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| IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711 |
Int J Clin Exp Med 2013;6(1):26-29
Original Article
Hemodynamic changes following the administration of propofol to facilitate
endotracheal intubation during sevoflurane anesthesia
Elisabeth Dewhirst, Christopher Lancaster, Joseph D Tobias
Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio and Department of Anesthesiology,
the Ohio State, University, Columbus, Ohio, USA
Received August 7, 2012; accepted October 29, 2012; Epub November 18, 2012; Published January 1, 2013
Abstract: Background: The common intravenous anesthetic agent, propofol, is frequently reported to have negative inotropic and
chronotropic effects. In the pediatric population, propofol is commonly used after inhalation induction to facilitate endotracheal
intubation without the need for a neuromuscular blocking drug agent. In this setting, we have noted that propofol administration is
commonly followed by tachycardia. The current study prospective evaluates heart rate and blood pressure changes following the
administration of propofol to pediatric patients anesthetized with nitrous oxide (N2O) and sevoflurane. Methods: ASA class 1 and 2
pediatric surgical patients were enrolled in the study. After premedication with midazolam and inhalation induction with N2O in oxygen
and sevoflurane, a bolus dose of propofol was administered to facilitate endotracheal intubation. Heart rate (HR) was measured at
baseline and at 30 second intervals following propofol administration. Blood pressure (MAP) was measured at baseline and 120
seconds post-administration. Results: The study cohort consisted of 40 patients who ranged in age from 1 to 15 years. After inhalation
induction, propofol (average dose of 2.6 mg/kg) was administered. The end-tidal N2O and sevoflurane concentrations were 62.2 ±
10.3% and 5.7 ± 1.1% respectively. Nineteen of 40 patients had a HR increase >10 bpm. When comparing these patients to those who
did not experience a HR increase >10 bpm, there were no differences in the demographic data. Those with a HR increase received a
greater dose of propofol when compared to patients whose HR change was <10 bpm (3.0 ± 0.8 versus 2.2 ± 0.5 mg/kg; p=0.0007).
There was a significantly greater decreased in the MAP at 120 seconds following propofol administration in the group that did not
sustain a >10 bpm HR increase. Conclusion: Tachycardia following propofol administration occurs in approximately 50% of pediatric
patients despite preceding inhalation induction and concurrent administration of N2O and sevoflurane. Future studies are needed to
define the mechanism for this effect. (IJCEM1208001).
Keywords: Propofol, tachycardia, anesthetic induction, endotracheal intubation
Address all correspondence to:
Dr. Joseph D Tobias
Department of Anesthesiology & Pain Medicine
Nationwide Children's Hospital
700 Children's Drive, Columbus, Ohio 43205.
Tel: (614) 722-4200; Fax: (614) 722-4203
E-mail: Joseph.Tobias@Nationwidechildrens.org
Original Article
Hemodynamic changes following the administration of propofol to facilitate
endotracheal intubation during sevoflurane anesthesia
Elisabeth Dewhirst, Christopher Lancaster, Joseph D Tobias
Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio and Department of Anesthesiology,
the Ohio State, University, Columbus, Ohio, USA
Received August 7, 2012; accepted October 29, 2012; Epub November 18, 2012; Published January 1, 2013
Abstract: Background: The common intravenous anesthetic agent, propofol, is frequently reported to have negative inotropic and
chronotropic effects. In the pediatric population, propofol is commonly used after inhalation induction to facilitate endotracheal
intubation without the need for a neuromuscular blocking drug agent. In this setting, we have noted that propofol administration is
commonly followed by tachycardia. The current study prospective evaluates heart rate and blood pressure changes following the
administration of propofol to pediatric patients anesthetized with nitrous oxide (N2O) and sevoflurane. Methods: ASA class 1 and 2
pediatric surgical patients were enrolled in the study. After premedication with midazolam and inhalation induction with N2O in oxygen
and sevoflurane, a bolus dose of propofol was administered to facilitate endotracheal intubation. Heart rate (HR) was measured at
baseline and at 30 second intervals following propofol administration. Blood pressure (MAP) was measured at baseline and 120
seconds post-administration. Results: The study cohort consisted of 40 patients who ranged in age from 1 to 15 years. After inhalation
induction, propofol (average dose of 2.6 mg/kg) was administered. The end-tidal N2O and sevoflurane concentrations were 62.2 ±
10.3% and 5.7 ± 1.1% respectively. Nineteen of 40 patients had a HR increase >10 bpm. When comparing these patients to those who
did not experience a HR increase >10 bpm, there were no differences in the demographic data. Those with a HR increase received a
greater dose of propofol when compared to patients whose HR change was <10 bpm (3.0 ± 0.8 versus 2.2 ± 0.5 mg/kg; p=0.0007).
There was a significantly greater decreased in the MAP at 120 seconds following propofol administration in the group that did not
sustain a >10 bpm HR increase. Conclusion: Tachycardia following propofol administration occurs in approximately 50% of pediatric
patients despite preceding inhalation induction and concurrent administration of N2O and sevoflurane. Future studies are needed to
define the mechanism for this effect. (IJCEM1208001).
Keywords: Propofol, tachycardia, anesthetic induction, endotracheal intubation
Address all correspondence to:
Dr. Joseph D Tobias
Department of Anesthesiology & Pain Medicine
Nationwide Children's Hospital
700 Children's Drive, Columbus, Ohio 43205.
Tel: (614) 722-4200; Fax: (614) 722-4203
E-mail: Joseph.Tobias@Nationwidechildrens.org
