Dose-dependent hemodynamic effects of propofol induction following brotizolam premedication in hypertensive patients taking angiotensin-converting enzyme inhibitors

• Published in: Journal of clinical anesthesia Vol. 22; no. 3; pp. 190 - 195
• Main Authors: Weisenberg, Marian, MD, Sessler, Daniel I., MD, Tavdi, Monica, MD, Gleb, Muzikant, MD, Ezri, Tiberiu, MD, Dalton, Jarrod E., MA, Protianov, Michael, MD, Zimlichmann, Reuven, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2010; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Anesthesia; Anesthesia & Perioperative Care; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Intravenous - administration & dosage; Angiotensin-converting enzyme inhibitors; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Antihypertensive medications; Arterial hypertension. Arterial hypotension; Azepines - administration & dosage; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - drug effects; Bradycardia - drug therapy; Cardiac arrhythmia; Cardiology. Vascular system; Dose-Response Relationship, Drug; Drug therapy; Heart attacks; Heart rate; Heart Rate - drug effects; Hemodynamic changes; Humans; Hypertension; Hypertension - drug therapy; Hypnotics and Sedatives - administration & dosage; Hypotension - drug therapy; Intubation; Medical sciences; Middle Aged; Pain Medicine; Preanesthetic Medication; Propofol; Propofol - administration & dosage; Prospective Studies; Statistical methods; Surgery; Tachycardia - drug therapy; Angiotensin-converting enzyme inhibitors; Anesthesia; General; Hemodynamic changes; Propofol; Antihypertensive medications; Human; Hypertension; Thienotriazolodiazepine derivatives; Psychotropic; Cardiovascular disease; Hypnotic; General anesthetic; Benzodiazepine derivatives; Antihypertensive agent; Brotizolam; Hemodynamics; Sedative; ACE inhibitor
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2009.07.008

Abstract Study Objective To determine a propofol dose that minimizes hemodynamic changes on induction of anesthesia in patients chronically taking angiotensin-converting enzyme inhibitors (ACEIs). Design Prospective, randomized trial. Setting Operating room of a university-affiliated general hospital. Patients 88 ASA physical status II and II hypertensive patients chronically taking ACEIs, scheduled for elective abdominal surgery with general anesthesia. Interventions Patients were premedicated with brotizolam and anesthesia was induced with propofol, fentanyl, and rocuronium; anesthesia was then maintained with isoflurane. Patients were randomly assigned to undergo anesthetic induction with propofol in doses of 1.3, 1.6, 2.0, or 2.3 mg/kg. Measurements Oscillometric blood pressure and heart rate were evaluated at one-minute intervals during the first 10 minutes of anesthesia. End-tidal isoflurane concentrations were also recorded. Episodes of hypertension, tachycardia, bradycardia, or hypotension (defined as > 30% of baseline values) were managed per protocol with esmolol, atropine, phenylephrine, or ephedrine. Administration of any of these drugs was considered a pharmacological intervention. Main Results After adjusting for covariables in a model assuming a linear relationship between dose and log-response, each propofol dose increase of 0.3 mg/kg was associated with a 31% increase in mean number of hypotensive/bradycardic episodes requiring interventions (95% confidence intervals of +5% and +65%; P = 0.018). Based on our model, a dose of 1.3 mg/kg resulted in the fewest number of pharmacological interventions. Conclusions In patients chronically taking ACEIs, low doses of propofol reduce hemodynamic instability.