Key result
Propofol blunts peak epinephrine ~43% but fails to prevent desflurane-induced hemodynamic surges.
RCT (n=5)
Randomized crossover (random order on three separate occasions)
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Shows propofol reduces epinephrine surges but fails to blunt heart rate or blood pressure spikes from desflurane in healthy volunteers, suggesting persistent sympathetic activation.
BACKGROUND: A rapid increase in desflurane concentration to greater than 1 MAC transiently increases heart rate, arterial blood pressure, and circulating catecholamine concentration. Because propofol decreases sympathetic outflow, it was hypothesized that propofol would blunt these responses. METHODS: To test this hypothesis, five healthy male volunteers were studied three times. After induction of anesthesia with 2 mg.kg-1 propofol, anesthesia was maintained with 4% end-tidal desflurane in oxygen (0.55 MAC) via an endotracheal tube for 32 min. On separate occasions, in random order, either no propofol or 2 mg.kg-1 propofol was administered either 2 or 5 min before increasing end-tidal desflurane concentration from 4% to 8%. RESULTS: Without propofol pretreatment, the increase to 8% desflurane transiently increased heart rate (from 63 +/- 3 beats/min to 108 +/- 5 beats/min, mean +/- SEM; P < 0.01), mean arterial pressure (from 73 +/- 1 mmHg to 118 +/- 6 mmHg; P < 0.01), and epinephrine concentration (from 14 +/- 1 pg.ml-1 to 279 +/- 51 pg.ml-1; P < 0.05). There was no significant change in norepinephrine concentration (from 198 +/- 37 pg.ml-1 to 277 +/- 46 pg.ml-1). The peak plasma epinephrine concentration was attenuated by each propofol pretreatment (158 +/- 35 pg.ml-1, propofol given 2 min before, and 146 + 41 pg.ml-1, propofol given 5 min before; P < 0.05), but neither propofol pretreatment modified the cardiovascular or norepinephrine responses. CONCLUSIONS: Although able to blunt the increase in epinephrine concentration, propofol 2 mg.kg-1 propofol does no attenuate the transient cardiovascular response to a rapid increase in desflurane concentration to greater than 1 MAC.
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Daniel et al. (1996) conducted an RCT in Cardiovascular and catecholamine response to rapid increases in desflurane concentration (n=5). Propofol pretreatment vs. No propofol pretreatment was evaluated on Cardiovascular (heart rate, mean arterial pressure) and plasma catecholamine (epinephrine, norepinephrine) responses to increasing desflurane concentration from 4% to 8% (p=<0.05). Propofol (2 mg/kg) blunted peak plasma epinephrine (158 and 146 vs 279 pg/ml; P<0.05) but failed to attenuate heart rate or blood pressure increases after rapid desflurane escalation.
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