Sedative Effects Of Propofol Research Articles

Sedative effects of propofol and risk factors for excessive sedation in the endoscopic treatment of biliary and pancreatic diseases.

The safety and effectiveness of propofol in more complex endoscopic procedures, such as endoscopic retrograde cholangiopancreatography, remain unknown. Thus, we aimed to evaluate propofol sedation during endoscopic cholangiopancreatography, ultrasound-guided intervention, and gastroduodenal stenting and examine risk factors for excessive sedation. We retrospectively analyzed data from 870 patients who underwent endoscopic treatment with propofol sedation for biliary and pancreatic disease between October 2020 and September 2021. Sedation included propofol and fentanyl, with continuous monitoring of vital signs and the bispectral index. The assessed risk factors included age, complications, body mass index, treatment duration, and specialty. Distal bile duct treatment (n = 367), hilar bile duct treatment (n = 197), post-small-intestinal reconstruction treatment (n = 75), endoscopic ultrasound-guided intervention (n = 140), and gastrointestinal obstruction treatment (n = 91) were performed. The rates of excessive sedation, hypoxemia, and hypotension were 7.8%, 6.0%, and 1.8%, respectively. Post-small-intestinal reconstruction treatment had the highest incidence rate of excessive sedation (16%), whereas endoscopic ultrasound-guided intervention had the lowest incidence rate (4.3%). Multivariate analysis revealed significant associations between excessive sedation and comorbid sleep apnea, obesity, and prolonged procedural time. Obesity, sleep apnea syndrome, and prolonged procedure time are risk factors for excessive sedation related to propofol use. Thus, sedation techniques should be tailored for these patients.

Sedative Effect of Propofol on Children during Anesthesia Induction

Sedative Effect of Propofol on Children during Anesthesia Induction

Sedative effect of propofol and midazolam in surgery under spinal anaesthesia: A comparative study

Intravenous medications are invariably required to allay anxiety related to surgical procedures, in patients undergoing surgery under regional anesthesia. A thorough pre anaesthetic check up and details of the surgical procedure planned are necessary before administration of sedative agents to attain desirable levels of sedation and avoid unwanted adverse events. To observe, record and analyse sedative effect of intravenous Propofol and Midazolam in lower extremities and lower abdominal surgery scheduled under regional anesthesia techniques.: A single blinded comparative study conducted in tertiary care hospital of Gujarat. Sixty patients with no organic pathology & a moderate but definite systemic disturbance categorized into two groups labeled as propofol group (n=30) and Midazolam group (n=30) of either gender and shortlisted for surgery using subarachnoid block. Observer’s Assessment of Alertness/Sedation Scale (OAA/S Scale) and Ramsay sedation scale was used to assess effective sedation.: Basic patients characteristics, Mean age (SD) was 31.57 + 10.57 years in category I (P group) and 35.33 + 9.98 years in category II (M group) was comparable between the groups. In category I 16(53.3%) patients reached targeted sedation level in < 60 seconds, in group M 18 (60%) patients required 90-120 seconds to achieved the same level of sedation (p<0.001). Propofol gives rapid onset of sedation and faster recovery, while midazolam provides more hemodynamic stability in regional anesthesia.

Doxapram as an additive to propofol sedation for endoscopic retrograde cholangiopancreatography: a placebo-controlled, randomized, double-blinded study

BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) requires moderate to deep sedation, usually with propofol. Adverse effects of propofol sedation are relatively common, such as respiratory and cardiovascular depression. This study was conducted to determine if doxapram, a respiratory stimulant, could be used to reduce the incidence of respiratory depression.MethodsThis is a single-center, prospective randomized double-blind study performed in the endoscopy unit of Helsinki University Central Hospital. 56 patients were randomized in a 1:1 ratio to either receive doxapram as an initial 1 mg/kg bolus and an infusion of 1 mg/kg/h (group DOX) or placebo (group P) during propofol sedation for ERCP. Main outcome measures were apneic episodes and hypoxemia (SpO2 < 90%). Mann–Whitney test for continuous variables and Fisher’s exact test for discrete variables were used and mixed effects modeling to take into account repeated measurements on the same subject and comparing both changes within a group as a function of time and between the groups.ResultsThere were no statistically significant differences in apneic episodes (p = 0.18) or hypoxemia (p = 0.53) between the groups. There was a statistically significant rise in etCO2 levels in both groups, but the rise was smaller in group P. There was a statistically significant rise in Bispectral Index (p = 0.002) but not modified Observer’s Assessment of Agitation/Sedation (p = 0.21) in group P. There were no statistically significant differences in any other measured parameters.ConclusionsDoxapram was not effective in reducing respiratory depression caused by deep propofol sedation during ERCP. Further studies are warranted using different sedation protocols and dosing regimens.Clinical trial registration ClinicalTrials.gov ID NCT02171910.

