• Title, Summary, Keyword: Propofol

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Comparative randomized study of propofol target-controlled infusion versus sevoflurane anesthesia for third molar extraction

  • Chung, Patrick K;Dhanrajani, Parmanand
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.18 no.3
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    • pp.169-175
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    • 2018
  • Background: The objective of this study was to compare hemodynamic and recovery characteristics of total intravenous anesthesia using propofol target-controlled infusion (TCI) versus sevoflurane for extraction of four third molar teeth. Methods: One hundred patients undergoing extraction of four third molar teeth under general anesthesia were randomized to one of two groups. Group 1 received propofol TCI-oxygen for induction and propofol TCI-oxygen-air for maintenance. Group II received a propofol bolus of 2 mg/kg for induction and sevoflurane-oxygen-air for maintenance. Heart rate, mean arterial pressure (MAP), operating time, time to emergence, nausea and vomiting, and sedation and pain scores were measured in each group. Results: Demographic data, including age, gender, weight, and height, were not significantly different between the two groups. The MAP was significantly higher after intubation (P = 0.007) and injection of anesthesia (P = 0.004) in the propofol group than in the sevoflurane group, with significant reflex bradycardia (P = 0.028). The mean time to emergence from anesthesia using propofol was 25 s shorter than that of sevoflurane (P = 0.02). Postoperatively, the propofol group was less sedated than the sevoflurane group at 30 min (0.02 versus 0.12), but this difference was not significant (P = 0.065). Conclusion: Both propofol TCI and sevoflurane are good alternatives for induction and maintenance of anesthesia for short day-case surgery. However, propofol TCI does not blunt the hemodynamic response to sudden, severe stimuli as strongly as sevoflurane, and this limitation may be a cause for concern in patients with cardiac comorbidities.

Medium- and long-chain triglyceride propofol reduces the activity of acetyl-coenzyme A carboxylase in hepatic lipid metabolism in HepG2 and Huh7 cells

  • Wang, Li-yuan;Wu, Jing;Gao, Ya-fen;Lin, Duo-mao;Ma, Jun
    • The Korean Journal of Physiology and Pharmacology
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    • v.24 no.1
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    • pp.19-26
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    • 2020
  • Medium- and long-chain triglyceride (MCT/LCT) propofol is widely used as an intravenous anesthetic, especially in the intensive care unit. The present study aimed to assess whether MCT/LCT propofol is safe in the hyperlipidemic population for long-term use. Free fatty acids (FFAs) were used to establish high-fat stimulation of HepG2 and Huh7 cells. Subsequently, these cells were treated with propofol at the concentration of 0, 4, or 8 ㎍/ml for 24 and 48 h. The results indicated that the cell viability was notably decreased when the cells were stimulated with 2 mmol/L FFAs and treated with 12 ㎍/ml MCT/LCT propofol. Accordingly, we chose 2 mmol/L FFAs along with 4 and 8 ㎍/ml MCT/LCT propofol for the subsequent experiments. Four and 8 ㎍/ml MCT/LCT propofol inhibited FFA-induced lipid accumulation in the cells and significantly reversed acetyl coenzyme A carboxylase (ACC) activity. In addition, MCT/LCT propofol not only significantly promoted the phosphorylation of AMPK and ACC, but also reversed the FFA-induced decreased phosphorylation of AMPK and ACC. In conclusion, MCT/LCT propofol reverses the negative effects caused by FFAs in HepG2 and Huh7 cells, indicating that MCT/LCT propofol might positively regulate lipid metabolism.

