Co-induction with a vasopressor “chaser” to mitigate propofol-induced hypotension when intubating critically ill/frail patients–A questionable practice

Publication date: Available online 12 September 2019Source: Journal of Critical CareAuthor(s): M.-H. Ho Anthony, Glenio B. MizubutiAbstractProphylactic administration of a vasopressor to mitigate the hypotensive effect of propofol (and/or other co-induction agents) during sedation/anesthesia immediately prior to tracheal intubation in frail patients in the intensive care unit and emergency and operating rooms appears to be not an uncommon practice. We submit that this practice is unnecessary and potentially harmful. Despite restoring the blood pressure, phenylephrine, for instance, may have an additive or synergistic effect with propofol in reducing the cardiac output and, ultimately, organ perfusion. Airway instrumentation often leads to sympathetic activation and hypertension (thereby increasing myocardial oxygen consumption) which may be exacerbated by an arbitrary prophylactic dose of phenylephrine. Finally, in spite of the well-recognized need to reduce dosages of propofol in frail patients, excessive doses are commonly given, leading to hypotension. We herein discuss each of these points and suggest alternative techniques to promote a stable induction in frail patients.
Source: Journal of Critical Care - Category: Gastroenterology Source Type: research

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Source: Frontiers in Physiology - Category: Physiology Source Type: research
Conditions:   Retinitis Pigmentosa;   Maculopathy, Age Related;   Macular Dystrophy;   Macular Edema;   Retinal Detachment;   Retinal Degeneration;   Glaucoma;   Vascular Inflammation;   Hypertension;   Stroke;   Diabetes;   Corneal Dystrophy;   Keratoconus;   Dry Eye;   Trauma Interventions:   Device: High-resolution retinal imaging through adaptive optics;   Device: High-resolution retinal imaging through holographic systems Sponsor:   Centre Hospitalier National d'Ophtalmologie des ...
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Conditions:   Retinitis Pigmentosa;   Maculopathy, Age Related;   Macular Dystrophy;   Macular Edema;   Retinal Detachment;   Retinal Degeneration;   Glaucoma;   Vascular Inflammation;   Hypertension;   Stroke;   Diabetes;   Corneal Dystrophy;   Keratoconus;   Dry Eye;   Trauma Interventions:   Device: High-resolution retinal imaging through adaptive optics;   Device: High-resolution retinal imaging through holographic systems Sponsor:   Centre Hospitalier National d'Ophtalmologie des ...
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Conditions:   Retinitis Pigmentosa;   Maculopathy, Age Related;   Macular Dystrophy;   Macular Edema;   Retinal Degeneration;   Diabetic Retinopathy;   Occlusion Retinal Vein;   Hypertension Intervention:   Sponsor:   Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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Source: Clinics in Geriatric Medicine - Category: Geriatrics Authors: Source Type: research
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Source: Current Hypertension Reports - Category: Primary Care Source Type: research
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Source: Current Hypertension Reports - Category: Primary Care Source Type: research
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Source: Clinical and Experimental Hypertension - Category: Cardiology Authors: Tags: Clin Exp Hypertens Source Type: research
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