Hernández PAL, Lozano OJ, Sánchez LJA, Bermúdez OMG, Gallardo HAG

Language: Spanish
References: 23
Page: 162-168
PDF size: 258.36 Kb.

ABSTRACT

Introduction: The usual doses of propofol for sedation in geriatric patients have been shown to actually induce general anesthesia, so a preclinical study calculated and validated by computer simulations specific doses for this population between 0.5 and 1 mg/kg/h. Objective: To carry out a clinical study to evaluate the efficacy and safety of these doses in cardiac patients with geriatrics during the placement of a definitive pacemaker. Material and methods: A randomized controlled clinical trial was carried out in patients older than 65 years, electively scheduled for definitive pacemaker placement. They were divided into three treatment groups, 2 mg/kg/h, 1 mg/kg/h and 0.5 mg/kg/h, no dose of propofol was administered in any group, administration was slow intravenous, closest to the venous catheter. Local anesthesia with lidocaine plus ropivacaine was performed at the site where the pacemaker generator was placed. Results: All the patients had moderate sedation corroborated by the BIS monitor, no patient presented hemodynamic instability and were discharged from hospital one hour after the procedure. Conclusion: The propofol doses tested in this study were safe and effective to maintain moderate sedation and hemodynamic stability in geriatric patients. Avoiding the loading dose of propofol in this population increases the anesthetic induction time, but avoids the risks of its side effects.

REFERENCES

1. Instituto Nacional de Estadística y Geografía. Esperanza de vida. Cuéntame INEGI. 2016.

2. Chung F, Mezei G, Tong D. Adverse events in ambulatory surgery. A comparison between elderly and younger patients. Can J Anaesth. 1999; 46 (4): 309-321.

3. AstraZeneca: Diprivan® (propofol) injectable emulsion for IV administration prescribing information. Wilmington, DE; 2001.

4. Ishii K, Makita T, Yamashita H, Matsunaga S, Akiyama D, Toba K et al. Total intravenous anesthesia with propofol is associated with a lower rate of postoperative delirium in comparison with sevoflurane anesthesia in elderly patients. J Clin Anesth. 2016; 33: 428-431.

5. Ozkose Z, Ercan B, Unal Y, Yardim S, Kaymaz M, Dogulu F et al. Inhalation versus total intravenous anesthesia for lumbar disc herniation: comparison of hemodynamic effects, recovery characteristics, and cost. J Neurosurg Anesthesiol. 2001; 13 (4): 296-302.

6. Goodchild CS, Serrao JM. Cardiovascular effects of propofol in the anaesthetized dog. Br J Anaesth. 1989; 63 (1): 87-92. doi: 10.1093/bja/63.1.87.

7. Ozaki M. The effects of propofol and midazolam on canine left ventricular contractility. Masui. 2002; 51 (6): 611-619.

8. Thomas SP, Thakkar J, Kovoor P, Thiagalingam A, Ross DL. Sedation for electrophysiological procedures. Pacing Clin Electrophysiol. 2014; 37 (6): 781-790. doi: 10.1111/pace.12370.

9. Hernandez-Perez AL, Gallardo-Hernandez AG, Ordoñez-Espinosa G, Martinez-Carrillo B, Bermudez-Ochoa MG, Revilla-Monsalve C et al. Significant and safe reduction of propofol sedation dose for geriatric population undergoing pacemaker implantation: randomized clinical trial. Aging Clin Exp Res. 2018; 30 (10): 1233-1239.

10. Gallardo-Hernandez AG, Hernandez-Perez AL, Ordoñez-Espinosa G, Sanchez-Lopez A, Revilla-Monsalve C, Islas-Andrade S. Clinical testing of propofol geriatic dose for sedation designed via in silico trial. Comput Methods Programs Biomed. 2016; 132: 21-27.

11. Sayfo S, Vakil KP, Alqaqa'a A, Flippin H, Bhakta D, Yadav AV et al. A retrospective analysis of proceduralist-directed, nurse-administered propofol sedation for implantable cardioverter-defibrillator procedures. Heart Rhythm. 2012; 9 (3): 342-346.

12. Lovett P, Gómez V, Hodge DO, Ladlie B. Propofol versus midazolam/fentanyl sedation for colonoscopy in the elderly patient population. J Perianesth Nurs. 2017; 32 (3): 210-214. doi: 10.1016/j.jopan.2015.12.012.

13. Priebe HJ. The aged cardiovascular risk patient. Br J Anaesth. 2000; 85 (5): 763-778.

14. Sieber FE, Gottshalk A, Zakriya KJ, Mears SC, Lee H. General anesthesia occurs frequently in elderly patients during propofol-based sedation and spinal anesthesia. J Clin Anesth. 2010; 22 (3): 179-183. doi: 10.1016/j.jclinane.2009.06.005.

15. Schnider TW, Minto CF, Shafer SL, Gambus PL, Andresen C, Goodale DB et al. The influence of age on propofol pharmacodynamics. Anesthesiology. 1999; 90 (6): 1502-1516.

16. Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010; 105 Suppl 1: i16-i23. doi: 10.1093/bja/aeq312.

17. Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth. 1970; 42 (6): 535-542.

18. McKeage K, Perry CM. Propofol: a review of its use in intensive care sedation of adults. CNS Drugs. 2003; 17 (4): 235-272.

19. Sepúlveda Voullieme PO, Abadía LL. Total intravenous anaesthesia in geriatrics: the example of propofol. Rev Esp Anestesiol Reanim. 2013; 60 (6): 327-335.

20. Pandya K, Patel MB, Natla J, Dhoble A, Habetler T, Holliday J et al. Predictors of hemodynamic compromise with propofol during defibrillator implantation: a single center experience. J Interv Card Electrophysiol. 2009; 25 (2): 145-151.

21. Kosowsky BD, Mufti SI, Grewal GS, Moon RH, Cashin WL, Pastore JO et al. Effect of local lidocaine anesthesia on ventricular escape intervals during permanent pacemaker implantation in patients with complete heart block. Am J Cardiol. 1983; 51 (1): 101-104.

22. Pineda-Díaz MV, Hernández-Carrillo MA, Gerardo-De La Cruz S, Hernández-Cruz MJ, Hernández-Pérez AL, Pineda-Díaz MV et al. Levobupivacaína comparada con ropivacaína para bloqueo caudal en pacientes pediátricos. Rev Mex Anest. 2004; 27 (3): 134-139.

23. Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Conscious sedation with propofol in elderly patients: a prospective evaluation. Aliment Pharmacol Ther. 2003; 17 (12): 1493-1501.

EVIDENCE LEVEL

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