Meta-analysis for Efficacy and Safety of Propofol during Dental Sedation

  • Choi, Seong-Seok;Seo, Kwang-Suk;Kim, Hyun-Jeong
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.12 no.2
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    • pp.75-91
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    • 2012
  • Background: Dental sedation reduces fear and phobia during dental treatment and helps patients get quality treatment by inducing adequate consciousness control. Propofol has recently grabbed the spotlight, but no meta-analysis for efficacy and safety of propofol in dentistry has yet been performed. Thus, the purpose of this study was to perform meta-analysis to verify the efficacy and safety of propofol for use in dental sedation. Methods: Articles published between 1980 and 2010 were searched in the web sites, journals and medical database including The Cochrane Library, MEDLINE and EMBASE. And a total of 22 studies were selected among the randomized controlled trials (RCTs) that compared the use of propofol with other sedatives (control group). The data was collected from these studies and meta-analysis for efficacy and safety was performed using Comprehensive Meta-Analysis 5.0 (CMA 5.0). Results: The patient recovered significantly faster and discharged significantly earlier in the propofol group (SMD = -1.442, P < 0.001). The satisfaction of patient and that of operator was higher in the propofol group (P < 0.05). The incidence of arrhythmia and apnea/ hypoventilation was significantly lower in the propofol group (OR = 0.071, P < 0.05), and there was no significant difference in the other side effects. On the level of sedation, although the sedation score was significantly lower in the propofol group (SMD = -0.430, P < 0.05). Conclusions: The present analysis showed that the use of propofol resulted in high satisfaction levels on the part of the patients and operators, a shorter recovery time, and faster hospital discharge. The incidence of complications, however, was lower in the propofol groups or not much different between the propofol and control groups. Thus, the adequate use of propofol in dentistry is believed to be helpful for the effective and safe sedation of the patients.

An Influence of a Combined Administration of Propofol and Isoflurane on Antioxidative Enzyme Activities in Growing Swine Erythrocytes (성장 돼지 적혈구에서의 항산화 효소 활성도에 대한 propofol 과 isoflurane 병용 투여의 영향)

  • Lee, Jae Yeon;Kim, Myung Cheol
    • Journal of Veterinary Clinics
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    • v.29 no.6
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    • pp.460-463
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    • 2012
  • The present study was aimed to evaluate and compare the oxidative stress status of isoflurane and propofol in pigs undergoing surgery with measuring the activities of antioxidant enzymes. The pigs were divided into 2 groups according to the type of anesthesia used for the surgical procedure. In the isoflurane group (group 1), anesthesia was induced and maintained with 2-2.5% isoflurane under 100% oxygen. The propofol group (group 2) received 8 mg/kg/h of IV propofol with 0.5-1% isoflurane under 100% oxygen. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities of isoflurane group were significantly lower at the end of surgery than at induction of anesthesia, while that of the propofol group maintained their baseline values. There were significant differences in all enzymes activities between groups at the end of surgery. These results indicate that propofol is capable of preserving the antioxidant capacity in pigs anesthetized with the combination of isoflurane and propofol infusion.

Treatment of Epidural-Morphine-Induced Pruritus: Propofol Versus Naloxone (경막외 Morphie 투여시 생기는 소양증에 대한 Propofol과 Naloxone의 효과 비교)

  • Park, Chung-Hyun;Jung, Hyun-Jung
    • The Korean Journal of Pain
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    • v.10 no.2
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    • pp.208-213
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    • 1997
  • Background: Pruritus is the most frequent undesirable symptom associated with epidural morphine. It is unpleasant and often difficult to treat. Naloxone is presently the drug of first choice for treating this symptom. Naloxone however decrease the pain threshold in some cases. Recently it was reported subhypnotic doses of propofol were efficient in relieving epidural-morphine-induced pruritus(EMIP). In a prospective. randomized, double-blinded clinical trial, we compared the efficacy of propofol and naloxone for treatment of EMIP. Methods: Forty patients with EMIP were allocated to receive either 20 mg propofol, or 1.5 ${\mu}g/kg$ naloxone intravenously. Pruritus and level of postoperative pain were assessed after 5 min, using pruritus rating scale and visual analogue scale. Results: The overall success rate in treating pruritus was similar in both groups (propofol 70% vs naloxone 65%). Twenty-five percent of the patients in the naloxone group had an increase in the level of postoperative pain versus none in the propofol group(P=0.018). Conclusions: These results suggest propofol and naloxone are equally effective in treating EMIP. However, the level of postoperative pain is significantly reduced when treated with propofol.

