Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical effects of a propofol-alfentanil association were studied in fifteen patients ASA II (mean age 50.1 +/- 14.1) anaesthetized for E.N.T. endoscopy after informed consent. All the patients received an intramuscular premedication with 0.10 to 0.15 mg.kg-1 midazolam. Propofol 2.5 mg.kg-1 was injected in a peripheral venous line with alfentanil 10 micrograms.kg-1, followed by continuous automatic injection of propofol at a dose of 5 to 10 mg.kg.h-1 and alfentanil 5 micrograms.kg-1 given just before suspension. After induction and during maintenance of anaesthesia, the patients were allowed to breathe oxygen spontaneously O2 assisted when apneic. The following variables were studied before induction (to), after induction (t1), during suspension (t2) and when stopping the infusion (t3): haemodynamic parameters using an invasive method and blood gases. Statistical analysis was performed using the Student's test for paired samples. Surgical conditions and anaesthetic quality were good with early recovery of consciousness and return of all reflexes. After an initial period of cardio vascular depression, the haemodynamic parameters did not vary much during the anaesthesia and propofol-alfentanil appeared to limit considerably the hypertension due to laryngoscopy. However, there was a moderate degree of hypercapnia (p less than 0.001) in most patients, giving evidence of some respiratory depression and possibly a greater depth of anaesthesia than desirable. Indeed, the doses of alfentanil required seemed to be more important with propofol because of a probably interference between the two drugs; the doses of these drugs should therefore be modified according to the length of surgery.
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PMID:[Circulatory and respiratory repercussions to direct suspension laryngoscopy in the adult: value of a propofol-alfentanil combination]. 249 72

The new form of propofol gives the same haemodynamic effects as the old one (propofol diluted in cremophor EL). There are few experimental studies concerning the haemodynamic effects of propofol. In the dwarf pig, Glen and Turner found a fall in arterial blood pressure and peripheral resistances, whilst the heart rate and cardiac output rose. In man, studies have shown that propofol gives haemodynamic effects similar to the other intravenous anaesthetic drugs, and especially thiopentone. In subjects with a healthy heart, and for doses included between 1.5 and 2.5 mg X kg-1, propofol gave a 25 to 30% fall in arterial blood pressure. There are also a 20% fall in peripheral resistances and a small fall (10%) in cardiac output. Blood pressure returned to its initial level 3 to 5 min after the injection. The heart rate was not much changed, and rather slowed, perhaps because of central vagotonia. When propofol was used to maintain anaesthesia, either by repeat injections, or by infusion, with the patient breathing spontaneously and not undergoing painful stimuli, blood pressure and heart rate remained steady within 55 to 65% of their initial values. Propofol appeared to avoid to some extent the increase in blood pressure and heart rate seen during intubation. When propofol and fentanyl were used together, the cardiovascular effects were more pronounced than when they were used alone. Moreover, propofol appeared to limit to a large extent the hypertension due to intubation and sternotomy in patients undergoing aorto-coronary arterial graft surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hemodynamic effects of propofol]. 349 88

This study was undertaken to assess the effects of propofol (versus enflurane, fentanyl, and thiopental) on hemodynamic stability and recovery characteristics when used for maintenance of anesthesia during elective coronary artery bypass grafting (CABG) procedures. Ninety premedicated patients scheduled for elective coronary revascularization had anesthesia induced with fentanyl 25 micrograms/kg intravenously (i.v.). When the mean arterial blood pressure (MAP) increased 10% above preoperative baseline values, patients were randomized to receive one of four anesthetic treatments: enflurane, 0.25-2.0%; fentanyl, 10-20 micrograms/kg i.v. bolus doses; propofol, 50-250 micrograms.kg-1.min-1 i.v.; or thiopental, 100-750 micrograms.kg-1.min-1 i.v.. The maintenance anesthesia was titrated to achieve hemodynamic stability (i.e., maintain the MAP within 10% of the baseline values and heart rate [HR] within 20% of the baseline values). After bypass, anesthetic and cardiovascular drugs were titrated to maintain the MAP > 65 mm Hg and the cardiac index (CI) > 2.3 L.min-1.m-2. Recovery was assessed by noting the times at which patients first opened their eyes, responded to verbal communication, correctly responded to specific commands, underwent tracheal extubation, and were discharged from the intensive care unit (ICU). Although less intraoperative hypertension was noted in the propofol-treated patients (19 +/- 11 min vs 38 +/- 26 min, 30 +/- 24 min, and 30 +/- 23 min in the enflurane, fentanyl, and thiopental groups, respectively) (P = 0.04), the incidence of hypotension did not differ significantly among the groups. Vasopressor drugs were required more often during the prebypass period in fentanyl and propofol patients (4/22 and 5/23, respectively) compared to the thiopental group (0/21) (P < 0.05). During CPB, fentanyl-treated patients required vasoconstrictors more often than patients in the other three treatment groups (14/22 vs 6/24, 4/23, and 5/21 in the enflurane, propofol, and thiopental groups, respectively) (P < 0.01). Although fentanyl-treated patients had significantly greater requirements for inotropic support during weaning from CPB than propofol-treated patients (14/22 vs 7/23) (P < 0.038), there were no significant differences among the groups in the postbypass or ICU periods. Propofol-treated patients responded to verbal stimuli (2.1 +/- 1.3h vs 4.0 +/- 3.5h, 4.7 +/- 2.7h, and 5.6 +/- 3.6h in the enflurane, fentanyl, and thiopental groups, respectively) (P = 0.01) and followed commands earlier (propofol 7.3 +/- 5.2h vs enflurane 12.5 +/- 5.7h, fentanyl 13.1 +/- 6.6h, and thiopental 12.8 +/- 6.7 h) (P = 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The effects of anesthetic technique on the hemodynamic response and recovery profile in coronary revascularization patients. 748 74

