Predictors of Severe Hypotension in Neurocritical Care Patients Sedated with Propofol

Abstract

Multiple factors predicted hypotension in NCC patients receiving propofol. Clinicians should use propofol cautiously in patients with a lower baseline MAP or receiving RRT. Development of protocols related to the frequency of dose titrations is also recommended to prevent this avoidable complication.

A Comparison of Severe Hemodynamic Disturbances Between Dexmedetomidine and Propofol for Sedation in Neurocritical Care Patients

“…For dexmedetomidine, MAP less than 70 mm Hg (OR, 4.4; 95% CI, 2.1-9.1; p < 0.001) and increasing APACHE II score (OR, 1.08; 95% CI, 1.03-1.14; p = 0.002) have been shown to be independently associated with hypotension (24). In the unmatched cohort of our study, 19 propofol patients (8.0%) were documented to have one of the confirmed dichotomous predictors (25), compared with nine patients (8.6%) in the dexmedetomidine group (24). There were similar frequencies of infusion rate changes and baseline APACHE II scores between groups as well.…”

“…These approximations were based on mean prevalence reported of the combined outcome of hypotension and bradycardia with dexmedetomidine in studies who utilized a similar definition as our methods (22)(23)(24). For propofol, we averaged data provided in the prescribing information, as well as a recent report by our study group (11,25). Two hundred seventy-six (78 dexmedetomidine and 148 propofol) patients would provide an 80% power to detect this difference with a significance level of 0.05 and a 1:2 allocation of dexmedetomidine to propofol.…”

“…We generated a propensity score (logit) using logistic regression and then matched patients on a 1:1 basis that received dexmedetomidine to those who received propofol based on a random seed, nearest neighbor (caliper ≤ 0. 25), and without replacement model (26 based on a nonsignificant Hosmer-Lemeshow goodness-offit p value of 0.54. Propensity score generation and matching were run using Stata 12.1 (Stata Corporation, College Station, TX).…”

“…DEX = dexmedetomidine, PRO = propofol. (25). For dexmedetomidine, MAP less than 70 mm Hg (OR, 4.4; 95% CI, 2.1-9.1; p < 0.001) and increasing APACHE II score (OR, 1.08; 95% CI, 1.03-1.14; p = 0.002) have been shown to be independently associated with hypotension (24).…”

Endoscopist-Directed Propofol: Pros and Cons

“…Local pain occurs in 30% of patients during administration of propofol. This can lead to a fall in systemic vascular resistance and cardiac contractility and consequent hypotension 17. Propofol can reduce cardiac output without a concomitant change in heart rate 18,19.…”