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Anaesthesia Using Propofol for Plastic Surgery (성형외과 수술 시 Propofol을 사용한 수면 마취)

  • Lee, Seung Ryong;Lee, Jong Youn;Kang, Sang Yoon;Cho, Sang Heon
    • Archives of Plastic Surgery
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    • v.33 no.3
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    • pp.353-358
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    • 2006
  • Propofol is widely used for supportive sedation in local and regional anaesthesia in plastic surgical procedure. We studied comparative effect of propofol comparing fontanel and midazolam that was previously used. From April 2003 to July 2005, 118 patients were reviewed whom propofol was used intravenous sedation in various plastic surgical procedures. In some cases, midazolam were used initially then converted to propofol. Patients were questioned for their satisfaction in group of propofol alone and midazoline and propofol combination. Vital sign(Blood pressure, Respiration rate) and $O_2$ saturaion, sedation time, side effect and subjective satisfaction were evaluated. The result reveals that propofol is effective medicine for supplement intravenous sedative medicine for plastic surgeries especially when it was used with combination of midazolam.

Propofol Infusion Associated Metabolic Acidosis in Patients Undergoing Neurosurgical Anesthesia : A Retrospective Study

  • Choi, Yoon Ji;Kim, Min Chul;Lim, Young Jin;Yoon, Seung Zhoo;Yoon, Suk Min;Yoon, Hei Ryeo
    • Journal of Korean Neurosurgical Society
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    • v.56 no.2
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    • pp.135-140
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    • 2014
  • Objective : Propofol and volatile anesthesia have been associated with metabolic acidosis induced by increased lactate. This study was designed to evaluate changes in pH, base excess (BE), and lactate in response to different anesthetic agents and to characterize propofol infusion-associated lactic acidosis. Methods : The medical records of patients undergoing neurosurgical anesthesia between January 2005 and September 2012 were examined. Patients were divided into 2 groups : those who received propofol (total intravenous anesthesia, TIVA) and those who received sevoflurane (balanced inhalation anesthesia, BIA) anesthesia. Propensity analysis was performed (1 : 1 match, n=47), and the characteristics of the patients who developed severe acidosis were recorded. Results : In the matched TIVA and BIA groups, the incidence of metabolic acidosis (11% vs. 13%, p=1) and base excess (p>0.05) were similar. All patients in the TIVA group who developed severe acidosis did so within 4 hours of the initiation of propofol infusion, and these patients improved when propofol was discontinued. Conclusions : The incidence of metabolic acidosis was similar during neurosurgical anesthesia with propofol or sevoflurane. In addition, severe acidosis associated with propofol infusion appears to be reversible when propofol is discontinued.

A Simulation Study of Propofol Effect-Site Concentration for Appropriate Sedation in Pediatric Patients Undergoing Brain MRI: Pharmacodynamic Analysis

  • Na, Se Hee;Song, Young;Kim, So Yeon;Byon, Hyo-Jin;Jung, Hwan-Ho;Han, Dong Woo
    • Yonsei Medical Journal
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    • v.58 no.6
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    • pp.1216-1221
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    • 2017
  • Purpose: We aimed to establish the propofol effect-site concentration (Ce) for appropriate sedation by pharmacodynamic analysis and to determine the propofol Ce during occurrence of sedation-related side effects in pediatric patients undergoing brain magnetic resonance imaging (MRI). Materials and Methods: In 50 pediatric patients scheduled for brain MRI, sedation was induced with 2.0 mg/kg propofol; additional propofol doses were 0.5-1 mg/kg. Propofol Ce was simulated by inputting the propofol administration profiles of patients into a pediatric compartmental model (Choi model). The relationship between propofol Ce and probabilities of sedation and recovery were analyzed using a sigmoidal Emax model. The simulated propofol Ce for sedation-related side effects was investigated. Population model parameters were estimated using the Nonlinear Mixed-Effects Modelling software. Results: The mean values of propofol $Ce_{50}$ for sedation during the preparation, scanning, and recovery phases were 1.23, 0.43, and $0.39{\mu}g/mL$. The simulated propofol Ce values during oxygen desaturation ($SpO_2$<90%) (3 patients; 6%), hypotension (16 patients; 32%), and bradycardia (12 patients; 24%) were $3.01{\pm}0.04$, $2.05{\pm}0.63$, and $2.41{\pm}0.89{\mu}g/mL$, respectively. Conclusion: The required propofol $Ce_{50}$ for applying monitors during the preparation phase before the start of MRI was higher than the propofol $Ce_{50}$ required during the scanning phase. During low-intensity stimulation phases, such as scanning, propofol bolus dose should be strictly titrated not to exceed the propofol Ce that can lead to oxygen desaturation because of the relatively low propofol Ce ($Ce_{95}$, $1.43{\mu}g/mL$) required for sedation in most patients.