Propofol for endotracheal intubation in neonates: a dose-finding trial

ObjectiveTo find propofol doses providing effective sedation without side effects in neonates of different gestational ages (GA) and postnatal ages (PNA).Design and settingProspective multicentere dose-finding study in 3 neonatal intensive...

Analysis of the clinical value of sufentanil combined with propofol in the treatment of anesthesia in children

Objective To explore the clinical value of combined treatment of sufentanil and propofol in children during anesthesia induction. Methods 72 children were selected, and they were randomly divided into three groups by full random allocation method: observation group A, observation group B and control group, 24 cases in each group.The observation group A was given intravenous infusion of sufentanil(0.01g·kg-1·min-1), the observation group B was given intravenous infusion of sufentanil (0.02g·kg-1·min-1), the control group was given intravenous saline infusion, then given propofol target controlled infusion after 30min.The bispectral index (BIS), propofol effect chamber (EC), OAA/S score and time of induction of anesthesia (LOC) time were recorded in the three groups. Results There was a significant correlation between BIS and propofol EC and OAA/S scores in the three groups, and there was a negative correlation between BIS and propofol EC (r=-0.82, -0.79, -0.88, all P 0.05]. The BIS of observation group B (78±5) was significantly higher than that of the observation group A and control group (t=6.12, 5.13, all P<0.01). Conclusion Sufentanil combined with propofol for anesthesia in children has a synergistic effect, which is beneficial to reduce the amount of propofol EC during anesthesia induction, shorten the time of LOC and enhance the sedative effect of propofol, and it is worthy of further clinical application. Key words: Sufentanil; Propofol; Anesthesia inductio; Child

Effects of propofol sedation on pacing thresholds : Results from an observational cohort study.

Propofol is one of the most commonly used intravenous anaesthetic drugs for surgical procedures. The use of propofol for sedation is also common practice during endoscopic procedures, electrophysiology studies, and ablation procedures, as well as pacemaker and defibrillator implantation. It was found that propofol alters the electrophysiologic properties of the heart and its conduction system. The effects of propofol on pacing thresholds are unknown and could have implications for pacemaker (PM) and defibrillator (ICD) implantation procedures, as well as sedation and anaesthesia in PM and ICD patients in general. We sought to investigate the effects of propofol sedation on atrial and right ventricular pacing thresholds in PM and ICD patients. A total of 50patients with PM, ICD, or cardiac resynchronization therapy (CRT) undergoing propofol sedation for electrophysiology (EP) investigation, transesophageal echocardiography (TEE), electrocardioversion (ECV), or bronchoscopy were included prospectively. Pacing thresholds, impedance, and sensing were assessed by device interrogation immediately prior to sedation and after the desired sedation depth was achieved by the administration of propofol. Mean atrial (0.68 V vs 0.77 V, p= 0.136) and mean right ventricular thresholds (0.90 V vs 0.93 V, p= 0.274) remained unchanged. Impedances and sensing remained unaffected in all patients. Propofol sedation did not affect pacing thresholds of atrial and right ventricular leads in this cohort of PM and ICD patients.

The feasibility of office-based propofol sedation for dental care in patients with intellectual disability by sedation practitioners.

The quality of oral health care for intellectually disabled patients is a significant challenge due to behavioral issues. Intravenous propofol sedation may be useful to relieve the anxiety and fear, and make dental procedures more acceptable. The aim of this study was to evaluate the safety and effectiveness of propofol sedation, by trained nonmedical sedation practitioners, during dental treatments in an office-based setting. Intellectually disabled patients (124) were subjected to restorative dental procedures and moderately sedated using intravenous propofol. Vital signs, cooperation of the patient, and sedation depth were continuously assessed. Propofol sedation was effective for dental treatment. All procedures resulted in a sufficient level of sedation without moderate or severe complications. Propofol sedation can be safely and effectively performed in an office-based setting by sedation practitioners, who have experience in propofol sedation and are trained in the care of patients with disabilities.

