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Indian Journal of Pharmacology 2016Pain on propofol injection (POPI) is a minor problem that all anesthetists face every day. Introduction of several new formulations and hundreds of clinical trials have... (Review)
Review
Pain on propofol injection (POPI) is a minor problem that all anesthetists face every day. Introduction of several new formulations and hundreds of clinical trials have failed to find its remedy with just one intervention in all patients. This article highlights the causes of POPI and interventions that are used to eliminate this pain in current practice. Relevant articles from Medline and Embase databases were searched and included in this descriptive review with the following conclusions: (1) POPI is due to irritation of venous adventitia leading to release of mediators such as kininogen from kinin cascade. (2) When two or more drugs or measures are used, the incidence of POPI decreases considerably. Hence, the approach to eliminating POPI should be multimodal. (3) Any regimen that includes a drug having local anesthetic effect combined with central sedative/analgesic and rapid injection into a large vein should definitely reduce the risk of POPI to negligible levels.
Topics: Anesthetics, Intravenous; Drug Compounding; Humans; Injections, Intravenous; Pain; Propofol
PubMed: 28066096
DOI: 10.4103/0253-7613.194845 -
BMC Anesthesiology Jun 2018Breast cancer is the second leading cause of cancer death in women. Surgery is the first line of treatment for breast cancer. Retrospective clinical studies suggest that... (Review)
Review
Breast cancer is the second leading cause of cancer death in women. Surgery is the first line of treatment for breast cancer. Retrospective clinical studies suggest that the type of anesthesia administered during oncological surgery may influence patient outcome. Propofol, the widely used intravenous anesthetic agent, may lead to better outcomes compared to volatile anesthetics. Here we review the literature on the effect of propofol in breast cancer cells, the immune system, pain management, and patient outcomes. Evidence from the study of breast cancer cell lines suggests that high concentrations of propofol have both anti-tumor and pro-tumor effects. Propofol and volatile anesthetics have different effects on the immune system. Propofol has also been shown to reduce the development and severity of acute and chronic pain following surgery. Although a retrospective study that included many types of cancer indicated that propofol increases the long-term survival of patients following surgery, the evidence for this in breast cancer is weak. It has been shown that Propofol combined with paravertebral block led to change of serum composition that affects the breast cancer cell behaviors and natural killer cell activity. Prospective studies are in progress and will be finished within 5 years. The existing evidence is not sufficient to warrant changes to current anesthetic management. Further research is needed to clarify the mechanisms by which propofol affects cancer cells and the immune system.
Topics: Anesthetics, Intravenous; Breast Neoplasms; Cell Line, Tumor; Humans; Immune System; Pain Management; Propofol; Treatment Outcome
PubMed: 29945542
DOI: 10.1186/s12871-018-0543-3 -
The Veterinary Clinics of North... May 1999Although questions may still remain regarding the use of this unique sedative-hypnotic drug with anesthetic properties in high-risk patients, our studies have provided... (Review)
Review
Although questions may still remain regarding the use of this unique sedative-hypnotic drug with anesthetic properties in high-risk patients, our studies have provided cardiopulmonary and neurological evidence of the efficacy and safety of propofol when used as an anesthetic under normal and selected impaired conditions in the dog. 1. Propofol can be safely and effectively used for the induction and maintenance of anesthesia in normal healthy dogs. Propofol is also a reliable and safe anesthetic agent when used during induced cardiovascular and pulmonary-impaired conditions without surgery. The propofol requirements to induce the safe and prompt induction of anesthesia prior to inhalant anesthesia with and without surgery have been determined. 