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Prophylactic atropine administration attenuates the negative haemodynamic effects of induction of anaesthesia with propofol and high-dose remifentanil : a randomised controlled trial

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Abstract
BACKGROUND: Induction of anaesthesia with propofol and remifentanil often induces unwanted bradycardia and hypotension, raising concerns regarding tissue oxygenation. The electrophysiological cardiac effects of remifentanil can be reversed by atropine. OBJECTIVE: To investigate if prophylactic administration of atropine can attenuate the negative haemodynamic effects of propofol and a high dose of remifentanil during induction of anaesthesia. DESIGN: A double-blind, randomised controlled trial. SETTING: Single-centre, University Medical Center Groningen, The Netherlands. PATIENTS: Sixty euvolaemic patients scheduled for surgery under general anaesthesia. INTERVENTIONS: Anaesthesia was induced and maintained with a target-controlled infusion of propofol with a target effect-site concentration (C-e) of 2.5 mu g ml(-1), remifentanil (target-controlled infusion), (C-e 8 ng ml(-1)) and cis-atracurium. Methylatropine (500 mu g) or 0.9% saline was administered at immediately before induction of anaesthesia. MAIN OUTCOME MEASURES: The changes (Delta) in mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), rate pressure product, cerebral tissue oxygenation and peripheral tissue oxygenation between induction of anaesthesia (T-0) and 10 min later (T-10). RESULTS: Atropine significantly attenuated the changes in the outcome measures between T0 and T10. Median (inter-quartile range) changes were MAP, Delta = -24 (-40 to -21) vs. Delta = -37 mmHg (-41 to -31) (P = 0.02); HR, Delta = 0 +/- 13 vs. -19 +/- 11 bpm (P<0.01); CI, Delta = -0.4 +/- 0.7 vs. -0.9 +/- 0.6l min(-1) m(-2) (P<0.01) and rate pressure product, Delta = -3241 (-5015 to -613) vs. Delta = -5712 mm Hg min(-1) (-6715 to -3917) (P<0.01). Cerebral tissue oxygenation and peripheral tissue oxygenation did not change in either group. Maximum HR after atropine was 102 (86 to 116) vs. 85bpm (76 to 95). CONCLUSION: Administration of atropine, before induction of anaesthesia with propofol and high-dose remifentanil, can significantly reduce the decreases in HR, MAP and CI.
Keywords
NEAR-INFRARED SPECTROSCOPY, CARDIAC-OUTPUT, TISSUE OXYGENATION, GENERAL-ANESTHESIA, ARTERIAL-PRESSURE, PHARMACODYNAMICS, SURGERY, MODEL, PHARMACOKINETICS, CONDUCTION

