Safety and Efficacy of Propofol With  EDTA When Used for Sedation  of Surgical Intensive Care Unit Patients

Herr, Daniel; Kelly, Kathleen; Hall, Jesse B.; Ulatowski, John A.; Fulda, Gerard J.; Cason, Brian A.; Hickey, Robert W.; Nejman, Antoni M.; Zaloga, Gary P.; Teres, Daniel

doi:10.1007/pl00003789

Cited by 39 publications

(22 citation statements)

References 10 publications

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“…In two studies of critically ill patients undergoing mechanical ventilation, a decline in serum PTH was observed over a span of several days of propofol sedation. 5,6 In contrast, propofol sedation did not affect serum PTH in patients with secondary HPT. 4 Wahr et al 7 postulated that the found increase in serum PTH in patients undergoing cardiac surgery and anesthesia with propofol was in response to either hypocalcemia or catecholamine release.…”

Section: Discussionmentioning

confidence: 88%

“…Whether propofol affects parathyroid serum concentrations or not is presently controversial. 2,[4][5][6] In healthy volunteers sedated with propofol serum, PTH increased in a dosedependent fashion while serum calcium concentrations remained unchanged. 2 At propofol infusion of 200 lgÁkg -1 Ámin -1 , serum PTH concentrations increased 40% from baseline to values that could be encountered in patients with primary HPT.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of propofol on intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism undergoing parathyroidectomy: a randomized control trial

Kivela

Šprung

Richards

et al. 2011

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Effects of propofol on intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism undergoing parathyroidectomy: a randomized control trial

Kivela

Šprung

Richards

et al. 2011

Can J Anesth/J Can Anesth

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“…Accordingly, surgical intensive care unit patients who received propofol with EDTA had significantly reduced mortality rates in comparison with those who received propofol without EDTA. 9 In contrast, clinical variables and incidence of adverse events were not affected by propofol/EDTA in patients after cardiac surgery. 10 The administration of propofol formulations with EDTA or sodium metabisulfite may thus increase the variability of the inflammatory response.…”

Section: In Replymentioning

confidence: 88%

In Reply

Schilling

Kozian²,

Şentürk³

et al. 2012

Anesthesiology

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Authors remarked that proinflammatory cytokines increased in the ventilated lung after one lung ventilation. Mediator release was more enhanced during propofol anesthesia compared with desflurane or sevoflurane administration. Postoperatively, the proinflammatory cytokines tumor necrosis factor-␣ (P Ͻ 0.001), interleukin-1␤ (IL-1␤) (P Ͻ 0.002), and interleukin 8 (IL-8) (P Ͻ 0.025) were more increased in patients during propofol administration compared with both volatile anesthesia groups, and postoperative serum concentration of IL-6 was increased in all patient groups after thoracic surgery (P Ͻ 0.001). The authors concluded that onelung ventilation increases the alveolar concentrations of proinflammatory mediators in the ventilated lung. Both desflurane and sevoflurane suppress the local alveolar, but not the systemic, inflammatory responses to one-lung ventilation and thoracic surgery. Lung injury after thoracic surgery is a relatively uncommon but major complication with high mortality. Many factors, including cytokine imbalance, ischemia reperfusion injury, and the use of one-lung ventilation, are involved in this process apart from the surgical insult itself.2 In our opinion, a point of this work is not sufficiently clear. EDTA and sulfite might be added as antimicrobial agents to several formulations of propofol, which may have different physiologic responses. Herr et al. 3 showed that the patients in the surgical intensive care unit receiving propofol with EDTA had significantly reduced mortality rates at 7 and 28 days compared with those receiving propofol without EDTA. Haitsma et al. 4 compared the effects of propofol with EDTA, propofol with sulfite, and ketamine/midazolam on tumor necrosis factor-␣, interleukin-6 (IL-6), and macrophage inflammatory protein-2 in an animal study. They showed that bronchoalveolar lavage IL-6 was significantly higher in the propofol with sulfite group compared with both the ketamine/ midazolam and the propofol with EDTA groups. They also remarked that pulmonary IL-6 can be modulated by additives in systemic anesthesia.Accordingly, we think that reporting detailed formula of propofol in studies evaluating the effect of propofol on inflammatory responses would be crucial, and we hope that the previously mentioned comments might add to the value of the manuscript by Schilling et al.

