Propofol Adrenaline

Current concepts of resuscitation after local anesthetic cardiotoxicity have been reviewed (17). Vasopressin may be a logical vasopressor in the setting of hypotension, rather than adrenaline, in view of the dysrhythmogenic potential of the latter. Amiodarone is probably of use in the treatment of dysrhythmias. Calcium channel blockers, phenytoin, and bretyllium should be avoided. In terms of new modes of therapy targeted at the specific action of local anesthetics, lipid infusions, propofol, and insulin/ glucose/potassium infusions may all have a role, but further research is necessary. 

Patients anaesthetised with inhalational anaesthetics (particularly cyclopropane and halothane, and to a lesser extent desflurane, enflurane, ether, isoflurane, methoxyflurane, and sevoflurane) can develop cardiac arrhythmias if they are given adrenaline (epinephrine) or noradrenaline (norepinephrine), unless the dosages are very low. Children appear to be less susceptible to this interaction. file addition of adrenaline to intrathecal tetracaine enhances the sedative effects of propofol. 

A study in 20 patients undergoing spinal anaesthesia with tetracaine found that propofol sedation (as measured by bispectral index monitoring (BIS)) was enhanced when adrenaline was added to the intrathecal tetracaine." A study in sheep found that adrenaline, noradrenaline and dopamine decreased propofol concentrations during a continuous propofol infusion, with the result that propofol anaesthesia was reversed. This was thought to be due to increased first pass clearance of propofol secondary to increased cardiac output. It was concluded that this could be of clinical importance if propofol is used in hyperdynamic circulatory conditions induced by either catecholamine infusions or disease states such as sepsis. ... 

A 44-year-old woman was given ondansetron, vecuronium, and propofol at induction for elective surgery and immediately became hypotensive (60/30 mmHg) [35 ]. There were no accompanying skin or systemic symptoms, and the episode resolved completely after treatment with intravenous adrenaline, promethazine, hydrocortisone, and fluids. Subsequent skin prick tests with ondansetron, vecuronium, and propofol were negative, but intradermal testing with ondansetron 0.02 mg/ml produced a positive wheal reaction. 

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