Propofol infusion for sedation in the intensive care unit: preliminary report.

Propofol (2,6,di-isopropylphenol) was given by continuous intravenous infusion to provide sedation after cardiac surgery in 30 patients and its effects compared with those of midazolam given to a further 30 patients. Propofol infusion allowed rapid and accurate control of the level of sedation, which was satisfactory for longer than with midazolam. Patients given propofol recovered significantly more rapidly from their sedation once they had fulfilled the criteria for weaning from artificial ventilation and as a result spent a significantly shorter time attached to a ventilator. There were no serious complications in either group. Both medical and nursing staff considered the propofol infusion to be superior to midazolam in these patients. These findings suggest that propofol is a suitable replacement for etomidate and alphaxalone-alphadolone for sedating patients receiving intensive care.     

The General Anesthetic Propofol Enhances the Function of γ-Aminobutyric Acid-Coupled Chloride Channel in the Rat Cerebral Cortex

The effect of the general anesthetic propofol on t-[35S]butylbicyclophosphorothionate ([35S]TBPS) binding to unwashed membrane preparations from rat cerebral cortex was studied and compared to that of other general anesthetics (pentobarbital, alphaxalone) which are known to enhance GABAergic transmission. Propofol produced a concentration-dependent complete inhibition of [35S]TBPS binding, an effect similar to that induced by pentobarbital and alphaxalone, although these agents differ markedly in potency (alphaxalone greater than propofol greater than pentobarbital). The concomitant addition of propofol either with alphaxalone or pentobarbital produced an additive inhibition of [35S]TBPS binding, suggesting separate sites of action or different mechanisms of these drugs. Moreover, although bicuculline (0.1 microM) completely antagonized the propofol-induced inhibition of [35S]TBPS binding, the effect of this anesthetic was not due to a direct interaction with the gamma-aminobutyric acidA (GABAA) recognition site. In fact, propofol, like alphaxalone and pentobarbital, markedly enhanced [3H]GABA binding in the rat cerebral cortex. Finally, propofol was able to enhance [3H]GABA binding in membranes previously incubated with the specific chloride channel blocker picrotoxin. Taken together these data strongly suggest that propofol, like other anesthetics and positive modulators of GABAergic transmission, might exert its pharmacological effects by enhancing the function of the GABA-activated chloride channel.     

Propofol is cardioprotective in a clinically relevant model of normothermic blood cardioplegic arrest and cardiopulmonary bypass

The general anesthetic propofol has been shown to be cardioprotective. However, its benefits when used in cardioplegia during cardiac surgery have not been demonstrated. In this study, we investigated the effects of propofol on metabolic stress, cardiac function, and injury in a clinically relevant model of normothermic cardioplegic arrest and cardiopulmonary bypass. Twenty anesthetized pigs, randomized to propofol treatment (n = 8) and control (n = 12) groups, were surgically prepared for cardiopulmonary bypass (CPB) and cardioplegic arrest. Doses of warm blood cardioplegia were delivered at 15-min intervals during a 60-min aortic cross-clamped period. Propofol was continuously infused for the duration of CPB and was therefore present in blood cardioplegia. Myocardial biopsies were collected before, at the end of cardioplegic arrest, and 20 mins after the release of the aortic cross-clamp. Hemodynamic parameters were monitored and blood samples collected for cardiac troponin I measurements. Propofol infusion during CPB and before ischemia did not alter cardiac function or myocardial metabolism. Propofol treatment attenuated the changes in myocardial tissue levels of adenine nucleotides, lactate, and amino acids during ischemia and reduced cardiac troponin I release on reperfusion. Propofol treatment reduced measurable hemodynamic dysfunction after cardioplegic arrest when compared to untreated controls. In conclusion, propofol protects the heart from ischemia-reperfusion injury in a clinically relevant experimental model. Propofol may therefore be a useful adjunct to cardioplegic solutions as well as being an appropriate anesthetic for cardiac surgery.     

