Benefits Of Propofol Research Articles

Risks and Benefits of Propofol and Midazolam for Sedation during Upper Gastrointestinal Endoscopy in Egyptian Cirrhotic Patients

Risks and Benefits of Propofol and Midazolam for Sedation during Upper Gastrointestinal Endoscopy in Egyptian Cirrhotic Patients

The benefits of propofol on cancer treatment: Decipher its modulation code to immunocytes.

Anesthetics are essential for cancer surgery, but accumulated research have proven that some anesthetics promote the occurrence of certain cancers, leading to adverse effects in the lives of patients. Although anesthetic technology is mature, there is no golden drug selection standard for surgical cancer treatment. To afford the responsibility of human health, a more specific regimen for cancer resection is indeed necessary. Immunosuppression in oncologic surgery has an adverse influence on the outcomes of patients. The choice of anesthetic strategies influences perioperative immunity. Among anesthetics, propofol has shown positive effects on immunity. Apart from that, propofol's anticancer effect has been generally reported, which makes it more significant in oncologic surgery. However, the immunoregulative function of propofol is not reorganized well. Herein, we have summarized the impact of propofol on different immunocytes, proposed its potential mechanism for the positive effect on cancer immunity, and offered a conceivable hypothesis on its regulation to postoperative inflammation. We conclude that the priority of propofol is high in oncologic surgery and propofol may be a promising immunomodulatory drug for tumor therapy.

A Comparison of the Effects of Prolonged Infusion of Propofol 2% and 1% During Total Intravenous Anaesthesia Using Target-Controlled Infusion Technique for Elective Neurosurgery.

BackgroundTotal intravenous anaesthesia (TIVA) with a combination of target-controlled infusions (TCIs) of propofol and remifentanil has been advocated for a favourable neurosurgical outcome. Neurosurgical procedures often involve a prolonged duration and large cumulative infusion of propofol. This study compares the serial serum lipid profile, acid-base balance and lactate level of neurosurgical patients anaesthetised with TCIs of propofol at 2% versus 1%.MethodsA total of 74 patients who underwent an elective craniotomy under general anaesthesia were randomised into two groups: i) propofol 1% (n = 37) and ii) propofol 2% (n = 37). All patients were anaesthetised using TCIs of propofol and remifentanil. Serial lipid profiles (serum triglyceride [TG] and cholesterol levels) were taken at the baseline, upon cessation of propofol and at 2 h post-operation. The total dosage, volume used and syringe changes of both groups were also documented.ResultsThe total volume of propofol used was significantly lower in the 2% group than the 1% group (157.19 mL [SD = 77.14] versus 335.17 mL [SD = 174.27]; P = 0.005) and the frequency of syringe changes was also less in the 2% than the 1% group (2 [3] versus 6 [3]; P < 0.001). However, there were no significant differences between the two groups in terms of serial serum TG, cholesterol, the acid-base balance or the lactate level. There was also no significant correlation of lipid profile with cumulative dose or volume of propofol infused between the two groups.ConclusionBoth concentrations of propofol, 1% and 2%, were comparable in terms of the serial lipid profile, acid-base balance and lactate level during TIVA using TCIs for elective neurosurgery. The benefits of propofol at 2% were that a lower volume was used and there were fewer syringe changes, which could minimise anaesthesia interruption throughout surgery.

Propofol Promotes Ankle Fracture Healing in Children by Inhibiting Inflammatory Response.

BackgroundThe present study aimed to investigate the potential effects of propofol on ankle fracture healing in children and the underlying molecular mechanisms.Material/MethodsWe first detected the levels of inflammatory cytokines from peripheral blood in children with or without ankle fracture using quantitative real-time polymerase chain reaction (qRT-PCR) and ELISA assay. Then, effects of propofol on inflammatory response in MG-63 cells were investigated. MG-63 cells were pre-treated with or without propofol and then stimulated with 1 μM bradykinin (BK). The productions of cytokines from MG-63 cells were determined by using qRT-PCR and Western blot assay. The expression levels of p-p38, NF-κB p-p65, NLRP3, ASC, caspase-1, and COX-2 were measured by Western blot and/or qRT-PCR.ResultsThe results showed that, compared with the healthy children, the levels of tumor necrosis factor (TNF-α), interleukin (IL)-1β, and IL-6 were significantly up-regulated in children with fractured ankles. No cytotoxicity was observed in MG-63 cells after propofol treatment. BK treatment significantly enhanced TNF-α, IL-1β, and IL-6 expression levels, and these enhancements were reduced by propofol treatment in a dose-dependent manner. Moreover, BK-induced up-regulation of p-p38, NF-κB p-p65, NLRP3, ASC, caspase-1, and COX-2 was dose-dependently down-regulated by propofol treatment.ConclusionsPropofol prevents inflammation in MG-63 cells by regulating p38MAPK-NF-κB pathway, NLRP3 inflammasome, and COX-2 expression. Our findings indicate the benefits of propofol in fracture healing, and provide a more theoretical basis for the clinical treatment of fractures.

