Propofol cardiovascular effects

Both alfentanil and propofol were effective and safe, provided respiratory and cardiovascular parameters were routinely monitored. 

BUotta F, Fiorani L, La Rosa I, Spinelh F, Rosa G. Cardiovascular effects of intravenous propofol administered at two infusion rates a transthoracic echocardiographic study. Anaesthesia 2001 56(3) 266-71. 

Cardiovascular effects of propofol in dogs with dilated cardiomyopathy. Anesthesiology 88 180-189 Parry B W, Anderson G A 1983 Influence of acepromazine maleate on the equine haematocrit. Journal of Veterinary Pharmacology and Therapeutics 6 121-126 Parry B W, Anderson G A, Gay C C 1982 Hypotension in the horse induced by acepromazine maleate. Australian Veterinary Journal 59 148-152 Pascoe P J, Black W D, Claxton J M et al 1991 The... 

Another study found that a single 80-mg dose of esmolol after induction of anaesthesia with propofol and either fentanyl or placebo did not affect the depth of anaesthesia (measured by BIS) in either group of patients, even though cardiovascular effects were seen (reduction in systolic arterial pressure and heart late). ... 

Recovery is sufficiently rapid with most intravenous drugs to permit their use for short ambulatory (outpatient) surgical procedures. In the case of propofol, recovery times are similar to those seen with sevoflurane and desflurane. Although most intravenous anesthetics lack antinociceptive (analgesic) properties, their potency is adequate for short superficial surgical procedures when combined with nitrous oxide or local anesthetics, or both. Adjunctive use of potent opioids (eg, fentanyl, sufentanil or remifentanil see Chapter 31) contributes to improved cardiovascular stability, enhanced sedation, and perioperative analgesia. However, opioid compounds also enhance the ventilatory depressant effects of the intravenous agents and increase postoperative emesis. Benzodiazepines (eg, midazolam, diazepam) have a slower onset and slower recovery than the barbiturates or propofol and are rarely used for induction of anesthesia. However, preanesthetic administration of benzodiazepines (eg, midazolam) can be used to provide anxiolysis, sedation, and amnesia when used as part of an inhalational, intravenous, or balanced anesthetic technique. 

Etomidate is a carboxylated imidazole that can be used for induction of anesthesia in patients with limited cardiovascular reserve. Its major advantage over other intravenous anesthetics is that it causes minimal cardiovascular and respiratory depression. Etomidate produces a rapid loss of consciousness, with minimal hypotension even in elderly patients with poor cardiovascular reserve. The heart rate is usually unchanged, and the incidence of apnea is low. The drug has no analgesic effects, and coadministration of opioid analgesics is required to decrease cardiac responses during tracheal intubation and to lessen spontaneous muscle movements. Following an induction dose, initial recovery from etomidate is less rapid (< 10 minutes) compared with recovery from propofol. 

Resuscitation from bupivacaine cardiovascular toxicity is extremely difficult even for experienced clinicians. Recent studies suggest that propofol can be useful in resuscitating patients acutely exposed to toxic levels of bupivacaine. The (S)-isomer, levobupivacaine, appears to have a lower propensity for cardiovascular toxicity than the racemic mixture or the (7 >isomer and has been approved for clinical use. The clinical effects of ropivacaine are similar to those of bupivacaine, but ropivacaine is allegedly associated with a lower potential for cardiovascular toxicity. Ropivacaine is available only as the ( SJ-stereoisomer, which has inherently less affinity for the cardiac sodium channel. However, both cardiac toxicity and CNS toxicity have been reported when large doses of ropivacaine were used for peripheral nerve blocks. 

Finally, newer intravenous anesthetics such as etomidate (Amidate) and propofol (Diprivan) are available. Etomidate is a hypnoticlike drug that causes a rapid onset of general anesthesia with a minimum of cardiopulmonary side effects. Flence, this drug may be useful in patients with compromised cardiovascular or respiratory function. Propofol is a short-acting hypnotic that is useful as a general anesthetic in some... 

Cardiovascular Propofol produces a dose-dependent decrease in blood pressure that is significantly greater than that produced by thiopental the effect is explained by vasodilation and mild depression of myocardial contractility. Propofol appears to blunt the baroreceptor refiex or is directly vagotonic. As with thiopental, propofol should be used with caution in patients at risk for or intolerant of decreases in blood pressure. 

Cardiovascular Cardiovascular stability after induction is a major advantage of etomidate over either barbiturates or propofol. Induction doses of etomidate typically produce a small increase in heart rate and little or no decrease in blood pressure or cardiac output. Etomidate has little effect on coronary perfusion pressure while reducing myocardial consumption. Thus, of all induction agents, etomidate is best suited to maintain cardiovascular stability in patients with coronary artery disease, cardiomyopathy, cerebral vascular disease, or hypovolemia. 

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