientes mecanicamente ventilados em uso de propofol tiveram diminuição de sua permanência na unidade de terapia intensiva e na duração da ventilação mecânica, respectivamente, em 47,97 horas e 21,65 horas. Com o uso de propofol, ocorreu redução média do custo de U$2.998,971 em comparação ao uso do midazolam. A custo-efetividade por hora de permanência na unidade de terapia intensiva evitada e por hora de ventilação mecânica evitada foi dominante, respectivamente, em 94,40% e 80,8% do tempo. Conclusão: Ocorreu diminuição significante do custo associado ao uso de propofol, no que se refere à permanência na unidade de terapia intensiva e à duração da ventilação mecânica para pacientes críticos adultos.


ABSTRACT Objective: To build a cost-effectiveness model to compare the use of propofol versus midazolam in critically ill adult patients under mechanical ventilation. Methods: We built a decision tree model for critically ill patients submitted to mechanical ventilation and analyzed it from the Brazilian private health care system perspective. The time horizon was that of intensive care unit hospitalization. The outcomes were cost-effectiveness per hour of intensive care unit stay avoided and cost-effectiveness per hour of mechanical ventilation avoided. We retrieved data for the model from a previous meta-analysis. We assumed that the cost of medication was embedded in the intensive care unit cost. We conducted univariate and probabilistic sensitivity analyses. Results: Mechanically ventilated patients using propofol had their intensive care unit stay and the duration of mechanical ventilation decreased by 47.97 hours and 21.65 hours, respectively. There was an average cost reduction of US$ 2,998.971 for propofol when compared to midazolam. The cost-effectiveness per hour of intensive care unit stay and mechanical ventilation avoided were dominant 94.40% and 80.8% of the time, respectively. Conclusion: There was a significant reduction in costs associated with propofol use related to intensive care unit stay and duration of mechanical ventilation for critically ill adult patients.


Subject(s)
Humans , Adult , Midazolam , Propofol , Cost-Benefit Analysis , Hospitalization , Hypnotics and Sedatives , Intensive Care Units
9.
Rev. cuba. anestesiol. reanim ; 20(2): e687, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289354

ABSTRACT

Introducción: La decisión de realizar la inducción anestésica con propofol o tiopental en la paciente obstétrica para operación cesárea es un tema controvertido, con resultados contradictorios entre las investigaciones. Objetivo: Presentar los resultados que se publicaron en la literatura nacional e internacional sobre el uso del propofol como agente anestésico en la inducción de la anestesia general en la operación cesárea electiva. Métodos: Se realizó una revisión no sistemática de la bibliografía basada en artículos que se publicaron en bases de datos indexadas en Infomed como Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane; en idioma español e inglés, durante los últimos diez años, utilizando palabras clave como: (inducción anestésica OR anestesia general OR) AND (propofol OR) AND (operación cesárea OR cesárea OR). Desarrollo: Se destacaron artículos donde se comparan los resultados del uso del propofol contra el tiopental y otros barbitúricos durante la inducción anestésica en cuanto a variables hemodinámicas, efectos adversos, calidad anestésica y desenlaces neonatales como el estado físico, capacidad de adaptación neurológica y gases arteriales. Conclusiones: El propofol es el agente más común para la inducción anestésica en la paciente obstétrica que necesita cesárea electiva. Este presenta resultados adecuados maternos y fetales, y menor incidencia de efectos adversos(AU)