Sedative and neuromuscular blocking (NMB) drugs are used to facilitate care of head trauma patients requiring mechanical ventilation or therapy of intracranial hypertension. Because no specific regimen is appropriate in all patients, drug selection and utilization exhibit significant regional variation. Sedatives are used to decrease anxiety and diminish awareness of noxious stimuli. Propofol offers particular promise in neurosurgical intensive care. NMB drugs are used in 1% to 10% or more of critically ill patients. Increasingly more information is available to guide the use of NMB drugs for patients suffering head trauma. Broad concerns about these drugs include their use as adjunctive therapy to control intracranial hypertension, the incidence of prolonged weakness or myopathy, the potential for direct neurologic toxicity, and their effect on outcome. Resolution of these issues will improve the use of sedative and NMB drugs in intensive care.
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PMID:Sedative and neuromuscular blocking drug use in critically ill patients with head injuries. 749 55

Propofol may be safely used in elderly patients provided that: hypovolaemia is corrected prior to procedure; a decrease in blood pressure of more than 25 per cent of the baseline value is treated with a sympathomimetic drug (e.g. ephedrine); bradycardia below 55 b.min-1 using atropine; not more than 5 mL (50 mg) of propofol are injected per minute; the induction dose does not exceed 1.5 mg.kg-1, with a possible further dose of 0.2 to 0.4 mg.kg-1, immediately prior to intubation; opioids are not administered before stabilization of blood pressure during the period proceeding intubation; nitrous oxide and halogenated anaesthetics are not used as long as haemodynamic parameters are unstable; the dose of beta-blockers, ACE inhibitors and calcium antagonists is decreased or the drugs discontinued prior to surgery, depending upon their effect and their duration of action, except in cases of unstable angina or severe hypertension.
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PMID:[Use of Diprivan in the elderly]. 787 47

This study explored the effectiveness of oral clonidine premedication in attenuating sympathetic activation, tachycardia, and hypertension triggered by desflurane. After institutional review board approval, informed consent was obtained from 15 young, healthy male volunteers. Heart rate (HR, electrocardiogram), mean arterial pressure (MAP, radial artery catheter), and central venous pressure (CVP, jugular vein) were monitored. Recordings of sympathetic nerve activity (SNA) were obtained from the peroneal nerve via percutaneously placed tungsten needles. After baseline recordings, subjects were randomized to receive either a placebo (n = 10) or 0.3 mg of clonidine (n = 9) per os (PO). One hour later, repeat recordings were obtained. Propofol (2.5 mg/kg) and vecuronium (0.15 mg/kg) were given intravenously. Ventilation via a mask (100% O2) was used to maintain normocarbia. Two minutes after propofol administration, the desflurane vaporizer was set at 3.6% (0.5 minimum alveolar anesthetic concentration [MAC]) and increased at 1-min intervals to 7.2% and 11% (1.0 and 1.5 MAC). After 10 min, the trachea was intubated and 20 min later steady-state neurocirculatory recordings were obtained at 5.4%, during the first 5 min after advancing the vaporizer from 5.4% to 11% ("transition"), and at 11%. Resting HR, MAP, and SNA were similar between the two groups. PO clonidine reduced SNA, CVP, and MAP but did not change HR. In both groups propofol decreased SNA and MAP, and increased HR. The administration of desflurane via a mask resulted in significant increases in SNA, HR, and MAP. Clonidine reduced the HR and MAP responses by approximately 30%-40% during induction and transition periods.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effects of clonidine on desflurane-mediated sympathoexcitation in humans. 789 34