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MLA
Poterman, Marieke, et al. “Prophylactic Atropine Administration Attenuates the Negative Haemodynamic Effects of Induction of Anaesthesia with Propofol and High-Dose Remifentanil : A Randomised Controlled Trial.” EUROPEAN JOURNAL OF ANAESTHESIOLOGY, vol. 34, no. 10, 2017, pp. 695–701.
APA
Poterman, M., Scheeren, T. W., van der Velde, M. I., Buisman, P. L., Allaert, S., Struys, M., & Kalmar, A. (2017). Prophylactic atropine administration attenuates the negative haemodynamic effects of induction of anaesthesia with propofol and high-dose remifentanil : a randomised controlled trial. EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 34(10), 695–701.
Chicago author-date
Poterman, Marieke, Thomas WL Scheeren, Marieke I van der Velde, Pieter L Buisman, Silvie Allaert, Michel Struys, and Alain Kalmar. 2017. “Prophylactic Atropine Administration Attenuates the Negative Haemodynamic Effects of Induction of Anaesthesia with Propofol and High-Dose Remifentanil : A Randomised Controlled Trial.” EUROPEAN JOURNAL OF ANAESTHESIOLOGY 34 (10): 695–701.
Chicago author-date (all authors)
Poterman, Marieke, Thomas WL Scheeren, Marieke I van der Velde, Pieter L Buisman, Silvie Allaert, Michel Struys, and Alain Kalmar. 2017. “Prophylactic Atropine Administration Attenuates the Negative Haemodynamic Effects of Induction of Anaesthesia with Propofol and High-Dose Remifentanil : A Randomised Controlled Trial.” EUROPEAN JOURNAL OF ANAESTHESIOLOGY 34 (10): 695–701.
Vancouver
1.
Poterman M, Scheeren TW, van der Velde MI, Buisman PL, Allaert S, Struys M, et al. Prophylactic atropine administration attenuates the negative haemodynamic effects of induction of anaesthesia with propofol and high-dose remifentanil : a randomised controlled trial. EUROPEAN JOURNAL OF ANAESTHESIOLOGY. 2017;34(10):695–701.
IEEE
[1]
M. Poterman et al., “Prophylactic atropine administration attenuates the negative haemodynamic effects of induction of anaesthesia with propofol and high-dose remifentanil : a randomised controlled trial,” EUROPEAN JOURNAL OF ANAESTHESIOLOGY, vol. 34, no. 10, pp. 695–701, 2017.
@article{8532600,
  abstract     = {BACKGROUND: Induction of anaesthesia with propofol and remifentanil often induces unwanted bradycardia and hypotension, raising concerns regarding tissue oxygenation. The electrophysiological cardiac effects of remifentanil can be reversed by atropine. 
OBJECTIVE: To investigate if prophylactic administration of atropine can attenuate the negative haemodynamic effects of propofol and a high dose of remifentanil during induction of anaesthesia. 
DESIGN: A double-blind, randomised controlled trial. 
SETTING: Single-centre, University Medical Center Groningen, The Netherlands. 
PATIENTS: Sixty euvolaemic patients scheduled for surgery under general anaesthesia. 
INTERVENTIONS: Anaesthesia was induced and maintained with a target-controlled infusion of propofol with a target effect-site concentration (C-e) of 2.5 mu g ml(-1), remifentanil (target-controlled infusion), (C-e 8 ng ml(-1)) and cis-atracurium. Methylatropine (500 mu g) or 0.9% saline was administered at immediately before induction of anaesthesia. 
MAIN OUTCOME MEASURES: The changes (Delta) in mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), rate pressure product, cerebral tissue oxygenation and peripheral tissue oxygenation between induction of anaesthesia (T-0) and 10 min later (T-10). 
RESULTS: Atropine significantly attenuated the changes in the outcome measures between T0 and T10. Median (inter-quartile range) changes were MAP, Delta = -24 (-40 to -21) vs. Delta = -37 mmHg (-41 to -31) (P = 0.02); HR, Delta = 0 +/- 13 vs. -19 +/- 11 bpm (P<0.01); CI, Delta = -0.4 +/- 0.7 vs. -0.9 +/- 0.6l min(-1) m(-2) (P<0.01) and rate pressure product, Delta = -3241 (-5015 to -613) vs. Delta = -5712 mm Hg min(-1) (-6715 to -3917) (P<0.01). Cerebral tissue oxygenation and peripheral tissue oxygenation did not change in either group. Maximum HR after atropine was 102 (86 to 116) vs. 85bpm (76 to 95). 
CONCLUSION: Administration of atropine, before induction of anaesthesia with propofol and high-dose remifentanil, can significantly reduce the decreases in HR, MAP and CI.},
  author       = {Poterman, Marieke and Scheeren, Thomas WL and van der Velde, Marieke I and Buisman, Pieter L and Allaert, Silvie and Struys, Michel and Kalmar, Alain},
  issn         = {0265-0215},
  journal      = {EUROPEAN JOURNAL OF ANAESTHESIOLOGY},
  keywords     = {NEAR-INFRARED SPECTROSCOPY,CARDIAC-OUTPUT,TISSUE OXYGENATION,GENERAL-ANESTHESIA,ARTERIAL-PRESSURE,PHARMACODYNAMICS,SURGERY,MODEL,PHARMACOKINETICS,CONDUCTION},
  language     = {eng},
  number       = {10},
  pages        = {695--701},
  title        = {Prophylactic atropine administration attenuates the negative haemodynamic effects of induction of anaesthesia with propofol and high-dose remifentanil : a randomised controlled trial},
  url          = {http://dx.doi.org/10.1097/eja.0000000000000639},
  volume       = {34},
  year         = {2017},
}

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