The effect and optimal dose of sufentanil in reducing injection pain of microemulsion propofol

다국어 초록 (Multilingual Abstract)

Background: Propofol is used as an induction and maintenance agent for general anesthesia but it can cause adverse reactions like hyperlipidemia, growth of microorganisms, and pulmonary embolisms. Microemulsion propofol was developed to avoid these side effects but incidence and severity of pain on injection is higher than with lipid emulsion propofol. We aimed to compare the effects of sufentanil in analgesic doses for reducing the injection pain of microemulsion propofol.
Methods: The candidates included eighty patients, 19-60 years old and ASA I-II. They were randomly classified into four groups and pretreated with normal saline, sufentanil 0.1 μg/kg, 0.2 μg/kg or 0.3 μg/kg before injection of microemulsion propofol. Five minutes after receiving pretreatment drug, 2 mg/kg of microemulsion propofol was injected and VAS was recorded.
Results: There were no significant differences in the incidence of injection pain among the groups. Severity of injection pain was significantly lower in the sufentanil 0.3 μg/kg group than normal saline and sufentanil 0.1 μg/kg group. Significant differences in blood pressure and heart rate were observed in sufentanil groups only after endotracheal intubation. One patient each in sufentanil 0.1 μg/kg and 0.3 μg/kg group experienced mild cough, one from sufentanil 0.3 μg/kg group experienced dizziness and another showed signs of hypoxia. One patient each in normal saline and sufentanil 0.1 μg/kg group showed clinical symptoms of phlebitis in the injection area.
Conclusions: Pretreatment with sufentanil 0.3 μg/kg reduced the severity of microemulsion propofol injection pain without increasing arterial blood pressure and heart rate after endotracheal intubation.

참고문헌 (Reference)

1 Böhrer H, "Tussive effect of a fentanyl bolus administered through a central venous catheter" 45 : 18-21, 1990

2 Kinoshita H, "Transient phlebitis induced by a bolus injection of propofol" 20 : 74-75, 2006

3 Song D, "The pharmacodynamic effects of a lower-lipid emulsion of propofol: a comparison with the standard propofol emulsion" 98 : 687-691, 2004

4 Park JW, "The effect of lidocaine on the globule size distribution of propofol emulsions" 97 : 769-771, 2003

5 Stein C, "The control of pain in peripheral tissue by opioids" 332 : 1685-1690, 1995

6 Doenicke AW, "Reducing pain during propofol injection: the role of the solvent" 82 : 472-474, 1996

7 Baker MT, "Propofol: the challenges of formulation" 103 : 860-876, 2005

8 Smith I, "Propofol. An update on its clinical use" 81 : 1005-1043, 1994

9 Devlin JW, "Propofol-associated hypertriglyceridemia and pancreatitis in the intensive care unit: an analysis of frequency and risk factors" 25 : 1348-1352, 2005

10 Honarmand A, "Prevention of propofol-induced injection pain by sufentanil: a placebo-controlled comparison with remifentanil" 28 : 27-35, 2008

11 Picard P, "Prevention of pain on injection with propofol: a quantitative systematic review" 90 : 963-969, 2000

12 Nathanson MH, "Prevention of pain on injection of propofol: a comparison of lidocaine with alfentanil" 82 : 469-471, 1996

13 Klein J, "Postoperative infection due to contaminated propofol" 154 : A767-, 2010

14 Lee EH, "Physicochemical properties, pharmacokinetics, and pharmacodynamics of a reformulated microemulsion propofol in rats" LIPPINCOTT WILLIAMS & WILKINS 109 : 436-447, 2008

15 Han J, "Physical properties and stability of two emulsion formulations of propofol" 215 : 207-220, 2001

16 Kim KM, "Pharmacokinetics and pharmacodynamics of propofol microemulsion and lipid emulsion after an intravenous bolus and variable rate infusion" LIPPINCOTT WILLIAMS & WILKINS 106 (106): 924-934, 2007

17 Lee SH, "Pharmacokinetics and pharmacodynamics of a new reformulated microemulsion and the long-chain triglyceride emulsion of propofol in beagle dogs" NATURE PUBLISHING GROUP 158 : 1982-1995, 2009

18 Sim JY, "Pain on injection with microemulsion propofol" The British Phrarmacological Society 67 (67): 316-325, 2009

19 Soulard A, "Optimal dose of sufentanil in children for intubation after sevoflurane induction without neuromuscular block" 102 : 680-685, 2009

20 Miller R, "Miller's anesthesia. 7th ed" Philadelphia, Churchill-Livingstone Elsevier 769-814, 2010

21 Barker P, "Effect of prior administration of cold saline on pain during propofol injection. A comparison with cold propofol and propofol with lignocaine" 46 : 1069-1070, 1991

22 Morey TE, "Anesthetic properties of a propofol microemulsion in dogs" 103 : 882-887, 2006

23 Chang J, "Acute respiratory arrest and rigidity after anesthesia with sufentanil: a case report" 63 : 710-711, 1985

24 Fujii Y, "A comparison of pretreatment with fentanyl and lidocaine preceded by venous occlusion for reducing pain on injection of propofol: a prospective, randomized, double-blind, placebo-controlled study in adult Japanese surgical patients" 31 : 2107-2112, 2009