Introduction: The decision to perform anesthetic induction with propofol or thiopental in obstetric patients for cesarean section is a controversial issue, with contradictory oncomes among investigations. Objective: To present the results published in the national and international literature about the use of propofol as an anesthetic agent in the induction of general anesthesia in elective cesarean section. Methods: A nonsystematic review of the bibliography was carried out, with a focus on articles in Spanish and English published, during the last ten years, in databases indexed in Infomed, such as Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, using keywords such as (inducción anestésica [anesthetic induction] OR anestesia general [general anesthesia] OR) AND (propofol OR) AND (operación cesárea [cesarean section] OR cesárea [cesarean] OR). Development: Articles were highlighted if they compared the results of propofol usage against thiopental and other barbiturates during anesthetic induction in terms of hemodynamic variables, adverse effects, anesthetic quality and neonatal outcomes such as physical state, neurological adaptation capacity and arterial gases. Conclusions: Propofol is the commonest agent for anesthetic induction in obstetric patients requiring elective caesarean section. This presents adequate maternal and fetal outcomes, as well as a lower incidence of adverse effects(AU)


Subject(s)
Humans , Female , Pregnancy , Propofol , Cesarean Section , Anesthesia, General
11.
Rev. colomb. anestesiol ; 49(2): e201, Apr.-June 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1251498

ABSTRACT

Abstract Introduction The analysis of the electrical activity of the brain using scalp electrodes with electroencephalography (EEG) could reveal the depth of anesthesia of a patient during surgery. However, conventional EEG equipment, due to its price and size, are not a practical option for the operating room and the commercial units used in surgery do not provide access to the electrical activity. The availability of low-cost portable technologies could provide for further research on the brain activity under general anesthesia and facilitate our quest for new markers of depth of anesthesia. Objective To assess the capabilities of a portable EEG technology to capture brain rhythms associated with the state of consciousness and the general anesthesia status of surgical patients anesthetized with propofol. Methods Observational, cross-sectional study that reviewed 10 EEG recordings captured using OpenBCI portable low-cost technology, in female patients undergoing general anesthesia with propofol. The signal from the frontal electrodes was analyzed with spectral analysis and the results were compared against the reports in the literature. Results The signal captured with frontal electrodes, particularly α rhythm, enabled the distinction between resting with eyes closed and with eyes opened in a conscious state, and sustained anesthesia during surgery. Conclusions It is possible to differentiate a resting state from sustained anesthesia, replicating previous findings with conventional technologies. These results pave the way to the use of portable technologies such as the OpenBCI tool, to explore the brain dynamics during anesthesia.


Resumen Introducción El análisis de la actividad eléctrica cerebral mediante electrodos ubicados sobre el cuero cabelludo con electroencefalografía (EEG) podría permitir conocer la profundidad anestésica de un paciente durante cirugía. Sin embargo, los equipos de EEG convencionales, por su precio y tamaño, no son una alternativa práctica en quirófanos y los equipos comerciales usados en cirugía no permiten acceder a la actividad eléctrica. Disponer de tecnologías portables y de bajo costo aumentaría el número de investigaciones sobre la actividad cerebral bajo anestesia general y facilitaría la búsqueda de nuevos marcadores para la profundidad anestésica. Objetivo Evaluar la capacidad de una tecnología EEG portable de adquirir ritmos cerebrales relacionados con el estado consciente y el estado de anestesia general de pacientes en cirugía anestesiados con propofol. Métodos Estudio observacional de corte transversal en el que se analizaron datos de 10 registros EEG obtenidos mediante tecnología portable y de bajo costo OpenBCI, de pacientes de sexo femenino que fueron sometidas a anestesia general con propofol. La señal obtenida de los electrodos frontales se analizó mediante análisis espectral y se contrastaron los resultados con lo descrito en la literatura. Resultados La señal obtenida con electrodos frontales, especialmente el ritmo α, permitió diferenciar el reposo con ojos cerrados y ojos abiertos en estado consciente, del estado de mantenimiento de la anestesia durante cirugía. Conclusiones Se logra la diferenciación de estado de reposo y de mantenimiento de la anestesia replicando hallazgos previos de tecnologías convencionales. Estos resultados abren la posibilidad de utilizar las tecnologías portables como el OpenBCI para investigar la dinámica cerebral durante la anestesia.


