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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 17  |  Issue : 4  |  Page : 252-255

Prevalence of Side Effects of Propofol Anesthesia among Adult and Pediatric Patients Undergoing Surgery


1 Department of Internal Medicine, Aljamhorya Hospital, Benghazi, Libya
2 Department of Internal Medicine, Faculty of Medicine, Benghazi University, Benghazi, Libya
3 Department of Anesthesia and Emergency Medicine, Higher Institute of Medical Professions, Benghazi, Libya

Date of Submission23-Jul-2020
Date of Acceptance28-Oct-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Khaled D Alsaeiti
Department of Internal Medicine, Aljamhorya Hospital, Benghazi
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_95_20

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  Abstract 


Introduction: Propofol is a short-acting medication that lowers awareness and causes a transient memory loss. It is given intravenously. The aim of this study was to assess the prevalence of various side effects of the use of propofol as an anesthetic in various surgical procedures and to compare their prevalence among adults and children. Materials and Methods: One hundred patients were included in the study, fifty adults and fifty of children, who underwent various types of surgery and received propofol anesthesia, at Pediatrics Hospital, Benghazi Medical Center (BMC) and Al-Hawari hospital, from September to November 2019. Results: The mean age was 6.37 ± 4.18 years in the pediatric group (ranging from 1 to 15 years) and 40.0 ± 17.03 years in the adult group (range from 16 to 97 years). The indication of surgery among the adult group was cholecystectomy (14 patients, 28%), followed by ENT operations (12 patients, 24%), while the indication of surgery among the pediatric group was tonsillectomy (20 patients, 40%), followed by hernia repair (15 patients, 30%). Thirty-five adults (70%) and 40 children (80%) suffered different types of complications during the study. Pain at the site of propofol injection was the most common complication. It was observed in 21 adult patients (42%) and 23 children (46%). Bronchospasm developed among 11 children who underwent tonsillectomy. Low blood pressure was more prevalent among adult patients (14 patients, 28%). An arrhythmia was developed in nine patients (six adults and three children). Two adults and five children experienced delayed recovery from anesthesia. The recovery time was 14.67 ± 8.37 min (5–45 min), Conclusion: Burning at site of propofol injection is the most common side effect of propofol anesthesia; other complications need further evaluation by more detailed studies.

Keywords: Benghazi, Propofol, side effect


How to cite this article:
Alsaeiti KD, Elbraky FM, Ibkhatra SA, Al-Zoubi KA, Alagoury GA, Al-Farajani FF, Al-Kharaz H, Al-Megrahi FA. Prevalence of Side Effects of Propofol Anesthesia among Adult and Pediatric Patients Undergoing Surgery. Apollo Med 2020;17:252-5

How to cite this URL:
Alsaeiti KD, Elbraky FM, Ibkhatra SA, Al-Zoubi KA, Alagoury GA, Al-Farajani FF, Al-Kharaz H, Al-Megrahi FA. Prevalence of Side Effects of Propofol Anesthesia among Adult and Pediatric Patients Undergoing Surgery. Apollo Med [serial online] 2020 [cited 2021 Jan 17];17:252-5. Available from: https://www.apollomedicine.org/text.asp?2020/17/4/252/305348




  Introduction Top


Propofol is a short-acting medication that results in a decreased level of consciousness and lack of memory for events. Its uses include the starting and maintenance of general anesthesia, sedation for mechanically ventilated adults, and procedural sedation. It is also used for status epilepticus if other medications have not worked. It is given by injection into a vein. Maximum effect takes about 2 min to occur, and it typically lasts 5–10 min. Propofol is believed to work at least partly through receptor for gamma-aminobutyric acid.[1] Propofol was discovered in 1977 and approved for use in the United States in 1989. [1,2] It is on the World Health Organization's list of essential medicines, the most effective, and safe medicines needed in a health.[3] The aim of this study is to assess prevalence of different side effects of propofol use as anesthetic in different surgeries and to compare their prevalence between adults and pediatrics.


  Materials and Methods Top


A prospective cohort study of 100 patients, fifty adults and fifty pediatrics, who undergo different types of surgery and receive propofol anesthesia, in pediatric hospital, Benghazi medical center and Al-Hawari hospital from September to November 2019. Data collection included patient's age, gender, indication of surgery, and complications of anesthesia.

Statistical analysis

The data were summarized using Microsoft Excels 2010 then coded and processed on IBM compatible computers, using the Statistical Package for the Social Sciences software (version 17), (SPSS Inc. Chicago, IL, USA). Descriptive statistics of the different variables were presented either as frequencies and percentages or as means ± standard deviation.


