medigraphic.com
ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2007, Number 3

<< Back Next >>

An Med Asoc Med Hosp ABC 2007; 52 (3)

Prevention of hypotension and bradycardia during anesthetic induction with remifentanil and propofol

Rodríguez RJ, Revilla PF, Díaz AMA, Sánchez RJP, Boone EA, Zamora LJ, Gallardo AL

Language: Spanish
References: 19
Page: 118-123
PDF size: 122.12 Kb.


ABSTRACT

Anesthetic induction represents one of the periods of major cardiovascular instability. Hypotension, hypertension, tachycardia and bradycardia are considered important clinical problems that increase morbidity and mortality, therefore a need for anesthetic stability induction. Objective: To determine and to compare the effect of atropine on heart rate and blood pressure during anesthetic induction with remiphentanyl and propophol. Material and methods: Experimental, blind study controlled with placebo. Ninety ASA I patients were included, divided in three groups of 30 each. All patients were induced with 2.5 mg/kg propophol and 0.40 mg/kg/min remiphentanyl. One group was managed with 10 mg/kg atropine, another with 100 mg/kg ephedrine, the other with placebo before induction. Heart rate and blood pressure were evaluated every two minutes during 10 minutes. Results: Changes in cardiac frequency and blood pressure in the control group were statistically significant. No important changes were observed in cardiac frequency or blood pressure in either the atropine group or the ephedrine group, the changes between groups were statistically significant. Conclusions: Atropine or ephedrine are useful to prevent hypotension and bradycardia during anesthetic induction with remiphentanyl and propophol.


REFERENCES

  1. Rosow CE. Anesthetic drug interaction: An overview. J Clin Anesth 1997; 9: 275-325.

  2. Reich D, Hossain S, Krol M, Baez B, Patel P, Bernstein A, Bodian CA. Predictors of hypotension after induction of general anesthesia. Anesth Analg 2005; 101: 622-628.

  3. Reich DL, Bodian CA, Krol M, Kuroda M, Osinski T, Thys D. Intraoperative haemodynamic predictors of mortality, stroke and myocardial infarction following coronary artery bypass surgery. Anesth Analg 1999; 89: 814-822.

  4. Loeb RG. A measure of intraoperative attention to monitor displays. Anesth Analg 1993; 76: 337-341.

  5. De Souza G, Lewis MC, Ter RMF. Severe bradycardia alter remifentanil. Anesthesiology 1997; 87: 1019-1020.

  6. Wee LH, Moriarty A et al. Remifentanil infusion for major abdominal surgery in small infants. Paediatr Anaesth 2003; 9: 415-418.

  7. Roulleau P, Gall O, Desjeux L, Dagher C, Murat I. Remifentanil infusion for cleft palate surgery in young infants. Paediatr Anaesth 2003; 13: 701-707.

  8. Reitan JA, Stengert KB, Wymore ML, Martucci RW. Central vagal control of fentanil induced bradycardia during halothane anesthesia. Anesth Analg 1978; 57: 31-36.

  9. Hug CCJ, McLeskey CH, Nahrwold ML, Roizen MF, Stanley TH, Thisted RA, Walawander CA. Hemodynamic effects of propofol, data from over 25000 patients. Anesth Analg 1993; 77: 521-529.

  10. Monk CR, Prys-Roberts C, Turtle M. Hemodynamic effects of prolonged propofol infusions supplementing nitrous oxide anaesthesia for peripheral vascular surgery. Br J Anaesth 1987; 59: 954-960.

  11. Kanaya N, Murray PA, Dmron DS. Propofol and ketamine only inhibit intracellular calcium transients and contraction in rat ventricular myocytes at supraclinical concentrations. Anesthesiology 1998; 88: 781-791.

  12. Warner DS, Bradley HJ, Todd M. Intracranial pressure and hemodynamic effects of remifentanil versus alfentanil in patients undergoing supratentorial craniotomy. Anesth Analg 1996; 83: 348-353.

  13. Kazmaier S, Hanekop GG, Buhre W. Myocardial consequences of remifentanil in patients with coronary artery disease. Br J Anaesth 2000; 84: 578-583.

  14. Hall AP, Thompson JP, Leslie NA, Fox AJ, Kumar N, Rowbotham DJ. Comparison of different doses of remifentanil on the cardiovascular response to laryngoscopy and tracheal intubation. Br J Anaesth 2000; 84: 100-102.

  15. Sebel Hoke JF, Westmoreland C, Hug CC Jr, Muir KT, Szlam F. Histamine concentrations and hemodynamic responses after remifentanil. Anesth Analg 1995; 80: 990-993.

  16. Mc Coy EP, Maddineni VR, Elliott P, Mirakhur RK, Carson IW, Cooper RA. Haemodynamic effects of rocuronium during fentanyl anaesthesia; comparison with vecuronium. Can J Anaesth 1993; 40: 703-708.

  17. Horiguchi T, Nishikawa T. Heart rate response to intravenous atropine during propofol anesthesia. Anesth Analg 2002; 95: 389-392.

  18. Gamlin F, Vucevic M, Winslow L, Berridge J. The haemodynamic effects of propofol in combination with ephedrine. Anaesthesia 1996; 51 (5): 488-491.

  19. Meersschaert K, Brun L, Gourdin M, Mouren S, Bertrand M, Riou B, Coriat P. Terlipressin-ephedrine versus ephedrine to treat hypotension at the induction of anesthesia in patients chronically treated with angiotensin converting-enzyme inhibitors: A prospective, randomized, double-blinded, crossover study. Anesth Analg 2002; 94: 835-840.




2020     |     www.medigraphic.com