Subject(s)
Humans , Spectrum Analysis , Technology , Electroencephalography , Anesthesia, General , Brain Mapping , Propofol , Observational Studies as Topic
12.
Acta Physiologica Sinica ; (6): 878-884, 2021.
Article in Chinese | WPRIM | ID: wpr-921291

ABSTRACT

The aim of the present study was to investigate the protective effect of propofol on the experimental myocardial infarction in rats. The myocardial infarction model was established by ligating the anterior descending branch of left coronary artery in rats. Model rats were treated with propofol. Cardiac function was evaluated by echocardiography. Cardiac hemodynamic changes were detected by multiconductor biorecorder. Pathological changes in the infarcted myocardia were detected by HE staining. The expression levels of cardiac hypertrophy marker genes and fibrosis marker proteins were analyzed by real-time quantitative PCR and Western blot. The results showed that, compared with the sham surgery group, the model group exhibited larger infarct size (> 40%), impaired heart function, and significantly increased left ventricular end-diastolic pressure (LVEDP). Propofol reduced cardiac function impairment and decreased LVEDP in the model group. Propofol significantly reduced lung weight/body weight ratio, heart weight/body weight ratio, left ventricular weight/body weight ratio and left atrial weight/body weight ratio in the model group. Furthermore, after myocardial infarction, the administration of propofol significantly improved the diastolic strain rate, down-regulated the mRNA expression levels of myocardial hypertrophy markers, atrial natriuretic peptide and β-myosin heavy chain, and reversed the up-regulation of matrix metalloproteinase 2 (MMP2), MMP9 and tissue inhibitor of metalloproteinase-2 (TIMP-2) induced by myocardial infarction. These results suggest propofol can reduce adverse ventricular remodeling, cardiac dysfunction, myocardial hypertrophy and fibrosis after myocardial infarction, and has protective effect against the experimental myocardial infarction induced by coronary artery ligation in rats.


Subject(s)
Animals , Cardiotonic Agents/pharmacology , Matrix Metalloproteinase 2 , Matrix Metalloproteinase 9 , Myocardial Infarction/drug therapy , Myocardium , Propofol/pharmacology , Rats , Tissue Inhibitor of Metalloproteinase-2/genetics , Ventricular Remodeling
13.
Article in English | WPRIM | ID: wpr-888511

ABSTRACT

To investigate the effect of multiple propofol anesthesia and operative trauma on neuroinflammation and cognitive function in development rats and its mechanism. A total of 104 13-day-old neonatal Sprague-Dawley rats were randomly divided into 4 groups with 26 rats in each group: control group was treated with saline q.d for propofol group was treated with propofol q.d for surgery group received abdominal surgery under local anesthesia and then treated with saline q.d for surgery with propofol group received propofol anesthesia plus abdominal surgery under local anesthesia with ropivacaine at d1, then treated with propofol q.d for At d2 of experiment, 13 rats from each group were sacrificed and brain tissue samples were taken, the concentration of TNF-α in hippocampus was detected with ELISA, the expression of caspase-3 and c-fos in hippocampal tissue was determined with immunohistochemical method, the number of apoptotic neurons in hippocampus was examined with TUNEL assay. Morris water maze test was used to examine the cognitive function of the rest rats at the age of 60 d, and the TNF-α concentration, caspase-3, c-fos expressions and the number of apoptotic neurons in hippocampus were also detected. Compared with control group, TNF-α concentration, caspase-3, c-fos expression and the neuroapoptosis in hippocampus increased significantly in other three groups (all 0.05). Morris water maze test showed that there were no significant differences in swimming speed, escape latency, target quadrant residence time and crossing times among groups (all >0.05). TNF-α level, expressions of caspase-3 and c-fos and apoptotic cell numbers in hippocampus had no significant differences among the 4 adult rats groups (all >0.05). Abdominal surgery and multiple propofol treatment can induce neuroinflammation and neuroapoptosis in hippocampus of neonatal rats, however, which may not cause adverse effects on neurodevelopment and cognitive function when they grown up.


