Anesth Analg 2006;103:260
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000215229.42669.2D
LETTER TO THE EDITOR
Hemodynamics with Propofol: Is Propofol Dangerous in Classes III-V Patients?
Maurice Lippmann, MD, and
Clinton Kakazu, MD
Department of Anesthesiology; Harbor-UCLA Medical Center; Torrance, CA; smaddox{at}ladhs.org
To the Editor:
The article by Reich et al. (1) is consistent with the hemodynamic profile of propofol induction previously reported by our research group (2). We also found decreased mean arterial blood pressure, cardiac index, left cardiac work index, and left stroke work index. In our study the maximum hemodynamic depression occurred within 2–3 min after injection of 2.5 mg/kg IV propofol induction done over 30–45 s. The combined results of these studies suggest that propofol needs to be administered carefully in debilitated or very ill patients. Previous administration of opioids may exacerbate postinduction hypotension.
These results raise the question of whether propofol is safe for high-risk patients with known cardiac dysfunction. Drugs that cause profound myocardial depression or that increase minute volume of oxygen consumption, secondary to increases in heart rate and arterial blood pressure, may be contraindicated in these patients. On the other hand, diminished cardiac performance ensures less myocardial demand and less consumption of myocardial oxygen and energy stores, thus preserving more functioning myocardium. The quandary continues.
Our results suggest that propofol causes more cardiovascular depression than thiopental. Both drugs should be used with caution when used as an induction drug in patients with cardiac dysfunction and in the elderly, as cardiovascular depression may be far less predictable and potentially more serious in these patient populations.
Footnotes
Dr. Reich does not wish to respond.
REFERENCES
- Reich D, Hossain S, Krol M, et al. Predictors of hypotension after induction of general anesthesia. Anesth Analg 2005;101:622–8.[Abstract/Free Full Text]
- Lippmann M, Paicius R, Gingerich S, et al. A controlled study of the hemodynamic effects of propofol versus thiopental during anesthesia induction. Seminars in Anesthesia 1988:116–22.
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