Prophylactic atropine administration attenuates the negative haemodynamic effects of induction of anaesthesia with propofol and high-dose remifentanil
| Autor: | Marieke I van der Velde, Silvie Allaert, Pieter L Buisman, Marieke Poterman, Thomas Scheeren, Alain Kalmar, Michel Struys |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Atropine Male Bradycardia Cardiac output Remifentanil Hemodynamics law.invention 03 medical and health sciences 0302 clinical medicine Double-Blind Method Piperidines Randomized controlled trial 030202 anesthesiology law medicine Humans Prospective Studies Propofol Aged Dose-Response Relationship Drug business.industry 030208 emergency & critical care medicine Middle Aged Analgesics Opioid Anesthesiology and Pain Medicine Blood pressure Anesthesia cardiovascular system Drug Therapy Combination Female Pre-Exposure Prophylaxis medicine.symptom business Adjuvants Anesthesia medicine.drug |
| Zdroj: | European Journal of Anaesthesiology. 34:695-701 |
| ISSN: | 0265-0215 |
| DOI: | 10.1097/eja.0000000000000639 |
| Popis: | Induction of anaesthesia with propofol and remifentanil often induces unwanted bradycardia and hypotension, raising concerns regarding tissue oxygenation. The electrophysiological cardiac effects of remifentanil can be reversed by atropine.To investigate if prophylactic administration of atropine can attenuate the negative haemodynamic effects of propofol and a high dose of remifentanil during induction of anaesthesia.A double-blind, randomised controlled trial.Single-centre, University Medical Center Groningen, The Netherlands.Sixty euvolaemic patients scheduled for surgery under general anaesthesia.Anaesthesia was induced and maintained with a target-controlled infusion of propofol with a target effect-site concentration (Ce) of 2.5 μg ml, remifentanil (target-controlled infusion), (Ce 8 ng ml) and cis-atracurium. Methylatropine (500 μg) or 0.9% saline was administered at immediately before induction of anaesthesia.The changes (Δ) in mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), rate pressure product, cerebral tissue oxygenation and peripheral tissue oxygenation between induction of anaesthesia (T0) and 10 min later (T10).Atropine significantly attenuated the changes in the outcome measures between T0 and T10. Median (inter-quartile range) changes were MAP, Δ = -24 (-40 to -21) vs. Δ = -37 mmHg (-41 to -31) (P = 0.02); HR, Δ = 0 ± 13 vs. -19 ± 11 bpm (P 0.01); CI, Δ = -0.4 ± 0.7 vs. -0.9 ± 0.6l min m (P 0.01) and rate pressure product, Δ = -3241 (-5015 to -613) vs. Δ = -5712 mmHg min (-6715 to -3917) (P 0.01). Cerebral tissue oxygenation and peripheral tissue oxygenation did not change in either group. Maximum HR after atropine was 102 (86 to 116) vs. 85 bpm (76 to 95).Administration of atropine, before induction of anaesthesia with propofol and high-dose remifentanil, can significantly reduce the decreases in HR, MAP and CI.Clinicaltrials.gov identifier: NCT01871922. |
| Databáze: | OpenAIRE |
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