Subject(s)
Anesthesia , Animals , Cognition , Hippocampus , Propofol/adverse effects , Rats , Rats, Sprague-Dawley
14.
Article in Chinese | WPRIM | ID: wpr-880828

ABSTRACT

OBJECTIVE@#To investigate the maximum dose of continuous mivacurium infusion for intraoperative neuromonitoring (IONM) and observe the adverse reactions during thyroid surgery under total intravenous anesthesia (TIVA).@*METHODS@#Thirty patients undergoing IONM during thyroid surgery received continuous infusion of mivacurium at the initial rate of 14.97 μg · kg@*RESULTS@#The EC@*CONCLUSIONS@#In patients undergoing thyroid surgery under TIVA, the EC


Subject(s)
Anesthesia, Intravenous , Humans , Mivacurium , Propofol , Remifentanil , Thyroid Gland
15.
Article in English | WPRIM | ID: wpr-880617

ABSTRACT

OBJECTIVES@#To investigate the effects of propofol on the proliferation and invasion of glioma U87 cells and to explore the possible anti-tumor mechanisms.@*METHODS@#The glioma U87 cells was divided into a blank group, a positive control group, and the propofol groups (1.00, 2.00 or 5.00 mmol/L). Cell counting kit-8 (CCK-8) was used to detect cell proliferation; Transwell method was used to detect the effect of propofol on invasion and migration of U87 cells; real-time PCR was used to detect the expression of microRNA-134 (miR-134); Western blotting was used to detect the expression levels of reproduction-related protein Ki-67, invasion-related protein metalloproteinase-2 (MMP-2), metalloproteinase-9 (MMP-9) and phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt) signaling pathway-related protein.@*RESULTS@#Compared with the blank group, the proliferation, invasion and migration capacity of U87 cells were reduced in the positive control group and the propofol groups after 48 hours (all @*CONCLUSIONS@#Propofol can decrease the proliferation rate, and the invasion and migration abilities of U87 cells, which may be achieved by up-regulation of miR-134 and suppression of PI3K/Akt signaling pathway.


Subject(s)
Cell Line, Tumor , Cell Movement , Cell Proliferation , Glioma/genetics , Humans , Matrix Metalloproteinase 2/genetics , MicroRNAs/genetics , Phosphatidylinositol 3-Kinases/genetics , Propofol/pharmacology , Proto-Oncogene Proteins c-akt/genetics
16.
Acta cir. bras ; 36(10): e361004, 2021. tab
Article in English | LILACS, VETINDEX | ID: biblio-1349863

ABSTRACT

ABSTRACT Purpose: To investigate the effects of propofol on inflammatory response and activation of p38 mitogen-activated protein kinase (MAPK) signaling pathway in rats with ventilator-associated lung injury (VALI). Methods: Thirty-six Sprague Dawley (SD) rats were divided into control, VALI and VALI+propofol groups. The VALI group received the mechanical ventilation for 2 h. The VALI+propofol group received the mechanical ventilation for 2 h, which was accompanied by intravenous injection of propofol with dose of 8 mg·kg-1·h-1. At the end, the mean arterial pressure (MAP) and blood gas indexes were measured, and the lung wet/dry mass ratio (W/D) and biochemical indexes of lung tissue and bronchoalveolar lavage fluid (BALF) were determined. Results: Compared with VALI group, in VALI+propofol group the blood pH, partial pressure of oxygen, partial pressure of carbon dioxide and MAP were increased, the lung W/D, lung tissue myeloperoxidase activity and total protein concentration, white blood cell count, and tumor necrosis factor α, interleukin 1β and interleukin 6 levels in BALF were decreased, and the p-p38 MAPK protein expression level and phosphorylated p38 MAPK (p-p38 MAPK)/p38 MAPK ratio were decreased. Conclusions: Propofol treatment may alleviate the VALI in rats by reducing the inflammatory response and inhibiting the activation of p38 MAPK signaling pathway.