  Results Top


Within 3 months duration, we review 100 patients who underwent different types of surgery, among these hospitalizations, there were fifty adults and fifty pediatrics [Table 1]. The mean age was 6.37 ± 4.18 years in the pediatric group (range: 1–15 years) and 40.0 ± 17.03 years in the adult group (range: 16–97 years) [Table 1]. Indication of surgery among adult group was cholecystectomy (14 patients, 28%), followed by ENT operations (12 patients, 24%), while indication of surgery among pediatric group was tonsillectomy (20 patients, 40%), followed by hernial repair (15 patients, 30%) [Graph 1].
Table 1: Characteristics of the studied cases

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Adverse propofol outcomes

Prevalence of different side effects of propofol is shown on [Table 2]. Thirty-five adults (70%) and forty pediatrics (80%) developed different types of complications, Recovery time was 14.67 ± 8.37 min (5–45 min); two adults and five pediatrics experienced a delayed recovery from anesthesia, Burning at injection site was the most common complication of propofol; it developed in 21 adult patients (42%) and 23 pediatric patients (P = 0.003, P = 0.005), for adults and pediatrics respectively.
Table 2: Side effects developed for patients receive propofol

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Bronchospasm developed among 11 pediatrics, six of them were operated for tonsillectomy.

Hypotension was more prevalent among adult patients (14 patients, 28%), (P/0.023).

Arrhythmia developed in nine patients (six adults and three pediatrics).


  Discussion Top


Arrhythmia in adults

Renwick J found that atrioventricular (AV) node reentry is the most common type of SVT seen in approximately 50% of the cases. It is more common in women, and it usually develops before the age of 40 years. [4,5] In this arrhythmia, the heart rate can range from 100 to 280 bpm with a mean of 170 bpm.

In our study, we found 12% develop arrhythmia.

Arrhythmia in pediatric

Wu et al. 28 after using propofol in anesthesia for EP studies reported that, out of nine pediatric patients with ectopic atrial tachycardia, in four (44%), it was not possible to induce a sustained tachycardia and therefore, locate its origin, avoiding ablation during anesthesia with propofol. Based on this and on studies with rabbits, in which propofol prolonged the atrial refractory period and AV conduction, the author suggested that the use of this drug in anesthesia during ablation in patients with ectopic atrial tachycardia should be avoided.[6]

Similar conclusions were published by Lai et al. in a series of 150 patients, in which the majority (148/152) of tachycardia's remained inducible after anesthesia with propofol. However, in four out of seven pediatric patients (57%) with ectopic atrial tachycardia, it stopped after the administration of propofol, and it could not be induced even after the infusion if isoproterenol – a drug used to facilitate programmed induction of those arrhythmias during EEF. The authors suggest that this anesthetic agent should be carefully used in pediatric patients with ectopic atrial tachycardia undergoing EP.[7]

In our study found (6%) develop arrhythmia.

Pain at injection site in adults

Singleton found no statistically significant difference occurred in pain prevention between treatment groups. In the lidocaine group, 53% (8/15) of patients were pain free; in the propofol group, 47% (7/15) were pain free. However, when pain occurred, it was more likely to be classified as severe by the propofol group, 50% (4/8), compared with the lidocaine group, 14% (1/7).

No difference existed in the ability of propofol or lidocaine to decrease the incidence of pain during an induction dose of propofol. The incidence of severe pain, however, was more frequent in the propofol group. The small number of patients experiencing severe pain precluded statistical analysis. Blunting pain associated with propofol warrants further study.[8]

In our study found (42%) develop pain at injection.

Pain injection site in pediatrics

Pak J Med Sci study about A total of 360 pediatric patients (aged 5–12-year-old) who received elective surgery were randomly divided into six groups (n = 60) as follows: S Group: control group; L group: lidocaine group; L + P group: lidocaine + propofol group; K group: ketamine group; K + P group: ketamine + propofol group. the verbal rating scale (VRS) 4-point scale showed that the incidence rates of injection pain of S group, L group, L + P group, K group, K + P group, and M group were 78.3%, 66.67%, 51.66%, 43.33%, 48.33%, and 45%, respectively.[9]

in the current study. 42 patients (46%) develop pain at injection site of propofol.

Confusion

Grant studied eighty patients anaesthetized using one of three different techniques. Propofol was administered to 20-day case patients for induction of anesthesia, to twenty patients for induction and maintenance by intermittent bolus injection to supplement spinal blockade, and to forty patients for induction and maintenance by continuous infusion with spontaneous ventilation.[10]

Its effects were compared with those of methohexitone (all three techniques) and thiopentone (day case study only). The assessment of postoperative recovery included measurement of the speed of immediate recovery, psychometric testing comprising choice reaction time and critical flicker fusion threshold, and the incidence of postoperative sequelae.[11]

In all three techniques, propofol was associated with rapid and symptom-free recovery from anesthesia. With the day case and infusion techniques, immediate recovery was more rapid after propofol than after methohexitone and thiopentone. Recovery of psychomotor function was more rapid after propofol in the day case study.[12]

The frequency of sequelae such as nausea and vomiting (5% of cases), headache (1%), and confusion/restlessness (2.5%) was considerably lower overall after propofol and in each individual study than with the other agents.[13]

There are no data show that propofol causes confusion in pediatric. In our study, 18% of adults and 10% of pediatrics developed confusion.