小型猪生物可降解支架置入术中不同麻醉方法的研究

目的比较两种不同麻醉方法对小型猪的麻醉效果。方法将12头小型猪随机分成两组,每组6头,一组是戊巴比妥钠复合氯胺酮静脉麻醉（Ⅰ组）,另一组是丙泊酚复合氯胺酮静脉麻醉（Ⅱ组）。麻醉后对动物实施心脏生物可降解支架置入术,观察动物麻醉起效时间、苏醒时间、麻醉效果、呼吸频率（RR）、心率（HR）、血氧饱和度（SpO2）及术后苏醒情况。结果两种方法麻醉后,动物分别在7.6±2.4 min（Ⅰ组）、2.4±1.4 min（Ⅱ组）进入麻醉状态（P〈0.05）。术后苏醒时间分别为30.8±8.8 min（Ⅰ组）、16.5±2.8min（Ⅱ组）（P〈0.05）,Ⅱ组动物比Ⅰ组动物苏醒平稳（P〈0.05）。两组心率及呼吸频率变化无明显差别,而氧饱和度在第10 min（Ⅰ组87%,Ⅱ组92%）和30 min（Ⅰ组94%,Ⅱ组89%）由于追加麻醉药后,两组值差异较大,但很快恢复正常。Ⅱ组麻醉效果较Ⅰ组麻醉效果好。结论两种麻醉方法均能达到良好的麻醉效果,丙泊酚复合氯胺酮麻醉较戊巴比妥钠复合氯胺酮麻醉的效果强且术后苏醒快,是一种比较理想的麻醉方法。     

联合用药靶控静脉麻醉在纤维支气管镜检查术中的麻醉效果分析

目的：分析纤维支气管镜检查术中丙泊酚联合右美托咪啶靶控静脉麻醉的效果,为临床麻醉提供参考。方法：选取73例行纤维支气管镜检查术的患者作为研究对象,按麻醉方式不同分为观察组38例（采用右美托咪啶联合丙泊酚麻醉）和对照组35例（单用丙泊酚麻醉）。观察分析各时点心率、呼吸次数、平均动脉压、血氧饱和度、镇静效果评分、苏醒时间以及不良反应发生率等指标。结果：Ramsay评分：对照组6分的例数为22例（62．9％）,观察组为32（84．2％）,差异有统计学意义;丙泊酚总用量：观察组为（334．5±54．6）mg,对照组为（463．2±60．5）mg,差异有统计学意义,医生满意度：观察组为92．1％,对照组为74.3％,差异有统计学意义。结论：丙泊酚联合右美托咪啶靶控静脉麻醉安全有效,效果显著,适合纤维支气管镜检查术。     

Propofol inhibits the myeloperoxidase activity by acting as substrate through a redox process

BackgroundPropofol (2,6-diisopropylphenol) is frequently used as intravenous anesthetic agent, especially in its injectable form (Diprivan), to initiate and maintain sedative state during surgery or in intensive care units. Numerous studies have reported the antioxidant and anti-inflammatory effect of propofol. The oxidant enzyme myeloperoxidase (MPO), released from activated neutrophils, plays a key role in host defense. An increase of the circulating MPO concentration has been observed in patients admitted in intensive care unit and presenting a systemic inflammatory response related to septic shock or trauma.MethodsThis study investigates the immunomodulatory action of propofol and Diprivan as inhibitor of the oxidant activity of MPO. The understanding of the redox action mechanism of propofol and Diprivan on the myeloperoxidase chlorination and peroxidase activities has been refined using the combination of fluorescence and absorption spectroscopies with docking and cyclic voltammetry.ResultsPropofol acts as a reversible MPO inhibitor. The molecule interacts as a reducing substrate in the peroxidase cycle and promotes the accumulation of compound II. At acidic pH (5.5), propofol and Diprivan do not inhibit the chlorination activity, but their action increases at physiological pH (7.4). The main inhibitory action of Diprivan could be attributed to its HOCl scavenging property.General significancePropofol can act as a reversible MPO inhibitor at clinical concentrations. This property could, in addition to other previously proven anti-inflammatory actions, induce an immunomodulatory action, beneficial during clinical use, particularly in the treatment of systemic inflammation response syndrome.     

