Key result
Prophylactic ephedrine counters propofol-induced hypotension during valve surgery, but higher doses increase ischemic episodes.
Why the study?
Does prophylactic ephedrine prevent propofol-induced hypotension in patients undergoing valve surgery?
RCT (n=150)
randomly assigned
Does prophylactic ephedrine prevent propofol-induced hypotension in patients undergoing valve surgery?
Prophylactic use of small doses of ephedrine (0.07-0.1 mg/kg) safely and effectively counters propofol-induced hypotension during valve surgery without causing the ischemic episodes seen with higher doses or phenylephrine.
Answers are grounded in this paper and cite their sources.
Low-dose ephedrine prophylaxis may be considered before propofol in valve surgery; extends RCT evidence for hemodynamic stability in cardiac anesthesia.
The prophylactic use of small doses of ephedrine may counter the hypotension response to propofol anesthesia with minimal hemodynamic changes. One hundred-fifty patients scheduled for valve surgery were randomly assigned into five groups (n = 30 for each) to receive saline, 0.07, 0.1, or 0.15 mg/kg of ephedrine, or phenylephrine 1.5 μg/kg before induction of propofol-fentanyl anesthesia. After induction, patient receiving ephedrine had higher mean arterial pressure, systemic vascular resistance (SVRI), cardiac (CI), stroke volume (SVI), and left ventricular stroke work (LVSWI) indices. Patients received 0.15 mg/kg of ephedrine showed additional increased heart rate and frequent ischemic episodes (P < 0.001). However, those who received phenylephrine showed greater rise in SVRI, reduced CI, SVI, and LVSWI and more frequent ischemic episodes. We conclude that the prophylactic use of small doses of ephedrine (0.07-0.1 mg/kg) is safe and effective in the counteracting propofol-induced hypotension during anesthesia for valve surgery.
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A 2011 study conducted an RCT in valve surgery (n=150). Ephedrine vs. Saline or phenylephrine 1.5 μg/kg was evaluated on Hemodynamic changes and ischemic episodes (p=<0.001). Prophylactic ephedrine (0.07-0.1 mg/kg) effectively countered propofol-induced hypotension during valve surgery, while 0.15 mg/kg increased heart rate and ischemic episodes (P<0.001).
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