Propofol for sedation can shorten the duration of ED stay in joint reductions

BackgroundFor joint reductions, adequate sedation is often required. Propofol has increasingly been used for sedation in the emergency department (ED) in recent years. The benefits of propofol are the rapid onset of action and the short recovery time. However, whether these characteristics can shorten the duration of ED stay is not been proved. ObjectiveOur study retrospectively compared patients receiving propofol for sedation during joint reductions with those who received sedatives other than propofol. The primary objective was to compare the duration of ED stay between the 2 groups. The secondary outcomes were rate of adverse events and the success of the procedure. MethodsPatients were included if they had a dislocated joint requiring management in the ED. The following covariates were recorded on a standard form for each patient: age, sex, indication for procedural sedation, sedative used, pain medications used, physician levels, duration of ED stay, failed reduction, and adverse events. We further matched each patient in the propofol group to the patient in the nonpropofol group using a standard propensity score greedy-matching algorithm. The primary and secondary outcomes were compared accordingly. ResultsA total of 241 patients met our inclusion criteria and were enrolled for further analysis. In the propensity score assignment, 56 patients (28 in each group) were further selected. The duration of ED stay in the propofol group is significantly shorter compared with the nonpropofol group (127 vs 192 minutes, P = .0019). The successful reduction rate is higher in the propofol group (96.4% vs 64.3%, P = .002). The complication rate is similar in both groups (3.6% vs 0%, P = .313). ConclusionPropofol is a safe sedative with few complications and higher successful rates when applied in the joint reductions. It can also shorten the duration of ED stay.

Propofol Infusion Syndrome: Is There Any More Information?

With great interest, we read about the reports of death by Wysowski and Pollock1 regarding the use of propofol for long-term sedation in pediatric and adult patients. In this article, the authors present factors contributing to the so-called propofol infusion syndrome2 in a larger number of patients. Regarding these analyses, it is obvious that high doses of propofol (especially in children) and/or long-term administration are risk factors for development of propofol infusion syndrome. However, the incidence and pathophysiology3 of this syndrome are still controversial.The major problem regarding the incidence and etiology of propofol infusion syndrome is the lack of well-designed, systematic studies. Most previous studies were not adequately designed to give more insight into these issues.For example, Martin et al.4 investigated nine children receiving low doses of propofol (1–4 mg · kg−1 · h−1) for a limited duration (48 h) after cardiac surgery. They concluded that propofol may be used safely in the recommended doses and in combination with an opioid. However, the number of patients included in this study was too small to draw any conclusions about safety.In a second retrospective study, a total of 198 pediatric patients were included, from which 106 received propofol and 92 received other sedative agents.5 The propofol doses ranged between 0.4 and 30.0 mg · kg−1 · h−1, and the duration of treatment was between 30 min and 156 days. Regarding these large differences, a definite conclusion with respect to safety is impossible. The authors of a further retrospective analysis also concluded sedation with propofol might be safe6; however, 102 of 142 children received propofol for less than 24 h, and 133 for less than 48 h. Furthermore, maximum doses were limited to 3 mg · kg−1 · h−1.With respect to previous investigations, Wysowski and Pollock1 concluded that additional studies may be warranted to compare the risks and benefits of propofol with other sedative agents. However, this study has already been performed some years ago (trial 0859IL-0068), but the results were not presented adequately until now.* In this study, a total number of 327 mechanically ventilated pediatric intensive care unit patients were allocated to one of the following groups: sedation with 2% propofol (n = 113), 1% propofol (n = 109), and standard sedative agents (lorazepam, fentanyl, ketamine, pentobarbital, and so on; n = 105). The Pediatric Risk of Mortality scores for the three groups were not different. In the standard sedative agents group, mortality was 4%; patients treated with 1% propofol had 8% mortality; and those receiving 2% propofol had 12% mortality. Interpretation of these results is difficult because (1) no statistics are given, (2) information regarding the study design is limited, and (3) nearly half of the deaths came from one participating center.Recently, the manufacturer of Diprivan published an article presenting its view on safety of propofol as well as the pathophysiology of propofol infusion syndrome.7 This report mentions the above-presented trial, but unfortunately lacks further relevant information from this.This leads to two serious problems. First, without presentation of all data from trial 0859IL-0068, an interpretation of the results from this study and especially the mortality rates is significantly limited. Second, additional studies as proposed by Wysowski and Pollock1 may be impossible from an ethical point of view.Therefore, the complete information from trial 0859IL-0068 should be submitted to a peer-reviewed journal to enable presentation of all relevant data and to have the chance to get more insights into the effects and safety of propofol in (pediatric) intensive care medicine.

Reports of Death with Use of Propofol (Diprivan) for Nonprocedural (Long-term) Sedation and Literature Review

Reports of Death with Use of Propofol (Diprivan) for Nonprocedural (Long-term) Sedation and Literature Review