Propofol anesthesia in children does not induce sister chromatid exchanges in lymphocytes

BACKGROUND: Propofol is frequently used for general anesthesia in children although little is known about possible genotoxic effects in humans. We investigated the formation of sister chromatid exchanges (SCE) in metaphase chromosomes of T-lymphocytes of children as a marker for possible genotoxocity following total intravenous anesthesia with propofol for minor surgical procedures. METHODS: 40 children ASA classification I-III were included (ASA I n=34, ASA II n=5, ASA III n=1) in the study. Anesthesia was induced by propofol (3mg/kg) and alfentanil. Succinylcholine or rocuronium were administered for muscle relaxation. After tracheal intubation anesthesia was maintained by continuous propofol infusion at 12 mg/(kgh). Blood samples were drawn before induction and after termination of anesthesia. Following a 72 h cell culture period, 25 T-lymphocyte metaphases per blood sample for all children were analyzed for SCE frequencies. RESULTS: Total intravenous anesthesia with propofol on children did not influence SCE rates in metaphase chromosomes of T-lymphocytes. No SCE differences could be detected between blood samples before initiation and after termination of anesthesia (Wilcoxon signed rank test). Slightly elevated SCE rates were obtained in T-lymphocytes of girls compared to boys, but these differences did not reach statistical significance. CONCLUSIONS: Propofol anesthesia under the chosen conditions did not induce the formation of SCE in children in vivo. No genotoxic effect of a short term exposure to propofol during pediatric anesthesia had been observed.     

Low-dose propofol infusion for sedation during local anesthesia

The safety and efficacy of lose-dose propofol for sedation were investigated on 90 consenting patients who had undergone surgical procedures with local anesthesia. After being premedicated with intravenous midazolam 0.05 mg.kg(-1), all patients were randomly divided into two groups and received intravenously either a loading dose of propofol 0.8 mg.kg(-1) followed by a continuous infusion of propofol 30 microg.kg(-1)min(-1) (propofol group) or an equivalent volume of saline (placebo group) during operation. Study groups were compared with respect to the level of sedation, hemodynamic variables, oxygen saturation, and the incidence of intraoperative side effects. In addition, the discharge time and the satisfaction of both patients and surgeons with this sedative technique were assessed. Propofol reduced patients' discomfort and lowered their arterial pressure and heart rate during the infiltration of local anesthetics. It also promoted an adequate level of sedation without clinically significant oxygen desaturation in the intraoperative period. Surgeons and patients in the propofol group showed a higher level of satisfaction than those in the placebo group. There was no significant difference between the two groups with regard to the incidence of adverse effects and the discharge time. In conclusion, it was found that the use of low-dose propofol infusion was a safe and effective sedative technique for local anesthesia.     

Propofol anesthesia in children does not induce sister chromatid exchanges in lymphocytes

Background: Propofol is frequently used for general anesthesia in children although little is known about possible genotoxic effects in humans. We investigated the formation of sister chromatid exchanges (SCE) in metaphase chromosomes of T-lymphocytes of children as a marker for possible genotoxocity following total intravenous anesthesia with propofol for minor surgical procedures.Methods: 40 children ASA classification I–III were included (ASA I n=34, ASA II n=5, ASA III n=1) in the study. Anesthesia was induced by propofol (3 mg/kg) and alfentanil. Succinylcholine or rocuronium were administered for muscle relaxation. After tracheal intubation anesthesia was maintained by continuos propofol infusion at 12 mg/(kg h). Blood samples were drawn before induction and after termination of anesthesia. Following a 72 h cell culture period, 25 T-lymphocyte metaphases per blood sample for all children were analyzed for SCE frequencies.Results: Total intravenous anesthesia with propofol on children did not influence SCE rates in metaphase chromosomes of T-lymphocytes. No SCE differences could be detected between blood samples before initiation and after termination of anesthesia (Wilcoxon signed rank test). Slightly elevated SCE rates were obtained in T-lymphocytes of girls compared to boys, but these differences did not reach statistical significance.Conclusions: Propofol anesthesia under the chosen conditions did not induce the formation of SCE in children in vivo. No genotoxic effect of a short term exposure to propofol during pediatric anesthesia had been observed.     

