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Paediatric clinical pharmacology
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Propofol is an ultra-short acting, parenteral anaesthetic agent that has gained wide acceptance for the induction and maintenance of anaesthesia in both adults and children. It’s short elimination half-life and rapid distribution kinetics allows patients to recover rapidly upon discontinuation of infusion with much fewer adverse effects than have been observed with other parenteral anesthestic agents (e.g., barbiturates, ketamine). Propofol has also been used as a sedative to facilitate prolonged mechanical ventilation in critically ill children. To date, there have been at least 12 children dying following the use of propofol as a sedative in the UK [13–15]. These children developed severe metabolic acidosis and lipaemia. Many of the children were originally admitted to hospital with upper airway obstruction and thus, were not expected to suffer multi-organ failure. The mechanism(s) associated with the production of metabolic acidosis by propofol in children without concomitant hypoxemia is not known. It is, however, noted that the dose of propofol used in the children who died was considerably higher than has been recommended by other groups, thus implying an enhanced risk associated with the extent of drug exposure (i.e., dose) [15].
Surgical Facilities, Peri-Operative Care, Anesthesia, and Surgical Techniques
Published in Yuehuei H. An, Richard J. Friedman, Animal Models in Orthopaedic Research, 2020
Alison C. Smith, M. Michael Swindle
Propofol is a steroidal anesthetic that must be administered by continuous iv infusion. The agent may be profoundly hypotensive in some species. It may be administered as a sole agent for general anesthesia in some species.14-16
Neurointensive care: Sedation and analgesia in the ICU
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
The most common side effect of propofol is hypotension. This is often observed in a dose-dependent manner, and almost universally experienced in doses greater than 1 mg/kg intravenous boluses. Other adverse side effects include bradycardia, cardiac arrhythmias, myoclonus, meningismus, respiratory acidosis, hypertriglyceridemia, green or white discoloration of the urine, and anaphylaxis (26–30).
Different effects of intravenous and local anesthesia in patients undergoing ultrasound-guided radiofrequency ablation of thyroid nodules: a prospective cohort study
Published in International Journal of Hyperthermia, 2022
Shuhang Gao, Yalin Zhu, Mengying Tong, Lina Wang, Shuangsong Ren, Liu Rui, Fang Yang, Zhiqing Lian, Ying Che
Major and minor complications occurred with both methods of anesthesia. Although there is no evidence to prove that the incidence of adverse events is different due to the small number of cases, we observed slightly different types of complications in both groups. Patients with IV have specific symptoms of post-procedural nausea and intra-procedural snoring. These conditions are considered to be caused by the application of intravenous anesthetics. The most common side effects of propofol and remifentanil are gastrointestinal reactions, such as nausea and vomiting. Snoring may be caused by excessive sedation or obesity (body mass index, 28.1 kg/m2). This suggests that individualized medication dosage and close anesthesia care are significantly important during IV induction.
GAS5, a FoxO1-actived long noncoding RNA, promotes propofol-induced oral squamous cell carcinoma apoptosis by regulating the miR-1297-GSK3β axis
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2019
Chengshun Gao, Chunmei Ren, Zhongxi Liu, Li Zhang, Ranran Tang, Xiaojie Li
Propofol is an intravenous sedative-hypnotic agent administered to induce and maintain anaesthesia [4]. Additionally, many studies have reported that propofol exerts antitumour properties in numerous cancers [5]. However, its role in OSCC remains unknown. In this study, we found that propofol suppresses OSCC cell proliferation and induces cell apoptosis via upregulating GAS5 expression. Elevated GAS5 can bind to miR-1297, leading to decreased miR-1297 in response to propofol treatment. Subsequently, we found that GSK3β is a downstream target gene of miR-1297. Propofol promotes GSK3β expression via miR-1297 downregulation. Increased GSK3β enhances Mcl1 degradation and propofol-induced cell apoptosis. Our data also revealed that FoxO1 directly binds to the promoter of GAS5, facilitating its transcription in response to propofol treatment. Taken together, these results suggest that propofol exhibits antitumour effects in OSCC.
Advances in interventional diagnostic bronchoscopy for peripheral pulmonary lesions
Published in Expert Review of Respiratory Medicine, 2019
Tsukasa Ishiwata, Alexander Gregor, Terunaga Inage, Kazuhiro Yasufuku
With the widespread use of interventional bronchoscopy, the question of procedural sedation is an important one. In usual flexible bronchoscopic procedures for diagnosing PPLs, the desired depth of sedation is conscious/moderate sedation to achieve bronchoscopic ease and patient comfort while maintaining respiratory derive. Conscious/moderate sedation is defined as ‘a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation’ [84]. Conscious/moderate sedation is usually performed using a combination of short-acting sedative hypnotic and opioids. Midazolam has been widely used for sedation in bronchoscopy because it has relatively limited cardiovascular depressant effects and can be reversed by flumazenil. Recently, the use of propofol in the bronchoscopy suite is increasing. Propofol shows rapid peak and short duration of effect. However, the administration of propofol in the bronchoscopy suite by non-anesthesiologists is controversial since its therapeutic window is narrow and the depth of sedation tends to be deeper than targeted. In some institutions, dexmedetomidine is used as a sedative in interventional bronchoscopy. However, there is no standardized practice for the use of sedation. Although many diagnostic bronchoscopy cases can be performed successfully with conscious/moderate sedation, physicians in some institutions prefer deep sedation or general anesthesia especially in procedures that require complex new emerging technologies.