The Relaxant Effect of Propofol on Isolated Rat Intrapulmonary Arteries

  • Zhang, Guangyan;Cui, Jianxiu;Chen, Yijing;Ma, Jue
    • The Korean Journal of Physiology and Pharmacology
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    • v.18 no.5
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    • pp.377-381
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    • 2014
  • Propofol is a widely used anesthetic. Many studies have shown that propofol has direct effects on blood vessels, but the precise mechanism is not fully understood. Secondary intrapulmonary artery rings from male rats were prepared and mounted in a Multi Myograph System. The following constrictors were used to induce contractions in isolated artery rings: high $K^+$ solution (60 mmol/L); U46619 solution (100 nmol/L); 5-hydroxytryptamine (5-HT; $3{\mu}mol/L$); or phenylephrine (Phe; $1{\mu}mol/L$). The relaxation effects of propofol were tested on high $K^+$ or U46619 precontracted rings. Propofol also was added to induce relaxation of rings preconstricted by U46619 after pretreatment with the nitric oxide synthase inhibitor $N^G$-nitro-L-arginine methyl ester (L-NAME). The effects of propofol on $Ca^{2+}$ influx via the L-type $Ca^{2+}$ channels were evaluated by examining contraction-dependent responses to $CaCl_2$ in the absence or presence of propofol (10 to $300{\mu}mol/L$). High $K^+$ solution and U46619 induced remarkable contractions of the rings, whereas contractions induced by 5-HT and Phe were weak. Propofol induced dose-dependent relaxation of artery rings precontracted by the high $K^+$ solution. Propofol also induced relaxation of rings precontracted by U46619 in an endothelium-independent way. Propofol at different concentrations significantly inhibited the $Ca^{2+}$-induced contractions of pulmonary rings exposed to high $K^+$-containing and $Ca^{2+}$-free solution in a dose-dependent manner. Propofol relaxed vessels precontracted by the high $K^+$ solution and U46619 in an endothelium-independent way. The mechanism for this effect may involve inhibition of calcium influx through voltage-operated calcium channels (VOCCs) and receptor-operated calcium channels (ROCCs).

Propofol promotes osteoclastic bone resorption by increasing DC-STAMP expression

  • Kim, Eun-Jung;Kim, Hyung Joon;Baik, Seong Wan;Kim, Kyung-Hoon;Ryu, Sie Jeong;Kim, Cheul-Hong;Shin, Sang-Wook
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.18 no.6
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    • pp.349-359
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    • 2018
  • Background: Propofol is an intravenous anesthetic which has antioxidant effects due to its similarity in molecular structure to ${\alpha}$-tocopherol. It has been reported that ${\alpha}$-tocopherol increases osteoclast fusion and bone resorption. Here, we investigated the effects of propofol on signaling pathways of osteoclastogenic gene expression, as well as osteoclastogenesis and bone resorption using bone marrow-derived macrophages (BMMs). Methods: BMMs were cultured with macrophage colony-stimulating factor (M-CSF) alone or M-CSF plus receptor activator of nuclear factor kappa B ligand (RANKL) in the presence of propofol ($0-50{\mu}M$) for 4 days. Mature osteoclasts were stained for tartrate-resistant acid phosphatase (TRAP) and the numbers of TRAP-positive multinucleated osteoclasts were counted. To examine the resorption activities of osteoclasts, a bone resorption assay was performed. To identify the mechanism of action of propofol on the formation of multinucleated osteoclasts, we focused on dendritic cell-specific transmembrane protein (DC-STAMP), a protein essential for pre-osteoclastic cell fusion. Results: Propofol increased the formation of TRAP-positive multinucleated osteoclasts. In addition, the bone resorption assay revealed that propofol increased the bone resorption area on dentin discs. The mRNA expression of DC-STAMP was upregulated most strongly in the presence of both RANKL and propofol. However, SB203580, a p38 inhibitor, significantly suppressed the propofol/RANKL-induced increase in mRNA expression of DC-STAMP. Conclusion: We have demonstrated that propofol enhances osteoclast differentiation and maturation, and subsequently increases bone resorption. Additionally, we identified the regulatory pathway underlying osteoclast cell-cell fusion, which was enhanced by propofol through p38-mediated DC-STAMP expression.