Diazepam and propofol used as anesthetics during open-heart surgery do not cause chromosomal aberrations in peripheral blood lymphocytes

Diazepam is a benzodiazepine with anticonvulsant, anxiolytic, sedative and muscle-relaxing properties. Many aspects of its toxicity have been investigated, including genotoxic and carcinogenic effects in various model systems. However, it is still unclear whether diazepam is in fact a genotoxic agent. Propofol is a rapid-onset, short-acting intravenous anesthetic agent. It is used widely for the induction and maintenance of anesthesia as well as for long-term sedation in intensive care units. There is limited information in the literature on its genotoxic effects. Both drugs are commonly used as anesthetic in patients undergoing open-heart surgery. Therefore, we investigated the possible genotoxic effects of propofol and diazepam in those patients, using a chromosomal aberration (CA) assay. Peripheral blood samples were collected from 45 patients before induction of anesthesia and at the end of the anesthesia with diazepam or propofol. In Group I (n=24), anesthesia was induced with 0.2 mg kg(-1) diazepam and 10 microg kg(-1) fentanyl. In Group II (n=21), anesthesia was induced with 1 mg kg(-1) propofol and 10 microg kg(-1) fentanyl. Pancuronium bromide (0.1 mg kg(-1)) was administered for skeletal muscle relaxation in both groups. Anesthesia was maintained by diazepam administration at 5 mg kg(-1) in Group I or by continuous propofol administration at 2-4 mg (kg h)(-1) in Group II. All patients received 0.02 mg kg(-1) pancuronium and 5 microg kg(-1) fentanyl boluses at 30-40 min intervals for anesthesia maintenance. Body temperature was controlled during bypass in the two groups. We found that the mean frequency of CAs in both groups before and at the end of the anesthesia were not statistically significantly different. Our analysis also indicated that age, smoking habit and gender were not confounding factors. In conclusion, our results indicate that diazepam and propofol do not exert genotoxic effects in blood cells during open-heart surgery.     

异丙酚对正常大鼠脊髓背角感觉神经元反应性的抑制作用

脊髓背角感觉神经元不仅在感觉信息的传递和调节中起到重要作用,也是各种内源性和外源性药物的作用靶位.为了解静脉麻醉剂异丙酚是否对背角感觉神经元的反应性具有调节作用,本实验采用在体单细胞胞外记录技术,观察了脊髓背表面直接滴注0.5 μmol异丙酚对戊巴比妥钠麻醉大鼠脊髓背角广动力域(WDR)神经元和低阈值机械感受型(LTM)神经元反应性的影响.实验发现,异丙酚能抑制背角WDR神经元由施加于外周感受野伤害性热刺激(45、47、49和53℃,15 s)和夹捏机械刺激(10 s)诱发的反应性,与DMSO对照组比较具有显著性统计学差异(P＜0.05);同样,异丙酚对非伤害性机械刺激诱发的WDR或LTM神经元的反应性也具有显著的抑制作用(P＜0.05).本结果提示,异丙酚可直接作用于正常大鼠脊髓背角神经元,对由非伤害性和伤害性纤维介导的神经元反应性均产生抑制作用,因此异丙酚的脊髓抗伤害作用可能不是特异性的.     

丙泊酚对全肝缺血再灌注大鼠脑损伤的保护作用及机制研究

目的:探究丙泊酚对全肝缺血再灌注(THIR)大鼠脑损伤的保护作用及机制.方法:选取72只健康成年雄性SD大鼠,将其按照抽签法分成假手术组、对照组以及丙泊酚组.所有大鼠予以12h禁食处理,采用3％戊巴比妥钠行腹腔注射麻醉处理,常规消毒后取上腹部正中切口进入腹腔.假手术组仅暴露肝门,不予以阻断处理.对照组与丙泊酚组则以无创...     

Evaluation of isoflurane and propofol anesthesia for intraabdominal transmitter placement in nesting female canvasback ducks

