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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to compare the effects of inhaled isoflurane and a constant infusion of propofol on maternal haemodynamics and uterine arterial and umbilical venous flows in pregnant ewes. Late term pregnant ewes (n = 5) were randomly assigned to receive either inhaled isoflurane or an intravenous infusion of propofol for 1 h, each on separate occasions. Maternal systemic arterial, right atrial and pulmonary arterial blood pressures, cardiac index, systemic vascular resistance index, stroke volume index, heart rate, and uterine arterial and umbilical venous flows were determined over the 1 h period of each treatment. Data were analysed using an univariate analysis of variance for repeated measures performed on the ranks of the data. Propofol anaesthetized ewes had significantly higher heart rate (P = 0.0040), mean arterial pressure (P = 0.0003) and cardiac index (P = 0.0475) compared to isoflurane anaesthetized ewes. There were no significant differences in uterine arterial flows, umbilical venous flows, or other measured variables. Continuous propofol infusions maintain maternal haemodynamics at significantly higher levels than does inhaled isoflurane, while uterine arterial and umbilical venous flows do not differ significantly.
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PMID:A comparison of the haemodynamic effects of propofol and isoflurane in pregnant ewes. 950 60

1. Extracardiac constraint and sensitivity to arterial pressure may be critical factors that limit the functional reserves of the developing fetal heart in utero. We hypothesise that extracardiac constraint is the predominant factor that limits fetal stroke volume (SV). To test this hypothesis we studied six chronically instrumented fetal sheep to determine the relative roles that extracardiac constraint and arterial pressure play in determining left ventricular (LV) function. 2. Pregnant ewes (128-131 days gestation, term = 147 days) were anaesthetised (5 mg kg(-1) Propofol I.V., then 1.5 % halothane, 50 % O(2), balance N(2)O by inhalation) and instrumented using sterile surgical techniques to record LV end-diastolic pressure (P(lved)), aortic pressure (P(ao)), pericardial pressure (P(per)), and LV SV. 3. After a minimum of 72 h recovery, LV function was assessed by altering fetal blood volume to vary P(lved). Ventricular function curves were generated using two measures of ventricular function, SV and stroke work index (SWI = SV x P(ao)), and two measures of ventricular filling, P(lved) and LV end-diastolic transmural pressure (P(lved,tm) = P(lved) - P(per)). 4. Although decreasing P(lved) from the resting level decreased SV, increasing P(lved) from the resting level did not increase SV because the ventricular function curve plateaued. This plateau was not explained solely by an increase in aortic pressure, as the plateau remained present in the SWI versus P(lved) curve. When extracardiac constraint was accounted for (SV against P(lved,tm)), the plateau was largely eliminated (approximately 80 %). The remaining portion of the plateau (approximately 20 %) was eliminated when both extracardiac constraint and arterial pressure were accounted for (SWI versus P(lved,tm)). 5. Thus, the major limitation upon LV function in the near-term fetus results from extracardiac constraint limiting ventricular filling while, at the same time, a much smaller limitation arises from increasing arterial pressure.
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PMID:Left ventricular stroke volume in the fetal sheep is limited by extracardiac constraint and arterial pressure. 1150 72

Pronounced decrease in arterial blood pressure during propofol or midazolam infusion for sedation of critically ill patients, has raised the possibility that they have a direct negative inotropic action. Accordingly, in the current study, changes in the left ventricular (LV) contractility were examined during i.v. infusion of these two sedatives in anesthetized dogs. Myocardial contractility was assessed with the slope (Ees) of the LV end-systolic pressure-volume relationship and the slope (Msw) of the LV end-diastolic volume-stroke work relationship. Propofol was administered at 5, 10 and 20 mg.kg-1.h-1, and midazolam at 0.3, 0.6 and 1.2 mg.kg-1.h-1 over 60 min. Propofol caused dose-dependent decrease in Ees (55 +/- 7 during the low dose to 27 +/- 3 mmHg.ml-1 during the high dose, P < 0.05) and in Msw (91 +/- 8 during the low dose to 67 +/- 6 erg.cm-3 x 10(-3) during the high dose, P < 0.05). Midazolam, also, decreased in Ees and Msw significantly. No significant differences were observed between three different doses of midazolam. It is concluded that propofol shows the dose-dependent inhibition of myocardial contractility, but midazolam induces dose-independent inhibition.
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PMID:[The effects of propofol and midazolam on canine left ventricular contractility]. 1213 49