2. The favorable recovery profile associated with propofol offers advantages over traditional anesthetics in clinical situations in which rapid recovery is important. Also, propofol compatibility with a large variety of preanesthetics may increase its use as a safe and reliable i.v. anesthetic for the induction and maintenance of general anesthesia and sedation in small animal veterinary practice. Although propofol has proven to be a valuable adjuvant during short ambulatory procedures, its use for the maintenance of general anesthesia has been questioned for surgery lasting more than 1 hour because of increased cost and marginal differences in recovery times compared with those of standard inhalant or balanced anesthetic techniques. When propofol is used for the maintenance of anesthesia in combination with a sedative/analgesic, the quality of anesthesia is improved as well as the ease with which the practitioner can titrate propofol; therefore, practitioners are able to use i.v. anesthetic techniques more effectively in their clinical practices. 3. Propofol can induce significant depression of respiratory function, characterized by a reduction in the rate of respiration. Potent alpha 2 sedative/analgesics (e.g., xylazine, medetomidine) or opioids (e.g., oxymorphone, butorphanol) increase the probability of respiratory depression during anesthesia. Appropriate consideration of dose reduction and speed of administration of propofol reduces the degree of depression. Cardiovascular changes induced by propofol administration consist of a slight decrease in arterial blood pressures (systolic, mean, diastolic) without a compensatory increase in heart rate. Selective premedicants markedly modify this characteristic response. 4. When coupled with subjective responses to painful stimuli, EEG responses during propofol anesthesia provide clear evidence that satisfactory anesthesia has been achieved in experimental dogs. When propofol is used as the only anesthetic agent, a higher dose is required to induce an equipotent level of CNS depression compared with the situation when dogs are premedicated. 5. The propofol induction dose requirement should be appropriately decreased by 20% to 80% when propofol is administered in combination with sedative or analgesic agents as part of a balanced technique as well as in elderly and debilitated patients. As a general recommendation, the dose of propofol should always be carefully titrated against the needs and responses of the individual patient, as there is considerable variability in anesthetic requirements among patients. Because propofol does not have marked analgesic effects and its metabolism is rapid, the use of local anesthetics, nonsteroidal anti-inflammatory agents, and opioids to provide postoperative analgesia improves the quality of recovery after propofol anesthesia. 6. The cardiovascular depressant effects of propofol are well tolerated in healthy animals, but these effects may be more problematic in high-risk patients with intrinsic cardiac disease as well as in those with systemic disease. In hypovolemic patients and those with limited cardiac reserve, even small induction doses of propofol (0.75-1.5 mg/kg i.v.) can produce profound hypotens
Topics: Anesthesia, General; Anesthetics, Intravenous; Animals; Cats; Dogs; Propofol
PubMed: 10332821
DOI: 10.1016/s0195-5616(99)50059-4 -
Contrast Media & Molecular Imaging 2022The anesthetic effect and safety of propofol in craniotomy patients by meta-analysis is investigated. Relevant studies consistent with the anesthetic effect and safety... (Meta-Analysis)
Meta-Analysis
The anesthetic effect and safety of propofol in craniotomy patients by meta-analysis is investigated. Relevant studies consistent with the anesthetic effect and safety of propofol in craniotomy patients are searched and screened from domestic and foreign literature databases such as Wanfang Medical Center, CNKI, VIP, and PubMed, and meta-analysis is performed by RevMan 5.2 software. Experimental results show that the recovery time, intracranial pressure, cerebral edema, partial cerebral oxygen pressure, glutamate, and MDA in the propofol group are better than those in the control group ( < 0.05), and the incidence of superoxide dismutase, TNF-, and adr in the propofol group is better than that in the control group ( > 0.05). Intravenous anesthesia with propofol in patients with craniotomy has the advantage of rapid recovery, and this program can improve intracranial pressure, brain edema, and brain oxygen partial pressure and help to improve oxidative stress and inflammatory reaction.
Topics: Anesthesia, Intravenous; Anesthetics; Craniotomy; Humans; Oxygen; Propofol
PubMed: 36051921
DOI: 10.1155/2022/6318051 -
Cells Jul 2023Glioblastoma (GBM) is the most common and aggressive primary brain tumor. GBM contains a small subpopulation of glioma stem cells (GSCs) that are implicated in treatment...