Subject(s)
Animals , Rats , Propofol/pharmacology , Ventilator-Induced Lung Injury/drug therapy , Signal Transduction , Rats, Sprague-Dawley , p38 Mitogen-Activated Protein Kinases/metabolism , Lung/metabolism
17.
J. pediatr. (Rio J.) ; 96(3): 289-309, May-June 2020. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1135034

ABSTRACT

Abstract Objectives: To determine the main indications and assess the most common adverse events with the administration of hypnotic propofol in most pediatric clinical scenarios. Sources: A systematic review of PubMed, SciELO, Cochrane, and EMBASE was performed, using filters such as a maximum of five years post-publication, and/or references or articles of importance, with emphasis on clinical trials using propofol. All articles of major relevance were blind-reviewed by both authors according to the PRISMA statement, looking for possible bias and limitations or the quality of the articles. Summary of the findings: Through the search criterion applied, 417 articles were found, and their abstracts evaluated. A total of 69 papers were thoroughly studied. Articles about propofol use in children are increasing, including in neonates, with the majority being cohort studies and clinical trials in two main scenarios: upper digestive endoscopy and magnetic resonance imaging. A huge list of adverse events has been published, but most articles considered them of low risk. Conclusions: Propofol is a hypnotic drug with a safe profile of efficacy and adverse events. Indeed, when administered by non-anesthesiologists, quick access to emergency care must be provided, especially in airway events. The use of propofol in other scenarios must be better studied, aiming to reduce the limitations of its administration by general pediatricians.


Resumo Objetivos: Determinar as principais indicações e examinar os eventos adversos mais comuns com uso do hipnótico propofol na maioria dos cenários clínicos pediátricos. Fontes: Realizada revisão sistemática da literatura nas bases de dados PubMed, Scielo, Cochrane e EMBASE, aplicando-se filtros como máximo de cinco anos de publicação e/ou referências ou publicações relevantes em outras hipóteses com enfoque em ensaios clínicos envolvendo o propofol. Todos os artigos de maior relevância foram avaliados cegamente pelos dois autores, de acordo com o PRISMA Statement, observando os riscos de vieses e qualidades ou limitações dos estudos. Resumo dos achados: Através dos mecanismos de pesquisa, 417 artigos foram encontrados e separados logo após, de acordo com os critérios de inclusão. Um total de 69 artigos foram estudados. Destacam-se a produção científica crescente sobre o propofol em crianças, incluindo recém-nascidos, sendo a grande maioria dos trabalhos coortes retrospectivos ou prospectivos, bem como ensaios clínicos com o propofol nos principais cenários: endoscopia digestiva alta e ressonância magnética. Ampla gama de eventos adversos foi citada, mas a maioria dos trabalhos não as consideraram significativas. Conclusões: O propofol apresenta um seguro perfil de eficácia e segurança. Quando administrado por médicos não anestesistas, deve-se redobrar o cuidado para ação rápida em emergências, especialmente de vias aéreas. A aplicação do fármaco em outros contextos deve ser estudada em maior profundidade, a fim de dirimir a dificuldade do uso por pediatras.


Subject(s)
Humans , Infant, Newborn , Child , Propofol/pharmacology , Hypnotics and Sedatives
18.
Rev. bras. anestesiol ; 70(6): 620-626, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155779