Effectiveness of remifentanil & propofol infusion for procedural sedation in patients undergoing gastrointestinal endoscopic procedures: a systematic review protocol

Effectiveness of remifentanil & propofol infusion for procedural sedation in patients undergoing gastrointestinal endoscopic procedures: a systematic review protocol

Safety and Effectiveness of Propofol Sedation during Endoscopic Retrograde Cholangiopancreatography

Objectives: Evidence of the safety and usefulness of propofol sedation during endoscopic retrograde cholangiopancreatography is presently insufficient; our study aimed to add such information. Methods: Patients were sedated using propofol or midazolam during endoscopic retrograde cholangiopancreatography. The safety and utility of the sedatives were compared. Safety parameters included examination cancellation rate, circulatory depression, and respiratory depression. Utility parameters included pain level, sedation tolerability rate, and bispectral index sedation level. Results: The propofol and midazolam groups contained 30 and 27 patients, respectively. No patient had an examination cancelled for sedation-related reasons. Blood pressure reduction (mmHg) was 24.1 ± 19.7 and 28.1 ± 20.7 in the midazolam and propofol groups, respectively, showing no significant difference. Pulse rate decrease (beats/min) was 2.4 ± 5.6 and 1.7 ± 4.5 in the propofol and midazolam groups, respectively, with no significant difference. Arterial carbon dioxide tension (mmHg) increased by 10.2 ± 6.5 and 10.8 ± 7.2 in the propofol and midazolam groups, respectively, showing no significant difference. Arterial oxygen saturation reduced by 2.9 ± 2.2% and 1.5±1.7% in the midazolam and propofol groups, respectively. The percentage of patients with <92% oxygen saturation showed no significant difference. The pain level was 0.9 ± 1.3 in the propofol group, and significantly lower than 2.4 ± 2.7 in the midazolam group. The sedation tolerability rate was 93.3% for propofol, and significantly higher than 74.1% for midazolam. The bispectral index (mean value/minimum value) was 75.1 ± 10.6/63.9 ± 12.1 for propofol, and significantly lower than 80.5 ± 4.2/72.0 ± 5.0 for midazolam. Conclusions: Propofol sedation had similar safety and superior efficacy to midazolam. Stepwise adjustments of propofol dosage likely result in safer sedation.

The emergence profile of propofol sedation compared with dexmedetomidine injection during ultrasound-guided oocyte pickup for in-vitro fertilization

Background The purpose of this study was to assess the quality, the recovery, and side effects of propofol sedation compared with dexmedetomidine in a very short minimally invasive procedure such as ultrasound-guided oocyte pickup for in-vitro fertilization. Patients and methods Sixty-two female patients undergoing 'ultrasound-guided oocyte pickup' were randomly enrolled in the study, conducted in a specialized center (Elite Fertility Center, Cairo, Egypt). The emergence profile of sedation with propofol+fentanyl versus dexmedetomidine +fentanyl was compared. The sedation level was assessed and titrated to an Observer's Assessment of Alertness/Sedation (OAAS) score of 1-2 (responds only after mild prodding or no response to prodding or shaking). Recovery was assessed objectively by OAAS and subjectively by visual analog scale (VAS). Results There is no significant difference in intraoperative parameters regarding the heart rate, the mean arterial blood pressure, the respiratory rate, and SpaO 2 between group D (dexmedetomidine) and group P (propofol). Yet the induction time to the desired level of sedation was significantly shorter in group P compared with group D. Most of the group D patients returned postoperatively to an OAAS score of 5 earlier than group P patients. Group D showed a significantly lower VAS as compared with group P at 1 and 2 h postoperatively, whereas there was no significant difference in the VAS between the two groups at 3 h postoperatively. Conclusion Both propofol and dexmedetomidine are useful and safe for short-period procedural sedation; yet dexmedetomidine has a more rapid induction time of sedation than propofol, better analgesic effect with similar hemodynamic effects, better preservation of respiratory function, and rapid recovery. Thus, dexmedetomidine is a good alternative for short-period procedural sedation such as in ultrasound-guided oocyte pickup.

