Canadian Journal of Anaesthesia

, Volume 40, Issue 8, pp 730–747 | Cite as

Propofol in patients with cardiac disease

  • Norman R. Searle
  • Philippe Sahab
Reports of Investigation

Abstract

Propofol is an intravenous anaesthetic which is chemically un-related to other iv anaesthetics. Most anaesthetists are now becoming familiar with propofol’s pharmacokinetic and pharm-acodynamic properties. It has proved to be a reliable drug that can be used safely for induction and maintenance of anaesthesia for most surgical procedures and unlike other anaesthetic agents, it can especially be extended into the postoperative setting or intensive care unit for sedation. Propofol’s greatest attributes are its pharmacokinetic properties which result in a rapid, clear emergence and lack of cumulative effects even after prolonged administration. Compared with other iv anaesthetics, the induction dose of propofol has a relatively higher incidence of respiratory depression, short-lived apnoea and blood pressure reduction that may occasionally be marked. Possible mechanisms for the hypotension may relate to (1) its action on peripheral vasculature (vasodilatation), (2) decreased myocardial contractility, 3) resetting of the baroreflex activity and (4) inhibition of the sympathetic nervous system outflow. In vitro studies indicate that propofol depresses the immunological reaction to bacterial challenge as well as the chemotactic activity. Clinical studies, in cardiac surgery, have demonstrated that propofol, in association with an opioid, is a logical anaesthetic choice. Propofol is about to receive approval for continuous iv sedation. Comparative studies of propofol and midazolam have clearly demonstrated the superiority of propofol in terms of rapid recovery and precise control of the level of sedation.

Key words

anaesthesia: cardiac anaesthetics, intravenous: propofol pharmacology 

Glossary

BRP

Brain retraction pressure

CI

Cardiac index

CPB

Cardiopulmonary bypass

Vc

Central volume

CSFP

Cerebral spinal fluid pressure

CPP

Cerebral perfusion pressure

CBF

Cerebral blood flow

CVR

Cerebrovascular resistance

CABG

Coronary artery bypass surgery

ICU

Intensive care unit

ICP

Intracranial pressure

SVR

Systemic vascular resistance

Vd

Volume of distribution

Résumé

Le propofol est un nouvel agent anesthésique iv qui se distingue des autres agents par sa structure chimique. Les anesthésistes sont maintenant familiers avec les propriétés pharmacocinétiques et pharmacodynamiques du propofol. Il s’est révélé efficace et sécuritaire comme agent d’induction et de maintien de l’anesthésie pour diverses procédures chirurgicales. Contrairement aux autres anesthésiques iv, le propofol peut être retenu comme agent de sédation en période postopératoire ou pour faciliter la ventilation mécanique aux soins intensifs. Ses atouts principaux relèvent de ses propriétés pharmacocinétiques qui expliquent sa rapidité d’émergence et l’absence d’accumulation même à la suite d’une administration prolongée. En contrepartie, le propofol occasionne une plus grande incidence de dépression respiratoire, d’apnée et une chute de la tension artérielle qui, occasionnellement, peut être sévère. Les mécanismes probables pour expliquer cette chute de tension sont: 1) la vasodilatation périphérique (diminution des résistances périphériques), 2) la diminution de la contractilité myocardique, 3) un réajustement de l’activité des barorécepteurs et 4) une inhibition du système nerveux sympathique. Une dépression du système immunitaire peut se manifester à la suite d’une infusion prolongée. Des études in vitro suggèrent une dépression de la réponse immunologique ainsi qu’une diminution de la réponse chémotactique des leucocytes. Des études cliniques chez des patients subissant une chirurgie cardiaque ont démontré que le propofol, en association avec un opiacé, est une alternative anesthésique acceptable. Le propofol va recevoir l’approbation pour l’administration intraveineuse continue à visée sédative. Des études comparatives entre le propofol et le midazolam ont démontré la supériorité du propofol en termes de rapidité de récupération de l’anesthésie et du contrôle précis du niveau de sédation.

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Copyright information

© Canadian Anesthesiologists 1993

Authors and Affiliations

  • Norman R. Searle
    • 1
  • Philippe Sahab
    • 1
  1. 1.Department of AnaesthesiaMontreal Heart InstituteMontrealCanada

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