Heart rate, occurrence of apnea, body temperature, quality of anesthesia and nest abandonment were compared during either propofol or isoflurane anesthesia of nesting female canvasback ducks (Aythya valisineria) at 15 to 18 days of incubation. One hundred eighteen canvasbacks were assigned randomly to three treatments so that nest abandonment could be compared among treatments from May to July 1995 and 1996. Sterile dummy silicone implants were placed during an abdominal laparotomy while ducks were anesthetized with either propofol or isoflurane, or ducks were flushed from the nest but not captured (control). Propofol was delivered through an intravenous catheter, while isoflurane was delivered in oxygen. Propofol provided smooth, rapid induction and recovery, whereas ducks recovering from isoflurane tended to struggle. At the nest, ducks in the propofol group were given additional boluses until they were lightly anesthetized, whereas birds that received isoflurane were released. All birds survived surgery but one death occurred prior to surgery in 1995 using propofol during a period without ventilation and monitoring. Adequate artificial ventilation is recommended to prevent complications. Heart rate declined significantly in both years during isoflurane anesthesia and in 1995 during propofol anesthesia but not 1996. During both isoflurane and propofol anesthesia, body temperature declined significantly over time. Nest abandonment was significantly different among treatments and occurred in all treatment groups in both years, but propofol (15%) and control groups (8%) had lower than expected abandonment compared to isoflurane (28%). Propofol offers several advantages over isoflurane for field use; equipment is easily portable, lower anesthetic cost, and ambient temperature does not alter physical characteristics of the drug. Advantages over isoflurane, including lower nest abandonment following intraabdominal radio transmitter placement, make propofol a good anesthetic choice for field studies.     

The timing of propofol administration affects the effectiveness of remote ischemic preconditioning induced cardioprotection in rats

The cardioprotection of remote ischemic preconditioning (RIPC) is abolished under propofol maintained anesthesia. Transient receptor potential vanilloid 1 (TRPV1) channel is present in the heart, and its activation could induce cardioprotection. Therefore, we tested whether the anesthetic propofol administration phase interfered with the RIPC-induced cardioprotection, and RIPC-induced cardioprotection via the cardiac TRPV1 channel. Male Sprague-Dawley rats were subjected to myocardial 30 minutes of ischemia followed by 2 hours of reperfusion. RIPC consisted of three cycles of 5-minute ischemia/reperfusion applied to a hindlimb. Propofol infusion at 12 mg/kg/h was commenced either at 10 minutes before the start of RIPC in the P-pre + RIPC group, or immediately after myocardial ischemia at the onset of reperfusion (P-post + RIPC) while performing RIPC. These two propofol infusion regimes were applied to another two grou bs without RIPC (P-pre and P-post groups). Infarct size (IS) was assessed by triphenyltetrazolium staining. Heart TRPV1 expression was detected by Western blot and immunofluorescence. RIPC significantly reduced myocardial IS compared with the control group (36.7 ± 3% versus 57.2 ± 4%; P < .01). When propofol was started before RIPC, the IS sparing effect of RIPC was completely abolished. However, propofol infusion starting immediately after myocardial ischemia did not affect RIPC-induced cardioprotection. TRPV1 expression significant increase after RIPC, then propofol inhibited the TRPV1 activation of RIPC if given before RIPC but not after. Our results suggest that the timing of propofol administration is critical to preserve the cardioprotection of RIPC. Propofol might cancel RIPC-induced cardioprotection via the cardiac TRPV1 receptor.     

Effects of propofol on the development of cancer in humans

Cancer is one of most the significant threats to human health worldwide, and the primary method of treating solid tumours is surgery. Propofol, one of the most widely used intravenous anaesthetics in surgery, was found to be involved in many cancer‐related pathophysiology processes, mainly including anti‐tumour and minor cancer‐promoting effects in various types of cancer. An increasing number of studies have identified that propofol plays a role in cancer by regulating the expression of multiple signalling pathways, downstream molecules, microRNAs and long non‐coding RNAs. Emerging evidence has indicated that propofol can enhance the anti‐tumour effect of chemotherapeutic drugs or some small molecular compounds. Additionally, in vivo animal models have shown that propofol inhibits tumour growth and metastasis. Furthermore, most clinical trials indicate that propofol is associated with better survival outcomes in cancer patients after surgery. Propofol use is encouraged in cancers that appear to have a better prognosis after its use during surgery. We hope that future large and prospective multicenter studies will provide more precise answers to guide the choice of anaesthetics during cancer surgery.     