The comparison of evaluation on the sedative effects of two drugs by cerebral state index during spinal anesthesia

Objective To investigate the feasibility of cerebral state index (CSI) in monitoring of sedation via observing the sedative effects of propofol or midazolam during spinal anesthesia.Mothods Forty patients undergoing lower abdominal or limb operation under spinal anesthesia were randomly divided into group Ⅰ and group Ⅱ (n=20).The patients were intravenously administered with propofol (group Ⅰ) or midazolam (group Ⅱ) respectively.Observer's assessment of alertness/sedation score (OAA/S),CSI,blood pressure (BP),pulse oxygen saturation (SpO2)were recorded.Drug injection was stopped when SpO2 is lower than 92％.Results Before SpO2 is lower than 92％,OAA/S scores of all the patients of group Ⅰ were 1.In group Ⅱ,6 patients got 2,2 patients got 1 while the others' scores were 3.With the decreasing of OAA/S scores,the corresponding CSI,systolic blood pressure (SBP),diastolic blood pressure (DBP) and SpO2 were significantly decreased in two groups(P＜0.05).When the OAA/S score is not less than 3,the correlation coefficient of OAA/S score and CSI was 0.745 in group Ⅰ (P＜0.01) and 0.684 in group Ⅱ (P＜0.01) respectively.There were no significant differences of correlation coefficient between the two groups.When the OAA/S score is less than 3,the correlation coefficient of OAA/S score and CSI was 0.672 in group Ⅰ (P＜0.01).Conclusions CSI can be used to monitor sedation with propofol or midazolam in spinal ansthesia,and can better reflect the dynamic changes of sedation depth. Key words: Propofol; Midazolam; Sedation; Spinal Anesthesia; Cerebral state index

Effect of ovarian cycle on sedative effect of propofol

Objective To investigate the effect of ovarian cycle on the sedative effect of propofol in patients. Methods Forty ASA Ⅰ or Ⅱ patients, aged 20-40 yr, with body mass index 20-25 kg/m2 , scheduled for elective gynecologic laparoscopic surgery, were divided into 2 groups according to the progesterone level ( n = 20 each): follicular phase group (group F, serum progesterone concentration 0.31-1.52 ng/ml) and luteal phase group (group L, serum progesterone concentration 5.16-18.56 ng/ml). Anesthesia was induced with target-controlled infusion (TCI) of propofol and iv injection of fentanyl and cisatracurium. The initial target plasma concentration (Cp) of propofol was set at 2 μg/ml, after the Cp reached the predetermined level, the Cp increased by 0.5 μg/ml every 30 s until the patients lost consciousness and BIS value was decreased to 50. The BIS value and Cp of propofol was recorded when the patients lost consciousness. The Cp of propofol was also recorded when BIS value was decreased to 50. The patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with TCI of propofol combined with remifentanil. BIS value was maintained at 45-55 by adjusting the Cp of propofol. Results The Cps of propofol were significantly higher when the patients lost consciousness and when BIS value was decreased to 50 in group F than in group L ( P ＜ 0.05 or 0.01) . There was no significant difference in BIS value when the patients lost consciousness between the two groups (P ＞ 0.05). Conclusion Ovarian cycle can affect the sedative effect of propofol in patients, which shows that the sedative effect during the follicular phase is lower than that during the luteal phase. Key words: Menstrual cycle; Propofol; Conscious sedation

Effects of different target effect-site concentrations of remifentanil on the sedative effect of propofol

Objective To investigate the effects of different target effect-site concentrations (Ces) of remifentanil on the sedative effect of propofol. Methods Fifty ASA Ⅰ or Ⅱ patients aged 20-55 yr weighing 48-86 kg with body mass index ＜ 30 kg/m2 were randomly divided into 5 groups ( n = 10 each) . Anesthesia was induced with TCI of remifentanil (Ce = 0, 2, 4, 6 and 8 ng/ml in groups R0-R4 respectively) and propofol. The initial Ce of propofol was 2.0 μg/ml in the 5 groups, and then the Ce of propofol increased by 0.5 μg/ml every 1 min until BIS value decreased to 50. BIS value and Ce of propofol were recorded as the patient lost consciousness. The effect-site concentration and consumption of propofol and the time required were recorded when BIS value decreased to 50.Results BIS value was significantly increased, while the effect-site concentration of propofol was significantly decreased as the patient lost consciousness, and the effect-site concentration and consumption of propofol were significantly decreased and the time required was shortened when BIS value decreased to 50 in R2-R4 groups compared with group R0 (P ＜ 0.05 or 0.01) . Conclusion The sedative effect of propofol can be enhanced when the Ce of remifentanil reaches 4 ng/ml, and the effects are comparable when the Ce of remifentanil reaches 4, 6 and 8 ng/ml. Key words: Piperidines; Propofol; Conscious sedation; Drug delivery system

Propofol-induced violent coughing in a patient with Becker′s muscular dystrophy

Propofol anesthesia is often associated with decreased incidence of gagging, coughing or laryngospasm, and provides intense suppression on airway reflex during tracheal intubation and laryngeal mask airway insertion. Propofol pretreatment is also effective in reducing the occurrence of opioid-induced coughing. These benefits are often attributed to bronchodilator and sedative effects of propofol. However, severe coughing following sedative doses of 1% propofol has not been reported so far. We report a rare case of violent coughing following low-dose propofol infusion in a patient with Becker's muscular dystrophy.

