ScienceDirect - Journal of Cardiothoracic Anesthesia : Sequestration of propofol in an extracorporeal circuit

Journal of Cardiothoracic Anesthesia
Volume 3, Issue 5, Supplement 1, October 1989, Page 75

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Rapid progressive central cooling to 29 [degree sign]C ...
Resuscitation

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Rapid progressive central cooling to 29 °C by extracorporeal circuit preserves cardiac function and hemodynamics in immature swine
Resuscitation, Volume 76, Issue 3, March 2008, Pages 443-448
Xue-Han Ning, Outi Hyyti, Ming Ge, David L. Anderson, Michael. A. Portman

Abstract

Summary

The International Liaison Committee on Resuscitation (ILCOR) consensus statement includes recommendations and guidelines for therapeutic hypothermia in infants and children. The information supporting these recommendations is sparse, and reveals a need for target temperature and cooling mode data in age-appropriate animal models. Accordingly, we determined cardiac function and hemodynamic indices in immature piglets (<28 days) undergoing graded and rapid central cooling from 36 to 20 °C over 20 min by directing cardiac output through an extracorporeal circuit. Functional parameters were recorded continuously using aortic flow probes and left ventricular (LV) pressure capacitance catheters. Stroke volume and work increased during temperature reduction, peaking at 29 °C, while systemic vascular resistance did not change. Although, heart rate decreased steadily, cardiac output, power, and LV dP/dt_max was maintained until 29 °C. All function parameters decreased below 29 °C, implying a critical threshold had been exceeded at lower temperatures. These data show that the temperature range (30 ± 1) °C maintains cardiac function and that this target should be further evaluated as a target for therapeutic hypothermia.

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Pentoxifylline is as effective as leukocyte depletion f...
Journal of Thoracic and Cardiovascular Surgery

Pentoxifylline is as effective as leukocyte depletion for modulating pulmonary reperfusion injury
Journal of Thoracic and Cardiovascular Surgery, Volume 126, Issue 6, December 2003, Pages 2052-2057
Stephen C. Clark, Jagan N. Rao, Paul A. Flecknell, John H. Dark

Abstract

Objective

Previous studies have suggested the amelioration of lung reperfusion injury when initial reperfusion is undertaken with leukocyte-depleted blood. Pharmacologic agents, such as pentoxifylline, are also effective, but no previous studies have demonstrated which is superior. We investigated these agents in a porcine model of left single-lung transplantation.

Methods

Donor lungs were preserved with modified Euro-Collins solution for a mean ischemic time of 18.6 hours. Gas exchange, pulmonary vascular resistance, neutrophil elastase level, and free radical release (measured on the basis of malonaldehyde levels) were assessed over a 12-hour period. Group A (n = 5) was a control group with no interventions added. Group B was reperfused through an extracorporeal circuit incorporating a leukocyte-depleting filter for 30 minutes before conventional blood flow was restored. Group C was reperfused with the addition of intravenous pentoxifylline (2 mg · kg⁻¹ · h⁻¹).

Results

Groups B and C were similar in terms of oxygenation, pulmonary vascular resistance, and free radical release. Group B displayed increased levels of neutrophil elastase. Both groups were superior with regard to these outcome measures compared with control group A.

Conclusions

Pentoxifylline, when administered to recipient animals, attenuates reperfusion injury to a degree similar to that seen with leukocyte-depleted reperfusion. This technique is simple, safe, and as effective as using a more complex extracorporeal circuit incorporating a leukocyte-depleting filter to ameliorate acute lung injury.

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The first fatal 2,6-di-isopropylphenol (propofol) poiso...
Forensic Science International

The first fatal 2,6-di-isopropylphenol (propofol) poisoning in Singapore: a case report
Forensic Science International, Volume 66, Issue 1, 25 May 1994, Pages 1-7
T. C. Chao, D. S. T. Lo, P. P. S. Chui, T. H. Koh

Abstract

The propofol levels in the blood and tissues of a 37-year-old Chinese male suspected of having fatally self-administered an intravenous dose of 1600 mg of propofol (12.3–15.4 times the dose required for the induction of anaesthesia) were determined by headspace gas chromatography. The blood (femoral), liver, kidney and brain propofol levels were 2.5 μg/ml, 22 μg/g, 3.6 μg/g and 11.3 μg/g, respectively. The blood propofol level in the present case is 11.4 times and the liver propofol level is 15.7 times that of the first propofol overdose reported in the literature.