This study was designed to investigate the influence of anaesthesia induced and maintained with propofol on the haemodynamic effects and the dose requirements of SNP during the course of induced hypotension. Twenty-four adult ASA physical status I patients undergoing middle ear surgery were randomly assigned to receive anaesthesia with either morphine, thiopentone, d-tubocurarine, halothane 0.6% end-tidal and N2O 70% in oxygen (group I n = 12), or morphine, propofol, d-tubocurarine, propofol infusion 108 micrograms.kg-1.min-1 and N2O in oxygen (group 2 n = 12). Mean arterial blood pressure (MAP) was reduced to 60-65 mmHg in all patients using a continuous infusion of sodium nitroprusside (SNP) 0.01%. Propofol produced a significant (17%) reduction in the MAP before institution of SNP infusion. This was related to a 24% reduction in the systemic vascular resistance index (SVRI). In the halothane group SVRI was significantly reduced during SNP infusion. Halothane anaesthesia was associated with significant reflex tachycardia in response to SNP induced hypotension. Eight patients in the halothane group (66%) required propranolol 0.5-3 mg to control tachycardia. Propofol anaesthesia attenuated significantly the reflex tachycardia in response to SNP induced hypotension. Two patients in the propofol group (16%) required 0.5 mg propranolol to control reflex tachycardia. The mean SNP dose requirements were 7.25 +/- 1.6 and 2.1 +/- 1.4 micrograms. kg-1.min-1 in the halothane and propofol groups, respectively (P < 0.0001). None of the patients in the two groups developed rebound hypertension following SNP withdrawal.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sodium nitroprusside induced hypotension: haemodynamic response and dose requirements during propofol or halothane anaesthesia. 821 18

This study was designed to evaluate the effects of propofol on mean arterial pressure (MAP) and systemic vascular resistance (SVR) during cardiopulmonary bypass (CPB). Twenty patients were divided randomly for administration of 2 mg.kg-1 propofol (group Propofol, n = 10) or 0.9% saline solution (group Control, n = 10) during CPB. The two groups were comparable with respect to sex, age, height, type of surgery (valvular or coronary), arterial hypertension and preoperative antihypertensive treatment. Only their weight and body surface area were significantly different (control group vs propofol group, respectively: 78.5 +/- 14.4 vs 64.7 +/- 7.7 kg, P < 0.05; and 1.85 +/- 0.2 vs 1.68 +/- 0.13 m2, P < 0.05). MAP, SVR and SVR index were significantly lower in the propofol group than in the control group at 10, 15 and 20 min of study, suggesting that the hypotensive effect of a bolus injection of propofol is due, at least in part, to a direct decrease in the SVR.
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PMID:Effects of propofol on mean arterial pressure and systemic vascular resistance during cardiopulmonary bypass. 835 64

Forty-two patients underwent cerebral aneurysm clipping at our institution in 1991, 35 with a ruptured aneurysm and 7 with an unruptured aneurysm. Preoperatively, 22 patients with a ruptured aneurysm were graded I or II according to the World Federation of Neurosurgical Societies and 21 underwent an operation on the first day. All underwent a standard cerebral protective general anesthesia, combining propofol with fentanyl, arterial normotension (mild hypertension with volume loading and/or dopamine during temporary clipping and once the aneurysm was secured), normocarbia or slight hypocarbia, brain relaxation with lumbar drainage, mannitol and propofol, and electroencephalogram burst suppression when temporary clipping (> or = 2 min) was required. Propofol doses for induction were 1.8 +/- 0.1 mg/kg (mean +/- standard error); for maintenance, doses were 86 +/- 3.5 micrograms/kg per min; and for burst suppression doses were 500 micrograms/kg per min. After clipping, the propofol dose rate was reduced to allow early recovery and neurological examination in the operating room. In 21 patients, temporary clipping was required for a mean duration of 8.8 +/- 1.3 minutes (range, 2-29); none of these patients deteriorated as compared with their preoperative neurological state. Twenty-four of the 42 patients (57%) had a Glasgow Coma Outcome Scale (GOS) score of 1, 7 patients had a GOS score of 2, 8 had a score of 3, and 3 had a score of 5. Thirty-two patients were extubated in the operating room with a mean GOS Score of 13.2 +/- 0.5, and 10 were extubated later in the intensive care unit.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Total intravenous anesthesia with propofol for burst suppression in cerebral aneurysm surgery: preliminary report of 42 patients. 843 62

The duration of action and cardiopulmonary effects of propofol (6.55 mg/kg intravenously), xylazine (0.8 mg/kg intramuscularly), medetomidine (30 micrograms/kg intramuscularly), xylazine plus propofol (3 mg/kg intravenously) and medetomidine plus propofol (3 mg/kg intravenously) were compared in dogs. A cannula inserted into a raised carotid artery before the drugs were given allowed the continuous recording of blood pressure and heart rate and the measurement of arterial pH, PCO2, PO2, bicarbonate and base balance. Xylazine and medetomidine premedication prolonged propofol anaesthesia in dogs. Propofol alone reduced blood pressure and transiently raised heart rate. The apnoea and hypoxaemia induced by propofol alone also occurred in the premedicated groups with hypoxaemia being most evident in the medetomidine/propofol group. Bradycardia was a common feature in all the dogs given xylazine or medetomidine, but hypertension was consistently recorded in all the dogs given medetomidine.
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PMID:Xylazine or medetomidine premedication before propofol anaesthesia. 848 49


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