Prolonged Propofol Use in a Critically III Pregnant Patient

Tajchman, Sharla; Bruno, Jeffrey J.

doi:10.1345/aph.1p427

Cited by 15 publications

(12 citation statements)

References 21 publications

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“…However, our study has considered the long-term outcome of maternal propofol exposure and its effects on learning and memory in offspring. Propofol has been widely used in pregnant woman for sedation [32,33], cesarean delivery [34][35][36] and nonobstetric surgery [37,38]. Clinical data indicates that nonobstetric surgeries during pregnancy are safe for mothers and their foetuses [40][41][42][43][44][45][46][47][48].…”

Section: Discussionmentioning

confidence: 99%

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Propofol exposure during late stages of pregnancy impairs learning and memory in rat offspring via the BDNF‐TrkB signalling pathway

Zhong

Luo

Zhao

et al. 2016

J Cellular Molecular Medi

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The brain‐derived neurotrophic factor (BDNF)‐tyrosine kinase B (TrkB) (BDNF‐TrkB) signalling pathway plays a crucial role in regulating learning and memory. Synaptophysin provides the structural basis for synaptic plasticity and depends on BDNF processing and subsequent TrkB signalling. Our previous studies demonstrated that maternal exposure to propofol during late stages of pregnancy impaired learning and memory in rat offspring. The purpose of this study is to investigate whether the BDNF‐TrkB signalling pathway is involved in propofol‐induced learning and memory impairments. Propofol was intravenously infused into pregnant rats for 4 hrs on gestational day 18 (E18). Thirty days after birth, learning and memory of offspring was assessed by the Morris water maze (MWM) test. After the MWM test, BDNF and TrkB transcript and protein levels were measured in rat offspring hippocampus tissues using real‐time PCR (RT‐PCR) and immunohistochemistry (IHC), respectively. The levels of phosphorylated‐TrkB (phospho‐TrkB) and synaptophysin were measured by western blot. It was discovered that maternal exposure to propofol on day E18 impaired spatial learning and memory of rat offspring, decreased mRNA and protein levels of BDNF and TrkB, and decreased the levels of both phospho‐TrkB and synaptophysin in the hippocampus. Furthermore, the TrkB agonist 7,8‐dihydroxyflavone (7,8‐DHF) reversed all of the observed changes. Treatment with 7,8‐DHF had no significant effects on the offspring that were not exposed to propofol. The results herein indicate that maternal exposure to propofol during the late stages of pregnancy impairs spatial learning and memory of offspring by disturbing the BDNF‐TrkB signalling pathway. The TrkB agonist 7,8‐DHF might be a potential therapy for learning and memory impairments induced by maternal propofol exposure.

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Section: Discussionmentioning

confidence: 99%

“…Most of these procedures must be completed under general anaesthesia . Propofol is the most widely used intravenous general anaesthetic and has been used in pregnant woman for sedation , cesarean delivery and/or nonobstetric surgery . It is well‐known that propofol can easily pass through the placental barrier .…”

Section: Introductionmentioning

confidence: 99%

Propofol exposure during late stages of pregnancy impairs learning and memory in rat offspring via the BDNF‐TrkB signalling pathway

Zhong

Luo

Zhao

et al. 2016

J Cellular Molecular Medi

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“…Some studies suggest that decreased doses of hypnotics during pregnancy may achieve similar sedation outcomes as higher doses in nonpregnant patients. 44,45 The pharmacokinetic and pharmacodynamic mechanisms related to this decreased dosage requirement remain theoretical, but a correlation to progesterone levels has been proposed. 44,46,47 Other theories include an increased rate of drug distribution secondary to increased cardiac output, lower levels of plasma proteins for binding, greater gastrointestinal absorption, and increased kidney elimination.…”

Section: Sedationmentioning

confidence: 99%

When One Drug Affects 2 Patients

Bulloch

Carroll

2012

Journal of Pharmacy Practice

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One of the most difficult challenges health care providers encounter is drug selection for pregnant patients. Drug selection can be complex as efficacy and maternal side effects must be weighed against potential risk to the embryo or fetus. Verification of an individual drug's fetal safety is limited as most evidence is deduced from epidemiologic, prospective cohort, or case-control studies. Medication selection for the pregnant inpatient is a particularly complex task as the illnesses and conditions that require hospitalization mandate different medications, and the risk versus benefit ratio can vary significantly compared to the outpatient setting. Some degree of acute pain is not uncommon among inpatients. Acetaminophen is generally considered the drug of choice in pregnancy for mild to moderate acute pain, while most opioids are thought to be safe for short-term use to manage moderate to severe pain. Providing sedation is particularly challenging as the few options available for the general population are further limited by either known increased risk of congenital malformations or very limited human pregnancy data. Propofol is the only agent recommended for continuous sedation, which has a Food and Drug Administration classification as a pregnancy category B medication. Treatment of infections in hospitalized patients requires balancing the microbiology profile against the fetal risk. Older antimicrobials proven generally safe include beta-lactams, and those with proven fetal risks include tetracyclines. However, little to no information regarding gestational use is available on the newer antimicrobials that are frequently employed to treat resistant infections more commonly found in the inpatient setting. Management of maternal blood pressure is based on the severity of blood pressure elevations and not the hypertensive classification. Agents generally considered safe to use in hypertensive pregnant patients include methyldopa, labetolol, and hydralazine, while angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, hydrochlorothiazide, and atenolol should be avoided.

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“…5 We were unable to find any studies focussing specifically on sedation, particularly in the antepartum population, except for isolated case reports. [6][7][8] One advised against the use of propofol immediately before caesarean section due to concerns of fetal sedation. 6 Another report, documenting prolonged propofol use, did not report fetal outcome.…”

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confidence: 99%

“…6 Another report, documenting prolonged propofol use, did not report fetal outcome. 7 However, two neurosurgical pregnant patients who received prolonged propofol infusions had successful deliveries of healthy babies. 8 In our intensive care unit (ICU) we debated the optimum sedation strategy in a 35-week gestation patient with H1N1 pneumonia requiring intubation and ventilation.…”

mentioning

confidence: 99%