Effect of different target plasma concentrations of remifentanil on sedative effect of propofol

Objective To investigate the effect of different target plasma concentrations (Cp) of remifentanil on sedative effect of propofol. Methods Eighty adult ASA Ⅰ or Ⅱ patients aged 18-60 yr undergoing elective laparoscopic cholecystectomy were randomly assigned into 4 groups (n = 20 each). Anesthesia was induced with TCI of remifentanil (Cp = 2, 4 and 8 ng/ml in group Ⅱ-Ⅳ respectively) and propofol TCI (the initial Cp of propofol was 2 μg/ml in the 4 groups). Then the Cp of propofol increased by 0.5 μg/ml every 1 min until BIS value decreased to 50. BIS value and the Cp of propofol were recorded as the patient lost consciousness.The Cp and consumption of propofol were recorded when BIS value decreased to 50. Results BIS value was significantly increased, while the Cp of propofol was significantly decreased as the patient lost consciousness, and the Cp and consumption of propofol were significantly decreased when BIS value decreased to 50 in group Ⅲ - Ⅳ compared with group Ⅰ (P ＜ 0.05). Conclusion Remifentanil 4 ng/ml is the suitable Cp for anesthesia when combined with propofol. Key words: Piperidines; Propofol; Conscious sedation; Drug delivery systems

Sedative effects of propofol in horses

ObjectiveWe hypothesized that propofol can produce rapidly-reversible, dose-dependent standing sedation in horses. Study designProspective randomized, blinded, experimental trial. AnimalsTwelve healthy horses aged 12 ± 6 years (mean ± SD), weighing 565 ± 20 kg, and with an equal distribution of mares and geldings. MethodsPropofol was administered as an intravenous bolus at one of three randomized doses (0.20, 0.35 and 0.50 mg kg−1). Cardiovascular and behavioral measurements were made by a single investigator, who was blinded to treatment dose, at 3 minute intervals until subjective behavior scores returned to pre-sedation baseline values. Continuous data were analyzed over time using repeated-measures anova and noncontinuous data were analyzed using Friedman tests. ResultsThere were no significant propofol dose or temporal effects on heart rate, respiratory rate, vertical head height, or jugular venous blood gases (pHv, PvO2, PvCO2). The 0.35 mg kg−1 dose caused mild sedation lasting up to 6 minutes. The 0.50 mg kg−1 dose increased sedation depth and duration, but with increased ataxia and apparent muscle weakness. Conclusions and clinical relevanceIntravenous 0.35 mg kg−1 propofol provided brief, mild sedation in horses. Caution is warranted at higher doses due to increased risk of ataxia.

Sedative effect of propofol used in mechanical ventilation patients in the exacerbation of chronic obstructive pulmonary disease

Objective To investigate the effect of propofol used in mechanical ventilation patients in the exacerbation of chronic obstructive pulmonary disease(COPD). Methods 35 patients who received mechanical ventilation and sedated by propofol were observed in the exacerbation of COPD. The time to get Ramsay sedation level Ⅲ～Ⅳ was observed. The parameters of pneusis and eirculation before ,after giving propofol and withdrawl were compared.Results The sedative time of propofol was (51.3±3. 80) seconds. In the most time(85% ) ,the level of Ramsay sedation was maintained at Ⅲ～Ⅳ after the usage of propofol. The time of awake from anesthesia was (5.8±4. 9) minutes, and the patients had no adverse reactions. The blood pressure, heart rate of patients were stable. And the parameters of respiratory rate,SaO2 ,arterial partial pressure of oxygen and partial pressure of carbon dioxide in artery were improved significantly( P＜0. 05 ). Conclusion The sedative effect of propofol is safe and effective in patients required mechanical ventilation in the exacerbation of COPD. Key words: Propofol; The exacerbation of chronic obstructive pulmonary disease; Ventilators

6: The effect of propofol sedation on body temperature change during spinal anesthesia

6: The effect of propofol sedation on body temperature change during spinal anesthesia

The effect of propofol sedation on body temperature change during spinal anesthesia

The effect of propofol sedation on body temperature change during spinal anesthesia