ABSTRACT

Abstract Background and objectives Day-case pediatric sedation is challenging. Dexmedetomidine is a sedative analgesic that does not induce respiratory depression. We compared dexmedetomidine to propofol when it was added to ketamine for sedation during pediatric endoscopy, regarding recovery time and hemodynamic changes. Methods We enrolled 120 patients (2−7 years in age) and randomly assigned them into two groups. Each patient received intravenous (IV) ketamine at a dose of 1 mg.kg-1 in addition to either propofol (1 mg.kg-1) or dexmedetomidine (0.5 µg.kg-1). The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored. Results There was no significant difference in hemodynamics between the groups. The Propofol-Ketamine (P-K) group showed significantly shorter recovery times than the Dexmedetomidine-Ketamine (D-K) group (21.25 and 29.75 minutes, respectively, p < 0.001). The P-K group showed more oxygen desaturation. Eleven and 6 patients experienced SpO2 < 92% in groups P-K and D-K, respectively. A significant difference was noted regarding the need for additional doses; 10% of patients in the D-K group needed one extra dose, and 5% needed two extra doses, compared to 25% and 20% in the P-K group, respectively (p = 0.001). The P-K group showed less post-procedure nausea and vomiting. No statistically significant difference between both groups regarding endoscopist satisfaction. Conclusions The P-K combination was associated with a shorter recovery time in pediatric upper gastrointestinal endoscopy, while the D-K combination showed less need for additional doses. Registration number Clinical trials.gov (NCT02863861).


Resumo Justificativa e objetivos A sedação ambulatorial pediátrica é um desafio. A dexmedetomidina é um analgésico sedativo que não induz à depressão respiratória. Comparamos a dexmedetomidina ao propofol quando associados à cetamina para sedação durante endoscopia pediátrica, quanto ao tempo de recuperação e às alterações hemodinâmicas. Métodos Foram recrutados 120 pacientes (2−7 anos de idade) que foram aleatoriamente alocados em dois grupos. Cada paciente recebeu cetamina IV na dose de 1 mg.kg‐1, além de propofol (1 mg.kg‐1) ou dexmedetomidina (0,5 µg.kg‐1). Comparamos o tempo de recuperação. A hemodinâmica, saturação de oxigênio, necessidade de doses adicionais, complicações pós‐operatórias e satisfação do endoscopista foram monitoradas. Resultados Não houve diferença significante entre os grupos no que diz respeito à hemodinâmica. O grupo Propofol‐Cetamina (P‐C) apresentou tempos de recuperação significantemente mais curtos do que o grupo Dexmedetomidina‐Cetamina (D‐C) (21,25 e 29,75 minutos respectivamente, p < 0,001). Observou‐se frequência maior de dessaturação de oxigênio no grupo P‐C. Onze e 6 pacientes apresentaram SpO2 < 92% nos grupos P‐C e D‐C, respectivamente. Uma diferença significante foi observada em relação à necessidade de doses adicionais; 10% dos pacientes no grupo D‐C precisaram de uma dose extra e 5% precisaram de duas doses extras, em comparação com 25% e 20% no grupo P‐C, respectivamente (p = 0,001). O grupo P‐C apresentou menos náuseas e vômitos após o procedimento. Não houve diferença estatisticamente significante entre os dois grupos em relação à satisfação do endoscopista. Conclusões A combinação P‐C foi associada a tempo mais curto de recuperação na endoscopia digestiva alta pediátrica, enquanto a combinação D‐C mostrou menor necessidade de doses adicionais. Número de registro Clinical trials.gov (NCT02863861).


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Propofol/administration & dosage , Endoscopy, Gastrointestinal , Anesthetics, Intravenous/administration & dosage , Anesthetics, Combined/administration & dosage , Dexmedetomidine/administration & dosage , Hypnotics and Sedatives/administration & dosage , Oxygen/blood , Time Factors , Blood Pressure/drug effects , Anesthesia Recovery Period , Heart Rate/drug effects , Analgesics/administration & dosage , Hypotension/chemically induced , Ketamine/administration & dosage
19.
Rev. bras. anestesiol ; 70(6): 682-685, Nov.-Dec. 2020. tab
Article in English, Portuguese | LILACS | ID: biblio-1155770

ABSTRACT

Abstract Myotonic dystrophy type-1 (Steinert disease) is an autosomal dominant, progressive multisystem disease in which myotonic crisis can be triggered by several factors including pain, emotional stress, hypothermia, shivering, and mechanical or electrical stimulation. In this report, dexmedetomidine-based general anesthesia, in combination with a thoracic epidural for laparoscopic cholecystectomy in a patient with Steinert disease, is presented. An Aintree intubation catheter with the guidance of a fiberoptic bronchoscope was used for intubation to avoid laryngoscopy. Prolonged anesthetic effects of propofol were reversed, and recovery from anesthesia was accelerated using an intravenous infusion of theophylline.


