Effect of acute hypervolemic hemodilution of 6% hydroxyethyl starch 130/0.4 on the EC50 of propofol at two clinical endpoints in patients

Li, Yuhong; Shan, Yue; Lin, Xuezheng

doi:10.3892/etm.2015.2886

Cited by 5 publications

(4 citation statements)

References 34 publications

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“…For the meta-analysis, 38 of the 63 studies were conducted in non-acutely ill subjects [ 7 , 11 – 23 , 25 – 27 , 29 – 35 , 37 – 48 ] and 25 in acutely ill patients, of which 10 were in patients with circulatory shock and/or severe hypovolemia [ 1 , 49 , 51 – 57 ], 8 in surgical or trauma patients [ 58 – 61 , 63 – 65 ], 6 in patients with sepsis [ 66 – 71 ], and 1 in patients with mixed conditions [ 72 ] (Additional file 1 : Table E3).…”

Section: Resultsmentioning

confidence: 99%

Effects of rapid fluid infusion on hemoglobin concentration: a systematic review and meta-analysis

et al. 2022

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Background Rapid fluid administration may decrease hemoglobin concentration (Hb) by a diluting effect, which could limit the increase in oxygen delivery (DO2) expected with a positive response to fluid challenge in critically ill patients. Our aim was to quantify the decrease in Hb after rapid fluid administration. Methods Our protocol was registered in PROSPERO (CRD42020165146). We searched PubMed, the Cochrane Database, and Embase from inception until February 15, 2022. We selected studies that reported Hb before and after rapid fluid administration (bolus fluid given over less than 120 min) with crystalloids and/or colloids in adults. Exclusion criteria were studies that included bleeding patients, or used transfusions or extracorporeal circulation procedures. Studies were divided according to whether they involved non-acutely ill or acutely ill (surgical/trauma, sepsis, circulatory shock or severe hypovolemia, and mixed conditions) subjects. The mean Hb difference and, where reported, the DO2 difference before and after fluid administration were extracted. Meta-analyses were conducted to assess differences in Hb before and after rapid fluid administration in all subjects and across subgroups. Random-effect models, meta-regressions and subgroup analyses were performed for meta-analyses. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I2 statistic. Results Sixty-five studies met our inclusion criteria (40 in non-acutely ill and 25 in acutely ill subjects), with a total of 2794 participants. Risk of bias was assessed as “low” for randomized controlled trials (RCTs) and ‘low to moderate’ for non-RCTs. Across 63 studies suitable for meta-analysis, the Hb decreased significantly by a mean of 1.33 g/dL [95% CI − 1.45 to − 1.12; p < 0.001; I2 = 96.88] after fluid administration: in non-acutely ill subjects, the mean decrease was 1.56 g/dL [95% CI − 1.69 to − 1.42; p < 0.001; I2 = 96.71] and in acutely ill patients 0.84 g/dL [95% CI − 1.03 to − 0.64; p = 0.033; I2 = 92.91]. The decrease in Hb was less marked in patients with sepsis than in other acutely ill patients. The DO2 decreased significantly in fluid non-responders with a significant decrease in Hb. Conclusions Hb decreased consistently after rapid fluid administration with moderate certainty of evidence. This effect may limit the positive effects of fluid challenges on DO2 and thus on tissue oxygenation.

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Section: Resultsmentioning

confidence: 99%

Effects of rapid fluid infusion on hemoglobin concentration: a systematic review and meta-analysis

et al. 2022

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“…However, some limitations have been noted. Firstly, there are many influencing factors of propofol EC50, including gender (15), age (16), intraoperative fluid supplementation (17), and the female hormonal fluctuations associated with the menstrual cycle (18), etc. All breast cancer patients included in this study were female, without any statistical difference in age between both groups.…”

Section: Discussionmentioning

confidence: 99%

Effects of dexmedetomidine as an adjuvant in thoracic paravertebral block on EC50 of propofol for successful laryngeal mask insertion: a randomized controlled trial

Guo¹,

Chen²,

Cai³

et al. 2020

Ann Transl Med

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Background: Dexmedetomidine as an adjuvant can improve the duration and the quality of thoracic paravertebral block (TPVB); however, its quantitative effect on propofol infusion is unclear. This study aimed to investigate the effect of dexmedetomidine as an adjuvant in TPVB on the medium effective concentration (EC50) of propofol for successful laryngeal mask insertion.Methods: Sixty breast cancer patients who underwent elective modified radical mastectomy were enrolled and randomized at a 1:1 ratio into control group (Group C, n=30) or dexmedetomidine group (Group D, n=30). Ultrasound-guided T3 paravertebral block was performed before induction of anesthesia. In Group C, 0.5% ropivacaine 0.3 mL/kg was injected into T3 paravertebral space, while subjects in Group D received 0.5% ropivacaine 0.3 mL/kg with dexmedetomidine (1 μg/kg). Propofol target-controlled infusion (TCI) was performed, with an initial target effect-site concentration of 5 μg/mL determined for both groups.The laryngeal mask was inserted once the effect chamber achieved the target concentration. Subsequent target concentrations were adjusted by Dixon up-down sequential method, where dose modifications were performed by 0.5 mg/mL intervals, based on the success of the laryngeal mask insertion. Probit analysis was used to determine the propofol EC50. Mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS) and application of atropine or ephedrine was recorded. Participants, TPVB giver, and data recorder were blinded to group assignment.Results: Propofol EC50 for successful laryngeal mask insertion were statistically significant, with 5.256 μg/mL (95% CI: 4.833, 5.738 μg/mL) in Group C and 3.172 μg/mL (95% CI: 2.701, 3.621 μg/mL) in Group D.Both groups displayed significantly lower MAP and HR, post propofol TCI (P<0.05). However, subjects in Group D exhibited lower MAP and HR levels compared to patients in Group C (P<0.05). Application of atropine (0% vs. 10%) and ephedrine (20.0% vs. 13.3%) were not significantly different between two groups.Conclusions: Dexmedetomidine, administered as an adjuvant in TPVB, can reduce the TCI concentration of propofol for successful laryngeal mask placement in females. The target concentration of propofol requires adjustment and close monitoring of hemodynamic changes, post induction is warranted.

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“…Both animal experiments and clinical case observations have confirmed its clinical safety and practicality. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

The effects of hypervolemic infusion on microcirculation perfusion of patients during laparoscopic colorectal surgery

Deng

Zhu

et al. 2017

Medicine

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Effect of acute hypervolemic hemodilution of 6% hydroxyethyl starch 130/0.4 on the EC50 of propofol at two clinical endpoints in patients

Cited by 5 publications

References 34 publications

Effects of rapid fluid infusion on hemoglobin concentration: a systematic review and meta-analysis

Effects of rapid fluid infusion on hemoglobin concentration: a systematic review and meta-analysis

Effects of dexmedetomidine as an adjuvant in thoracic paravertebral block on EC50 of propofol for successful laryngeal mask insertion: a randomized controlled trial

The effects of hypervolemic infusion on microcirculation perfusion of patients during laparoscopic colorectal surgery

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