High dose propofol enhances red cell antioxidant capacity during CPB in humans.

PURPOSE: To compare low vs. high dose propofol and isoflurane on red cell RBC antioxidant capacity in patients during aortocoronary bypass surgery (ACBP). METHODS: Twenty-one patients, for ACBP, were anesthetized with sufentanil 0.5-10 microg x kg(-1) and isoflurane 0-2%; ISO = control; n = 7), or sufentanil 0.3 microg x kg(-1), propofol 1-2.5 mg x kg(-1) bolus then 100 microg x kg(-1) min(-1) before, and 50 microg x kg(-1) x min(-1) during CPB (LO; n = 7), or sufentanil 0.3 microg x kg(-1), propofol 2-2.5 mg x kg(-1) bolus then 200 microg x kg(-1) x min(-1) (HI; n = 7). Venous blood was drawn pre- and post-induction, after 30 min CPB, 5, 10, and 30 min of reperfusion, and 120 min post-CPB to measure red cell antioxidant capacity (malondialdehyde (MDA) production in response to oxidative challenge with t-butyl hydrogen peroxide) and plasma propofol concentration. Pre- induction blood samples were analyzed for antioxidant effects of nitrates on red cells. The tBHP concentration response curves for RBC MDA in ISO, LO and HI were determined. RESULTS: Preoperative nitrate therapy did not effect RBC MDA production. Perioperative RBC MDA production was similar in ISO and LO groups. Sustained intraoperative decrease in RBC MDA was seen with propofol 8.0+/-2.4 - 11.8+/-4.5 microg x ml(-1) in HI (P<0.05-0.0001). MDA production vs. log plasma propofol concentration was linear in HI dose. CONCLUSIONS: During CPB, RBC antioxidant capacity is enhanced and maintained with HI dose propofol. Propofol, at this dose, may prove useful in protecting against cardiopulmonary ischemia-reperfusion injury associated with ACBP.

Extension of sensory blockade after thoracic epidural administration of a test dose of lidocaine at three different levels.

UNLABELLED: To evaluate the relationship between the level of thoracic epidural injection and the extension of sensory blockade, we inserted radiopaque epidural catheters in 87 patients at the high (C7-T2, n = 28), mid (T3-5, n = 29) or low (T7-9, n = 30) thoracic levels. Fifteen minutes after the epidural administration of 60 mg of lidocaine, the mean (+/- SD) sensory block extension varied from 5.4 +/- 3.1 to 7.7 +/- 1.8 segments. The level of epidural puncture was a statistically significant factor in determining the cranial and caudal borders of sensory blockade (P = 0.0001, analysis of variance), but in determining for the total number of segments blocked. The number of blocked dermatomes located cranially of the puncture level increased significantly with descending injection site (P = 0.0001). We acquired chest radiographs in 61 patients to determine epidural catheter tip position. Direction of the epidural catheter tip was not a significant factor in determining the extension or borders of sensory blockade. We conclude that the extension of sensory blockade in thoracic epidural anesthesia is not influenced by the level of epidural puncture or catheter tip direction. There is, however, a more cranial spread of sensory blockade in the low thoracic region compared with the high thoracic region. IMPLICATIONS: After evaluating the extension and pattern of sensory blockade in high, mid, and low thoracic epidural analgesia, the authors suggest that it is safe to use similar dosage regimens in all three regions, and that in high thoracic epidural analgesia, it is important to insert the epidural catheter at the level of the intended cranial border of blockade.