Resumo A Distrofia Miotônica (DM) tipo-1 (Doença de Steinert) é uma doença multissistêmica progressiva autossômica dominante em que a crise miotônica pode ser desencadeada por vários fatores, incluindo dor, estresse emocional, hipotermia, tremores e estímulo mecânico ou elétrico. O presente relato descreve anestesia geral realizada com dexmedetomidina em combinação com peridural torácica para colecistectomia laparoscópica em paciente com Doença de Steinert. Para evitar laringoscopia, a intubação traqueal foi realizada utilizando cateter de intubação Aintree guiado por broncofibroscopia óptica. Os efeitos anestésicos prolongados do propofol foram revertidos e a recuperação anestésica foi acelerada pelo uso de infusão intravenosa de teofilina.


Subject(s)
Humans , Female , Cholecystectomy, Laparoscopic/methods , Analgesics, Non-Narcotic , Dexmedetomidine , Anesthesia, Epidural/methods , Anesthesia, General/methods , Myotonic Dystrophy/complications , Theophylline/administration & dosage , Anesthesia Recovery Period , Propofol , Bronchoscopes , Analgesics, Opioid , Hypnotics and Sedatives , Intubation, Intratracheal/methods , Middle Aged
20.
Rev. bras. anestesiol ; 70(6): 605-612, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155767

ABSTRACT

Abstract Background and objectives Preoperative use of flurbiprofen axetil (FA) is extensively adopted to modulate the effects of analgesia. However, the relationship between FA and sedation agents remains unclear. In this study, we aimed to investigate the effects of different doses of FA on the median Effective Concentration (EC50) of propofol. Methods Ninety-six patients (ASA I or II, aged 18-65 years) were randomly assigned into one of four groups in a 1:1:1:1 ratio. Group A (control group) received 10 mL of Intralipid, and groups B, C and D received 0.5 mg.kg−1, 0.75 mg.kg−1 and 1 mg.kg−1 of FA, respectively, 10 minutes before induction. The depth of anesthesia was measured by the Bispectral Index (BIS). The "up-and-down" method was used to calculate the EC50 of propofol. During the equilibration period, if BIS ≤ 50 (or BIS > 50), the next patient would receive a 0.5 µg.mL−1-lower (or -higher) propofol Target-Controlled Infusion (TCI) concentration. The hemodynamic data were recorded at baseline, 10 minutes after FA administration, after induction, after intubation and 15 minutes after intubation. Results The EC50 of propofol was lower in Group C (2.32 µg.mL−1, 95% Confidence Interval [95% CI] 1.85-2.75) and D (2.39 µg.mL−1, 95% CI 1.91-2.67) than in Group A (2.96 µg.mL−1, 95% CI 2.55-3.33) (p = 0.023, p = 0.048, respectively). There were no significant differences in the EC50 between Group B (2.53 µg.mL−1, 95% CI 2.33-2.71) and Group A (p > 0.05). There were no significant differences in Heart Rate (HR) among groups A, B and C. The HR was significantly lower in Group D than in Group A after intubation (66 ± 6 vs. 80 ± 10 bpm, p < 0.01) and 15 minutes after intubation (61 ± 4 vs. 70 ± 8 bpm, p < 0.01). There were no significant differences among the four groups in Mean Arterial Pressure (MAP) at any time point. The MAP of the four groups was significantly lower after induction, after intubation, and 15 minutes after intubation than at baseline (p < 0.05). Conclusion High-dose FA (0.75 mg.kg−1 or 1 mg.kg−1) reduces the EC50 of propofol, and 1 mg.kg−1 FA reduces the HR for adequate anesthesia in unstimulated patients. Although this result should be investigated in cases of surgical stimulation, we suggest that FA pre-administration may reduce the propofol requirement when the depth of anesthesia is measured by BIS.