丙泊酚复合麻醉在实验犬外科手术中的效果观察

目的丙泊酚复合麻醉应用于实验犬外科手术,进行效果评价。方法成年健康杂种犬13只,雌雄不限。术前30 min肌内注射阿托品0.5 mg,吗啡10 mg,进行气管插管,静脉注射氯胺酮50 mg,静脉注射丙泊酚首次剂量5 mg/kg体重,维持剂量1 mg/kg。结果丙泊酚复合麻醉,平均麻醉起效时间40 s,首次剂量平均维持17.3min,重复给药平均维持13.6 min,无死亡。丙泊酚有较强的麻醉效果,诱导时间短,起效快,恢复快速平稳,而且无副作用。结论丙泊酚复合麻醉适合于犬的外科手术实验,是一种较为理想的麻醉方法。     

The effects of pentobarbital, fentanyl-droperidol, ketamine-xylazine and ketamine-diazepam on arterial blood pH, blood gases, mean arterial blood pressure and heart rate in adult male rats

Although anesthetics are known to cause respiratory and cardiovascular depression in humans, these adverse effects rarely have been investigated in laboratory rodents. This study evaluated the effects of four different injectable drugs, pentobarbital, fentanyl-droperidol (Innovar-Vet), ketamine-xylazine and ketamine-diazepam on the respiratory and cardiovascular systems of rats. Results showed marked acidosis, hypercarbia and hypoxia with high doses of Innovar-Vet, moderate respiratory depression with all dosages of pentobarbital and minimal respiratory depression with ketamine-xylazine and ketamine-diazepam. Innovar-Vet, ketamine-xylazine and pentobarbital caused profound hypotension, particularly at high dosages, while ketamine-diazepam caused the least depression in mean arterial blood pressure of all drugs evaluated. None of the drugs studied produced significant alterations in heart rate. Throughout all dosages investigated, the ketamine-diazepam combination showed the least overall effects on ventilation and perfusion of the four parenteral drug combinations studied.     

Ventilation and metabolism during propofol anesthesia in rats

Many anesthetics are known to decrease ventilation (V(E)) and metabolic rate (MR). Because MR is known to contribute to the V(E) level, one would expect some parallelism between the changes in V(E) and MR during anesthesia. We tested this hypothesis in normoxia and hypoxia (12% O2) on male Wistar rats (n = 10; 221-288 g) by using a short-acting intravenous anesthetic, propofol. Propofol anesthesia was induced with a 7-7.5 mg kg(-1) (60-70 s) dose and maintained with a 20-22 mg kg(-1) h(-1) (<40 min) dose. In normoxia, propofol significantly decreased V(E) and MR and maintained the V(E)/MR ratio. In hypoxia, propofol decreased MR without a significant decrease in V(E), and the V(E)/MR ratio tended to increase. As a result, both in normoxia and hypoxia, propofol did not significantly increase the partial pressure of CO2 in arterial blood (PaCO2). Propofol was also associated with decreased body temperature and mean arterial pressure. The results suggest that during anesthesia, a large part of the drop in V(E) can be accounted for by the drop in MR, and that in both normoxia and hypoxia the V(E)/MR ratios and PaCO2values are maintained close to the levels of the conscious state.     

Propofol suppresses proliferation,invasion, and migration of human melanoma cells via regulating microRNA-137 and fibroblast growth factor 9

Propofol is an intravenous anesthetic widely used in clinical surgeries, such as tumor resection. Propofol affects the growth of many cancers, though its effect on melanoma is unknown. Our study aimed to explore how propofol affects melanoma cells. Melanoma cells A2058 and WM793B were cultured with propofol for 24 hr. Propofol significantly suppressed proliferation, migration, and invasion of A2058 and WM793B cells. Lower miR-137 level was observed in A2058 and WM793B cells, compared with normal human epidermal melanocyte HEMa-LP cells. Propofol-induced miR-137 upregulation and decreased proliferation, invasive ability, and migrated ability of A2058 and WM793B cells. Transfection with the miR-137 inhibitor reversed these effects. Additionally, miR-137 was verified to target and negatively regulate fibroblast growth factor 9 (FGF9) expression. Propofol efficiently downregulated FGF9 protein expression by upregulating miR-137. Furthermore, FGF9 overexpression abrogated propofol's repressive effects on the malignant potential of A2058 and WM793B cells. These findings indicate that propofol suppressed melanoma cell proliferation, invasion, and migration by regulating miR-137 and FGF9.