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“…В исследовании в условиях хирур гического отделения реаниматологии пациенты, получав шие пропофол с ЭДТА, имели меньшую летальность на 7 е и 28 е сутки, чем те, которые получали пропофол без нее [67]. Потенциально положительный эффект от пропофола с ЭДТА может быть связан со способностью ЭДТА связывать катионы.…”

Section: седация и иммуномодуляцияunclassified

Psychomotor Agitation in Critically Ill Patients and the Role of Sedation

ФедарауМ.¹,

Комполо²,

Papadokos³

2012

rmt

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О Б Щ А Я Р Е А Н И М А Т О Л О Г И Я , 2 0 1 2 , V I I I ; 6 62 www.niiorramn.ru Существующая проблема психомоторных расст ройств, таких как возбуждение, тревога и делирий, многие годы привлекает внимание врачей и сестер отделений реани матологии, а также руководства больниц. Эти состояния мо гут напрямую влиять на оказание медицинской помощи больным, увеличивать их метаболические потребности и в конечном счете увеличивать заболеваемость и летальность. Данные состояния также связаны с увеличением продолжи тельности и стоимости нахождения больных в отделениях реаниматологии. В настоящее время дыхательная недоста точность является наиболее частой причиной поступления больных в отделение реаниматологии и сопровождается вы сокой летальностью. Однако только 16% больных, которым проводится искусственная вентиляция легких, умирают не посредственно от дыхательной недостаточности [1][2][3]. Сре ди внелегочных факторов, влияющих на летальность боль ных в критическом состоянии, возбуждение и делирий оста ются недооцененными и плохо изученными. В связи с этим необходима разработка и применение рекомендаций с сис темным и организационным подходом, направленных на профилактику и лечение данных нарушений.В течение последнего десятилетия были приняты реко мендации и протоколы, посвященные проведению седации в отделении реаниматологии и направленные на поддержание оптимального уровня комфорта и безопасности больных в критическом состоянии [4,5]. Седация и обезболивание рас сматриваются как жизненно важные мероприятия в течение всего периода госпитализации. Это приводит к увеличению усилий медицинского персонала, направленных на седацию и анальгезию у этой категории больных. В последнее время кли ницисты столкнулись со значительной нехваткой седативных препаратов, что повлияло на локальные протоколы отделений реаниматологии по всему миру. Наше растущее понимание важности изменений ментального статуса у больных в крити ческом состоянии и их влиянии на исход в свою очередь по влияло на тактику седации в отделениях реаниматологии. Это привело к изменению оценки и методов лечения больных.Critically ill patients often receive analgesia and sedation to keep them comfortable and to prevent agitation and delirium, which are serious, common and yet frequently underdiagnosed forms of brain dysfunction in intensive care environment with unclear but often unfavorable contribution to patient outcomes. Apart from delirium assessment and screening the most important aspect of ICU management is understanding the drugs given to patients and their specific advantages and disadvantages. It is crucial for clinicians and units to develop guidelines and protocols for the administration of sedatives depending on the type of patient population. Newer drugs, such as dexmedetomidine and remifentanyl, should be intro duced and extensively studied. The immunomodulating effects of sedation also must be explored, as these properties may greatly affect outcome. With an increased understanding of sedative drugs will come an improved ability to use multiple dru...

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Safety and Efficacy of Propofol With EDTA When Used for Sedation of Surgical Intensive Care Unit Patients

Cited by 39 publications

References 10 publications

Effects of propofol on intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism undergoing parathyroidectomy: a randomized control trial

Effects of propofol on intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism undergoing parathyroidectomy: a randomized control trial

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Psychomotor Agitation in Critically Ill Patients and the Role of Sedation

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