Resumo Justificativa e objetivos A administração pré‐operatória de Flurbiprofeno Axetil (FA) é amplamente usada para a modulação da analgesia. No entanto, a relação entre FA e fármacos sedativos permanece obscura. Neste estudo, nosso objetivo foi investigar os efeitos de diferentes doses de FA na Concentração Efetiva mediana (CE50) do propofol. Métodos Noventa e seis pacientes (ASA I ou II, com idades de 18-65 anos) foram alocados aleatoriamente em quatro grupos na proporção de 1:1:1:1. Dez minutos antes da indução, o Grupo A (grupo controle) recebeu 10 mL de Intralipid, enquanto os grupos B, C e D receberam FA na dose de 0,5 mg.kg‐1; 0,75 mg.kg‐1 e 1 mg.kg‐1, respectivamente. A profundidade da anestesia foi medida pelo Índice Bispectral (BIS). O método up‐and‐down foi usado para calcular a CE50 do propofol. Durante o período de equilíbrio, se o valor do BIS fosse ≤ 50 ou BIS > 50, o próximo paciente tinha a infusão de propofol ajustada para uma concentração alvo‐controlada 0,5 µg.mL‐1 inferior ou superior, respectivamente. Os dados hemodinâmicos foram registrados no início do estudo, 10 minutos após a administração de FA, após a indução, após a intubação e 15 minutos após a intubação. Resultados A CE50 do propofol foi menor no Grupo C (2,32 µg.mL‐1, Intervalo de Confiança de 95% [95% IC] 1,85-2,75) e D (2,39 µg.mL‐1, 95% IC 1,91-2,67) do que no Grupo A (2,96 µg.mL‐1; 95% IC 2,55-3,33) (p = 0,023, p = 0,048, respectivamente). Não houve diferenças significantes na CE50 entre o Grupo B (2,53 µg.mL‐1, 95% IC 2,33-2,71) e o Grupo A (p > 0,05). Não houve diferenças significantes na Frequência Cardíaca (FC) entre os grupos A, B e C. A FC foi significantemente menor no grupo D do que no grupo A após a intubação (66 ± 6 vs. 80 ± 10 bpm, p < 0,01) e 15 minutos após a intubação (61 ± 4 vs. 70 ± 8 bpm, p < 0,01). Não houve diferenças significantes entre os quatro grupos na Pressão Arterial Média (PAM) em qualquer momento. A PAM dos quatro grupos foi significantemente menor após a indução, após a intubação e 15 minutos após a intubação do que na linha de base (p < 0,05). Conclusão FA em altas doses (0,75 mg.kg‐1 ou 1 mg.kg‐1) reduz a CE50 do propofol, e 1 mg.kg‐1 de FA reduz a FC durante níveis adequados de anestesia em pacientes não estimulados. Embora esse resultado deva ser investigado na presença de estimulação cirúrgica, sugerimos que a pré‐administração de FA pode reduzir a necessidade de propofol durante anestesia cuja profundidade seja monitorada pelo BIS.


Subject(s)
Humans , Male , Female , Adult , Aged , Young Adult , Propofol/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Flurbiprofen/analogs & derivatives , Hypnotics and Sedatives/administration & dosage , Anesthesia , Pain, Postoperative/prevention & control , Phospholipids/administration & dosage , Blood Pressure/drug effects , Soybean Oil/administration & dosage , Drug Administration Schedule , Confidence Intervals , Flurbiprofen/administration & dosage , Elective Surgical Procedures , Electroencephalography/drug effects , Emulsions/administration & dosage , Fat Emulsions, Intravenous/administration & dosage , Remifentanil/administration & dosage , Heart Rate/drug effects , Analgesics, Opioid , Middle Aged
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