The safety and efficacy of propofol, a new intravenous anesthetic agent, have been demonstrated in healthy patients. Twenty-one patients, ASA III-IV, undergoing elective myocardial revascularization, were randomly chosen to receive either propofol, 2.5 mg/kg, or thiamylal, 4 mg/kg. for the induction of anesthesia. Hemodynamics were recorded at one and three minutes after drug administration during spontaneous respiration. After the addition of halothane and pancuronium with controlled ventilation, measurements were made immediately prior to and one minute after intubation. Five patients were dropped from the study, four due to airway problems and one due to severe hypotension following an induction dose of propofol. Statistics were done using data from the remaining 16 patients, eight in each group. Administration of propofol resulted in significant decreases in mean arterial pressure (MAP), systemic vascular resistance (SVR), and left ventricular stroke work index (LVSWI); as well as an increase in heart rate (HR). These changes were further accentuated by the addition of halothane and pancuronium prior to intubation. Patients in the thiamylal group experienced no significant hemodynamic changes until halothane and pancuronium were added and controlled ventilation was instituted. With these additions, the thiamylal group showed significant decreases in MAP and LVSWI immediately prior to intubation. Both groups experienced significant increases in HR following intubation, but no evidence of myocardial ischemia was seen in either group. All other parameters returned toward control values. Propofol appeared to be safe and effective for the induction of anesthesia in this group of patients, although its hemodynamic effects were greater than those of thiamylal.
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PMID:Comparative hemodynamic effects of propofol and thiamylal sodium during anesthetic induction for myocardial revascularization. 1717 99

In a prospective, blind, randomised study, we examined the effects of midazolam-propofol co-induction on haemodynamic (blood pressure, heart rate and stroke volume) and heart rate variability. The latter was measured by spectral analysis using the maximum-entropy method to calculate the following: the low frequency component (LF), which reflects both the cardiac sympathetic and parasympathetic activity, the high frequency component (HF) and entropy, which reflects the cardiac parasympathetic activity, the total power (TP), calculated by the addition of LF and HF, and the LF/HF ratio, which reflects the balance between the cardiac sympathetic and parasympathetic nervous activity. Forty patients were randomly allocated to the propofol group and the midazolam-propofol group, and the parameters described above were calculated at baseline (T1), post induction (T2), after tracheal intubation (T3), and 3 min (T4) and 5 min after intubation (T5). Propofol was administered at 2.5 mg.kg(-1) in the propofol group and midazolam at 0.1 mg.kg(-1) followed by propofol at 1.5 mg.kg(-1) in the midazolam-propofol group for anaesthesia induction. Then, propofol was administered at 4-6 mg.kg(-1)propofol for maintenance in both groups. The midazolam-propofol group showed compensated haemodynamic changes, which were related to significant increases in the LF/HF ratio at T2, T4 and T5 (p = 0.011, 0.038 and 0.034). These results suggest that the midazolam-propofol combination yielded compensated modulatory effects on the cardiovascular system, including preserved baroreflex activity.
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PMID:Haemodynamic changes and heart rate variability during midazolam-propofol co-induction. 1750 33

So far, several treatment modalities have been attempted to brain protection in cases such as brain trauma, stroke or brain hemorrhage. However, a treatment method that the effect begins immediately and definitely helpful has not been discovered yet. In this study, we aimed to compare the effects of propofol and erythropoietin (Epo) on brain injury caused by oxidative stress and antioxidant properties of these agents after closed head injury (CHI) in rats. For this study, female Wistar Albino rats were divided into five groups: non-traumatic control group, trauma performed group CHI, trauma with propofol (100 mg/kg) intraperitoneally (i.p.), trauma with Epo (5000 U/kg) i.p. and trauma with propofol and Epo performed study groups. Twenty-four hours after CHI, rats were sacrificed and the brains were removed. Superoxide dismutase (SOD), catalase (CAT), xanthine oxidase (XO), nitric oxide (NO), and malondialdehyde (MDA) levels were measured in brain tissue. MDA and NO levels were decreased significantly in Groups Epo, Propofol and Epo+Propofol than Group CHI (p<0.01). XO activity was significantly lower in Group Epo than Group CHI (p<0.05). Epo and propofol decreased oxidative stress by decreasing MDA and NO level in brain tissue after CHI. However, combination of Epo and propofol has no significant beneficial advantage than Epo or propofol alone.
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PMID:Propofol and erythropoietin antioxidant properties in rat brain injured tissue. 1776 98

