Epinephrine, norepinephrine and dopamine infusions decrease propofol concentrations during continuous propofol infusion in an ovine model.
OBJECTIVE
To determine the effects of exogenous ramped infusions of epinephrine, norepinephrine and dopamine on arterial and effluent brain blood concentrations of propofol under steady state intravenous anesthesia.


METHODS
Prospective, randomized animal study.


METHODS
University research laboratory.


METHODS
Five adult female merino sheep.


METHODS
Induction (5 mg/kg) and continuous infusion of propofol (15 mg/min) with controlled mechanical ventilation to maintain PaCO2 40 mmHg. After 1 h of continuous anesthesia, each animal randomly received ramped infusions of epinephrine, norepinephrine (10, 20, 40 microg/min) and dopamine (10, 20, 40 microg x kg x min) in 3 x 5 min intervals followed by a 30-min washout period.


METHODS
Arterial and sagittal sinus whole blood for determination of propofol concentrations using high-pressure liquid chromatography. Cardiac output using a thermodilution method. Level of consciousness using an observational scale.


RESULTS
All three drugs significantly and transiently increased cardiac output in a dose-dependent fashion to a maximum of 146-169% of baseline. Baseline arterial and sagittal sinus propofol concentrations were not statistically different prior to catecholamine infusions. All three drugs significantly reduced mean arterial propofol concentrations (95 % CI, p < 0.05): epinephrine to 41.8% of baseline (11.4-72), norepinephrine to 63 % (27-99) and dopamine to 52.9 % (18.5-87.3). There were parallel reductions of concentrations in sagittal sinus blood leaving the brain. The lowest blood concentrations were associated with emergence from anesthesia. Arterial concentrations were inversely related to the simultaneously determined cardiac output (r2 = 0.74, p < 0.0001). Comparison of the data with the predictions of a previously developed recirculatory model of propofol disposition in sheep showed the data were consistent with a mechanism based on increased first pass dilution and clearance of propofol secondary to the increased cardiac output.


CONCLUSIONS
Catecholamines produced circulatory changes that reversed propofol anesthesia. These observations have potential clinical implications for the use of propofol in hyperdynamic circulatory conditions, either induced by exogenous catecholamine infusions or pathological states.
Department of Anaesthesia and Intensive Care, University of Adelaide, Royal Adelaide Hospital, Australia. j.myburgh@unsw.edu.au
J A
JA
Myburgh
R N
RN
Upton
C
C
Grant
A
A
Martinez
D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000493:pharmacokinetics*; D000818:Animals; D002302:Cardiac Output / Q000187:drug effects; D003243:Consciousness / Q000187:drug effects; D004298:Dopamine / Q000008:administration & dosage / Q000493:pharmacokinetics*; D004336:Drug Antagonism; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage / Q000493:pharmacokinetics*; D005260:Female; D016014:Linear Models; D008657:Metabolic Clearance Rate; D008954:Models, Biological; D009638:Norepinephrine / Q000008:administration & dosage / Q000493:pharmacokinetics*; D015742:Propofol / Q000008:administration & dosage / Q000493:pharmacokinetics*; D011446:Prospective Studies; D011897:Random Allocation; D012756:Sheep
D018686:Anesthetics, Intravenous; D004298:Dopamine; D009638:Norepinephrine; D015742:Propofol; D004837:Epinephrine