Glioblastoma (GBM) is the most common and aggressive primary brain tumor. GBM contains a small subpopulation of glioma stem cells (GSCs) that are implicated in treatment resistance, tumor infiltration, and recurrence, and are thereby considered important therapeutic targets. Recent clinical studies have suggested that the choice of general anesthetic (GA), particularly propofol, during tumor resection, affects subsequent tumor response to treatments and patient prognosis. In this study, we investigated the molecular mechanisms underlying propofol's anti-tumor effects on GSCs and their interaction with microglia cells. Propofol exerted a dose-dependent inhibitory effect on the self-renewal, expression of mesenchymal markers, and migration of GSCs and sensitized them to both temozolomide (TMZ) and radiation. At higher concentrations, propofol induced a large degree of cell death, as demonstrated using microfluid chip technology. Propofol increased the expression of the lncRNA BDNF-AS, which acts as a tumor suppressor in GBM, and silencing of this lncRNA partially abrogated propofol's effects. Propofol also inhibited the pro-tumorigenic GSC-microglia crosstalk via extracellular vesicles (EVs) and delivery of BDNF-AS. In conclusion, propofol exerted anti-tumor effects on GSCs, sensitized these cells to radiation and TMZ, and inhibited their pro-tumorigenic interactions with microglia via transfer of BDNF-AS by EVs.
Topics: Humans; Brain Neoplasms; Brain-Derived Neurotrophic Factor; Extracellular Vesicles; Glioblastoma; Glioma; Microglia; Neoplastic Stem Cells; Propofol; RNA, Long Noncoding; Temozolomide
PubMed: 37566001
DOI: 10.3390/cells12151921 -
British Journal of Clinical Pharmacology Nov 2003The aim of this study was to define the relationship between unbound propofol concentrations in plasma and total drug concentrations in human cerebrospinal fluid (CSF),...
AIMS
The aim of this study was to define the relationship between unbound propofol concentrations in plasma and total drug concentrations in human cerebrospinal fluid (CSF), and to determine whether propofol exists in the CSF in bound form.
METHODS
Forty-three patients (divided into three groups) scheduled for elective intracranial procedures and anaesthetized by propofol target control infusion (TCI) were studied. Blood and CSF samples (taken from the radial artery, and the intraventricular drainage, respectively) from group I (17 patients) were used to investigate the relationship between unbound propofol concentration in plasma and total concentration of the drug in CSF. CSF samples taken from group II (18 patients) were used to confirm the presence of the bound form of propofol in this fluid. The CSF and blood samples taken from group III (eight patients) were used to monitor the course of free and bound CSF propofol concentrations during anaesthesia.
RESULTS
For group I patients the mean (and 95% confidence interval) total plasma propofol concentration was 6113 (4971, 7255) ng ml(-1), the mean free propofol concentration in plasma was 63 (42, 84) ng ml(-1), and the mean total propofol concentration in CSF was 96 (76, 116) ng ml(-1) (P < 0.05 for the difference between the last two values). For group II patients the fraction of free propofol in CSF was 31 (26, 37)%. For group III patients the fraction of free propofol in CSF during TCI was almost constant (about 36%).
CONCLUSIONS
The unbound propofol concentration in plasma was not equal to its total concentration in CSF and cannot be directly related to the drug concentration in the brain. Binding of propofol to components of the CSF may be an additional mechanism regulating the transport of the drug from blood into CSF.
Topics: Anesthetics, Intravenous; Chromatography, High Pressure Liquid; Female; Half-Life; Humans; Male; Middle Aged; Propofol
PubMed: 14651729
DOI: 10.1046/j.1365-2125.2003.01920.x -
Minerva Anestesiologica Apr 2020Advantages of propofol use in children may include less airway complications, less emergence agitation, and less postoperative behavioral changes. However, needle phobia...
Advantages of propofol use in children may include less airway complications, less emergence agitation, and less postoperative behavioral changes. However, needle phobia and the complexity of total intravenous anesthesia set-up, as well as the pharmacokinetic and pharmacodynamic restrictions may limit the wide use of propofol-based anesthesia in the form of total intravenous anesthesia. Furthermore, pediatric infusion models and monitoring techniques are not fully validated yet. The choice of anesthesia type in children seems to be the result of a complex interplay between many factors related to the patient and the provider as well as logistic and operational factors that contribute to the decision-making process. Propofol has earned its place as a valuable choice in pediatric anesthesia. In addition, propofol and inhalation anesthesia should not be looked at as mutually exclusive; a combination of both may sometimes be the best approach to complex clinical dilemmas.
Topics: Anesthesia, General; Anesthesia, Inhalation; Child; Humans; Hypnotics and Sedatives; Propofol
PubMed: 31818084
DOI: 10.23736/S0375-9393.19.14022-9 -
In Vivo (Athens, Greece) 2022The influence of surgical interventions and anaesthesiological procedures on tumour progression was investigated as early as the 1920s. In current cancer management, the...