The deleterious effects of anesthetic agents in patients suffering from coronary artery disease are well known. The risk increases when a patient has compromised ventricular function. There is a paucity of literature regarding the choice of the suitable agent to avoid deleterious effects in such patients. The use of etomidate and propofol has been considered superior to other intravenous anesthetic agents in these groups of patients. The aim of the present study is to compare the hemodynamic effects of anesthesia induction with etomidate, thiopentone, propofol, and midazolam in patients with coronary artery disease and left ventricular dysfunction. This randomized clinical trail was conducted at the All Indian Institute of Medical Sciences, New Delhi, India. Sixty patients with coronary artery disease and left ventricular dysfunction (ejection fraction < 45%) scheduled for elective coronary artery bypass surgery participated in this study. After stabilization baseline hemodynamic data stroke volume variation and systemic vascular resistance index were recorded for all patients (Flo Trac TM sensor with Vigileo cardiac output monitor used for hemodynamic monitoring). The patients were randomly alloted to one of the four groups and the intravenous induction agent was administered for over 60-90 seconds (Group E--Etomidate 0.2 mg/Kg; Group M--Midazolam 0.15 mg/Kg; Group T--Thiopentone 5 mg/Kg; Group P--Propofol 1.5 mg/Kg). Hemodynamic data were recorded at one minute intervals starting from induction till seven minutes after intubation,--the end point of the present study. There was a significant decrease in the heart rate in comparison to the baseline(-7 to -15%, P = 0.001), mean arterial pressure (-27 to -32%, P = 0.001), cardiac index (-36 to -38%, P = 0.001), and stroke volume index (-27 to -34%, P = 0.001) after induction in all four groups. The hemodynamic response was similar in all the four groups. There was no significant change in central venous pressure and stroke volume variation (SVV) during induction and intubation, while the effects on the systemic vascular resistance index (SVRI) were variable. The midazolam group was the most effective in preventing intubation stress (tachycardia,hypertension). The change from baseline values in heart rate (+ 4%, P = 0.12) and mean arterial pressure (-1%, P = 0.77) after intubation were not statistically significant in the midazolam group. The etomidate group was the least effective of all the four groups in minimizing stress response, with statistically significant increase from baseline in both heart rate (P = 0.001) and mean arterial pressure (P = 0.001) at 1 minute after intubation. All the four anesthetic agents were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction despite a 30-40% decrease in the cardiac index. Clinician experience along with knowledge of the potential interactions (e.g., premedication, concurrent opioid use) is needed to determine hemodynamic stability during anesthetic induction in these patients with ventricular dysfunction.
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PMID:A randomized trial of anesthetic induction agents in patients with coronary artery disease and left ventricular dysfunction. 2119 85

This study tested the hypothesis that propofol is associated with a higher hepatic blood flow in humans compared with desflurane. Using a cross over study design, 10 patients received first propofol and then desflurane, and a further 10 patients received desflurane and then propofol. Blood flow index in the right and middle hepatic veins, stroke volume index and cardiac index were assessed by transoesophageal echocardiography. Mean arterial blood pressure, stroke volume index and cardiac index were the same in both groups. Propofol was associated with significantly greater blood flow index in the right hepatic vein (median (IQR [range]) 199 (146-237 [66-388]) vs. 149 (112-189 [42-309]) ml.min(-1).m(-2); p = 0.005) and middle hepatic vein (150 (122-191 [57-341]) vs. 125 (92-149 [47-362]) ml.min(-1).m(-2); p < 0.001) compared with desflurane. In routine clinical conditions, propofol anaesthesia was associated with significantly greater hepatic blood flow than desflurane anaesthesia.
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PMID:The effect of propofol and desflurane anaesthesia on human hepatic blood flow: a pilot study. 2086 May 55

We previously reported that propofol (20 mg/kg/h) post-conditioning provided acute (up to 24 h) neuroprotection in rats with transient middle cerebral artery occlusion. In this study, we extend these data by examining long-term protection and exploring underlying mechanisms involving AMPA receptor GluR2 subunit internalization. Rats were treated with propofol 20 mg/kg/h after 60 min of occlusion (beginning of reperfusion for 4 h). Propofol post-conditioning reduced infarct volume and improved spatial memory deficiencies (up to 28 days) induced by ischemia/reperfusion injury. Additionally, Propofol post-conditioning promoted neurogenesis in the dentate gyrus of hippocampus, as measured by bromodeoxyuridine and neuron-specific nuclear protein immunofluorescence-double staining at day 28 after reperfusion. Finally, propofol post-conditioning increased the surface expression of AMPA receptor GluR2 subunit, thus inhibited the internalization of this part until 28 days after stroke. In conclusion, our data suggest that propofol post-conditioning provides long-term protection against focal cerebral ischemia/reperfusion injury in rats. Furthermore, we found that the inhibition of AMPA receptor GluR2 subunit internalization may contributed to this long-term neuroprotection.
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PMID:Propofol post-conditioning induced long-term neuroprotection and reduced internalization of AMPAR GluR2 subunit in a rat model of focal cerebral ischemia/reperfusion. 2179 Jun 6

We experienced anesthetic management of a patient with Becker muscular dystrophy. He had advanced dilated cardiomyopathy and high serum CK in the preoperative examinations. Anesthesia was planned to avoid triggering malignant hyperthermia or rhabdomyolysis and hemodynamic changes. Propofol, remifentanil and a minimum dose of rocuronium bromide were used for anesthetic induction and maintainance. Arterial pressure, cardiac output and stroke volume variation were monitored by Flotrac sensor. There were no adverse events observed during the anesthetic management. In conclusion, total intravenous anesthesia with the administration of rocuronium and circulatory monitoring by Flotrac sensor could be safe and efficient for anesthetic management of patients with Becker muscular dystrophy.
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PMID:[Anesthetic management of a patient with Becker muscular dystrophy]. 2186 23


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