Hypotension

Lai et al.[14] in their study of 150 patients aged 18 years to 60 years who randomly allocated to one of the three groups of fifty patients each. Group A (control) did not receive any study medication, Group B received Ringer's lactate 20 ml/kg over 10–15 min, and Group C received intravenous ephedrine 0.2 mg/kg before induction of anesthesia. Anesthesia was induced with propofol 2.5 mg/kg, fentanyl 1.5 μg/kg, and atracurim 0.5 mg/kg. Heart rate and blood pressure were recorded before induction and then every min for 5 min after induction of anesthesia. After the study period, patients were intubated and anesthesia was continued as required. Hypotension was defined as a drop in systolic arterial pressure more than or equal to 20% of baseline. A significant decrease in systolic arterial pressure occurred in both the fluid loaded and the control group. Least decrease in systolic arterial pressure was seen in the ephedrine group. The incidence of hypotension was also lower in ephedrine group when compared with control group. They conclude that crystalloid preloading is not efficacious in preventing hypotension and ephedrine markedly attenuates but does not fully abolish, the decrease in blood pressure caused by propofol and fentanyl induction, There are no data show that propofol causes decrease in blood pressure in pediatric.

In our study, adult (28%) and in pediatric (8%) develop hypotension.

Although no data show that propofol causes spasm or apnea and delay recovery and anxiety. In our study found spasm in adult and pediatric, apnea in adult found (6%) and in pediatric (2%).

  • Daley recovery we found in adult (4%) and pediatric (10%)
  • Anxiety found in our study adult (4%) and pediatric (10%).



  Conclusion Top


  • Burning at site of propofol injection is the most common side effect of propofol anesthesia, other complications need further evaluation by more detailed studies
  • We recommend studies with larger study sample size for further evaluation of propofol side effects.


Acknowledgment

All students contributed in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Prankerd RJ, Jones RD. Physicochemical compatibility of propofol with thiopental sodium. Am J Health Syst Pharm 1996;53:2606-10.  Back to cited text no. 1
    
2.
Miller's Anesthesia. 8th ed. Philadelphia, Elsevier Health Sciences; 2014. p. 920.  Back to cited text no. 2
    
3.
World Health Organization (2011) WHO model list of essential medicines 17th List March 2011. Available: http://whqlibdoc.who.int/hq/2011/a95053_eng.pdf. [Last accessed on 2012 Sep 12].  Back to cited text no. 3
    
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"Michael Jackson Search Warrant". Scribd. Archived from the Original on 5 March 2016. Available from: https://www.scribd.com/document/19058649/Michael-Jackson-search-warrant. [Last accessed on 2015 Aug 12].  Back to cited text no. 4
    
5.
"[email protected]: FDA Approved Drug Products". Accessdata.fda.gov. Archived from the original on 13 August 2014. [Last retrieved on 2013 Jun 08].  Back to cited text no. 5
    
6.
Barr J. Propofol: A new drug for sedation in the intensive care unit. Int Anesthesiol Clin 1995;33:131-54.  Back to cited text no. 6
    
7.
Isert PR. Lee D, Naidoo D, Carasso ML, Kennedy RA. Compatibility of propofol, fentanyl, and vecuronium mixtures designed for potential use in anesthesia and patient transport. J Clin Anesth 1996;8:329-36.  Back to cited text no. 7
    
8.
Kenneth RM, Loren L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc 2008;67:910-23.  Back to cited text no. 8
    
9.
Kratzer J, McGrail K, Strumpf E, Law MR. Cost-control mechanisms in Canadian private drug plans. Healthc Policy 2013;9:35.  Back to cited text no. 9
    
10.
Berger, Karen J, and Marilyn Brinkman Williams, eds. Fundamentals of nursing: Collaborating for optimal health. Vol. 2. Appleton & lange, 1999.  Back to cited text no. 10
    
11.
Tarighi P, Khoroushi M. A review on common chemical hemostatic agents in restorative dentistry. Dental Research Journal. 2014;11:423.  Back to cited text no. 11
    
12.
Machata AM, Willschke H, Kabon B, Kettner SC, Marhofer P. Propofol-based sedation regimen for infants and children undergoing ambulatory magnetic resonance imaging. Br J Anaesth 2008, 101.2: 239-243.  Back to cited text no. 12
    
13.
Dena LS, Brian S. Impact of seasonal and pandemic influenza on emergency department visits, 2003–2010, Ontario, Canada. Acad Emerg Med 2013;20:388-97.  Back to cited text no. 13
    
14.
CARSON, Johnny. INTERESTING PEOPLE AND TOPICS-HOWARD HUGHES Options. Available from: http://www.myispmonsters.com/Forum/yaf_postsm1133237_INTERESTING-PEOPLE-AND-TOPICS-HOWARD-HUGHES.aspx. [Last accessed on 2020 Jul 23].  Back to cited text no. 14
    



 
 
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