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Sedation controlee par le patient avec du propofol au c...
Annales Francaises d'Anesthesie et de Reanimation

Sedation contrôlée par le patient avec du propofol au cours de la lithotritie extracorporelle rénale
Annales Françaises d’Anesthésie et de Réanimation, Volume 18, Issue 4, April 1999, Pages 409-414
F. Sztark, C. Bourdallé-Badie, J.L. Pariente, A. Lamore, P.L. Gardien, P. Erny

Abstract

Objective

Evaluation of patient-controlled sedation with propofol for extracorporeal shock wave lithotripsy (ESWL) using an EDAP^;LT01 lithLT01 lithotriptor.

Study design

Prospective clinical study.

Patients

Fifty consecutive patients, ASA I or II, aged 18–65 years.

Methods

Patients received 50 mg of propofol five minutes before ESWL, then they self-administered 50 mg bolus doses of propofol with a ten minutes lockout interval. Pain (1–100 mm VAS) and sedation (four points scale) were assessed every five minutes. Patient satisfaction was recorded at the end of the procedure. Pharmacokinelic simulation was done with the Marsh's data set.

Results

Three patients were excluded. Patients received a mean propofol dose of 147 ± 68 mg during the procedure with a mean duration of 47 ± 8 minutes. The median of the higher sedation scores was 2 (drowsy) and mean maximal VAS was 40 ± 20 mm (10–70). No complications were recorded. Thirty-nine patients (83%) were satisfied or very satisfied by patient-controlled sedation.

Conclusion

Patient-controlled sedation with propofol is a safe and efficient mode of administration of an hypnotic agent for ESWL.

Résumé

Objectif

Évaluation d'une technique de sedation contrôlée par le patient avec du propofol pour le traitement des lithiases rénales par lithotritie extracorporelle (LEc) avec un appareil EDAP^;LT01.LT01.

Type d'étude

Étude clinique prospective.

Patients

Cinquante patients (ASA I ou II, âgés de 18 à 65 ans) inclus consécutivement.

Méthodes

Le propofol était administré à l'aide d'une pompe PCA selon le protocole suivant: un bolus de 50 mg (20 mg·min¹)) cinq minutes avant le début des tirs, puis la même dose pouvait être autoadministrée avec une période réfractaire de dix minutes. Outre les paramàtres du monitorage habituel, ont été recueillis toutes les cinq minutes les scores de douleur (EVA, 1 à 100 mm) et de sedation (de 1 à 4). Un antalgique (nalbuphine 10 mg) était administré si l'EVA ≥ 40 mm. Un indice de satisfaction était relevé aupràs de chaque patient en fin de séance. Une simulation pharmacocinétique a été réalisée selon le modàle de Marsh.

Résultats

Trois patients ont été exclus. La quantité de propofol administrée au cours d'une séance, de durée moyenne 47 ± 8 minutes (m ± DS), était de 147 ± 68 mg en 3 ± 1 bolus. La médiane des scores de sedation les plus élevés en cours de séance était égale à 2 (patient somnolent) et la moyenne des scores EVA maximaux était égale à 40 ± 20 mm (10–70). Aucune complication respiratoire ou circulatoire n'a été relevée. Trente-neuf patients (83 %) étaient tràs satisfaits ou satisfaits par cette technique.

Conclusion

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Biocompatibility of extracorporeal circuits in heart su...
Transfusion Science

Biocompatibility of extracorporeal circuits in heart surgery
Transfusion Science, Volume 11, Issue 1, 1990, Pages 5-31
W. van Oeveren, Ch. R. H. Wildevuur, M. D. Kazatchkine

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