BACKGROUND/AIM
The influence of surgical interventions and anaesthesiological procedures on tumour progression was investigated as early as the 1920s. In current cancer management, the perioperative phase is increasingly being considered a vulnerable period with an increased risk of tumour cell dissemination due to medication, surgical manipulation, and immunosuppression. The extent to which narcotics administered in the perioperative setting influence the oncological outcomes of patients with pancreatic cancer is still unclear.
MATERIALS AND METHODS
To investigate the effect of propofol and etomidate on the proliferation, cell-cycle distribution, apoptosis, and necrosis of pancreatic tumour cells in vitro, PaTu 8988t and Panc-1 pancreatic cancer cells were treated with 0-1,000 μM propofol or etomidate for 24 h each. Cell proliferation was measured with enzyme-linked immunosorbent-bromodeoxyuridine assay. The apoptosis rate was analysed with annexin V staining and the cell-cycle distribution with flow cytometry.
RESULTS
Propofol at 1,000 μM induced apoptosis and inhibited cell proliferation. The cell cycle showed an increased S-phase and reduced cells in the G-phase. At 100 μM, propofol significantly inhibited proliferation of the pancreatic cancer cell line PaTu 8988t and reduced cells in the G-phase in the cell cycle. Etomidate had no effects on cell-cycle distribution, proliferation, apoptosis, and necrosis at the concentrations used.
CONCLUSION
In this study, propofol was shown to have anticancer effects by induction of apoptosis and inhibition of cell proliferation, while etomidate did not affect pancreatic cancer cells. However, it is too early to make any recommendation for changes in clinical practice and further clinical studies are warranted to investigate the effect of anaesthetics on cancer progression.
Topics: Humans; Etomidate; Propofol; Apoptosis; Necrosis; Pancreatic Neoplasms; Cell Cycle; Cell Proliferation
PubMed: 36309382
DOI: 10.21873/invivo.13008 -
World Journal of Gastroenterology May 2014Compared to standard endoscopy, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are often lengthier and more complex, thus... (Review)
Review
Compared to standard endoscopy, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are often lengthier and more complex, thus requiring higher doses of sedatives for patient comfort and compliance. The aim of this review is to provide the reader with information regarding the use, safety profile, and merits of propofol for sedation in advanced endoscopic procedures like ERCP and EUS, based on the current literature.
Topics: Anesthetics, Intravenous; Cholangiopancreatography, Endoscopic Retrograde; Conscious Sedation; Cost-Benefit Analysis; Drug Costs; Endosonography; Humans; Propofol; Risk Factors
PubMed: 24833847
DOI: 10.3748/wjg.v20.i18.5171 -
Anesthesiology Oct 2005Propofol is a potent lipophilic anesthetic that was initially formulated in Cremophor El for human use. Because of the occurrence of Cremophor EL anaphylaxis and... (Review)
Review
Propofol is a potent lipophilic anesthetic that was initially formulated in Cremophor El for human use. Because of the occurrence of Cremophor EL anaphylaxis and improvements in the quality of lipid emulsions, it was ultimately brought to market as 1% propofol formulated in 10% soybean oil emulsion. Emulsions represent complex formulation compositions whose suitability for intravenous administration is dependent on a number of factors. Despite the success of propofol emulsions, drawbacks to such formulations include inherent emulsion instability, injection pain, a need for antimicrobial agents to prevent sepsis, and a concern of hyperlipidemia-related side effects. Efforts to overcome such drawbacks have involved the development of propofol emulsions with altered propofol and lipid contents, the addition of different excipients to emulsions for antimicrobial activity, and study of nonemulsion formulations including propofol-cyclodextrin and propofol-polymeric micelle formulations. In addition, a number of propofol prodrugs have been made and evaluated.
Topics: Chemistry, Pharmaceutical; Cyclodextrins; Drug Stability; Edetic Acid; Emulsions; Glycerol; Micelles; Particle Size; Prodrugs; Propofol; Sulfites
PubMed: 16192780
DOI: 10.1097/00000542-200510000-00026