Advertisement

Propofol Infusion Therapy

  • Ravi K. Grandhi
  • Alaa Abd-Elsayed
Chapter

Abstract

Propofol (2, 6 diisopropyl phenol) is a mainstay of anesthetic care both as an induction agent, but also as an agent in sedation. But recent research has also suggested applications beyond these indications including uses for headaches and analgesia. Propofol causes potentiation of the GABA receptors and antagonism of the NMDA receptors.

Keywords

Propofol Infusion Pain GABA Headache 

References

  1. 1.
    Sanna E, Garau F, Harris R. Novel properties of homomeric β1 γ-aminobutyric acid type a receptors: actions of the anesthetics propofol and pentobarbital. Mol Pharmacol. 1995;47(2):213–7.PubMedGoogle Scholar
  2. 2.
    Barron R, Carlsen J, Duff SB, Burk C. Estimating the cost of an emergency room visit for migraine headache. J Med Econ. 2008;6(1–4):43–53.Google Scholar
  3. 3.
    Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW. American College of Emergency P. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008;52(4):407–36.CrossRefGoogle Scholar
  4. 4.
    Long BJ, Koyfman A. Benign headache management in the emergency department. J Emerg Med. 2018;54(4):458–68.CrossRefGoogle Scholar
  5. 5.
    Nishikawa T, Scatton B. Inhibitory influence of GABA on central serotonergic transmission. Involvement of the habenulo-raphe pathways in the GABAergic inhibition of ascending cerebral serotonergic neurons. Brain Res. 1985;331(1):81–90.CrossRefGoogle Scholar
  6. 6.
    D'Andrea G, Granella F, Cataldini M, Verdelli F, Balbi T. Gaba and glutamate in migrane. J Headache Pain. 2001;2:S57–60.CrossRefGoogle Scholar
  7. 7.
    Welch KM, Chabi E, Bartosh K, Achar VS, Meyer JS. Cerebrospinal fluid gamma aminobutyric acid levels in migraine. Br Med J. 1975;3(5982):516–7.CrossRefGoogle Scholar
  8. 8.
    Marukawa H, Shimomura T, Takahashi K. Salivary substance P, 5-hydroxytryptamine, and gamma-aminobutyric acid levels in migraine and tension-type headache. Headache. 1996;36(2):100–4.CrossRefGoogle Scholar
  9. 9.
    Jayakar SS, Zhou X, Chiara DC, Dostalova Z, Savechenkov PY, Bruzik KS, et al. Multiple propofol-binding sites in a gamma-aminobutyric acid type A receptor (GABAAR) identified using a photoreactive propofol analog. J Biol Chem. 2014;289(40):27456–68.CrossRefGoogle Scholar
  10. 10.
    Alkire MT, Haier RJ, Barker SJ, Shah NK, Wu JC, Kao YJ. Cerebral metabolism during propofol anesthesia in humans studied with positron emission tomography. Anesthesiology. 1995;82(2):393–403; discussion 27A.CrossRefGoogle Scholar
  11. 11.
    Segovia G, Porras A, Del Arco A, Mora F. Glutamatergic neurotransmission in aging: a critical perspective. Mech Ageing Dev. 2001;122(1):1–29.CrossRefGoogle Scholar
  12. 12.
    Bloomstone JA. Propofol: a novel treatment for breaking migraine headache. Anesthesiology. 2007;106(2):405–6.CrossRefGoogle Scholar
  13. 13.
    Drummond-Lewis J, Scher C. Propofol: a new treatment strategy for refractory migraine headache. Pain Med. 2002;3(4):366–9.CrossRefGoogle Scholar
  14. 14.
    Soleimanpour H, Ghafouri RR, Taheraghdam A, Aghamohammadi D, Negargar S, Golzari SE, et al. Effectiveness of intravenous dexamethasone versus propofol for pain relief in the migraine headache: a prospective double blind randomized clinical trial. BMC Neurol. 2012;12:114.CrossRefGoogle Scholar
  15. 15.
    Krusz J, Scott V, Belanger J. Intravenous propofol: unique effectiveness in treating intractable migraine. Headache. 2001;40(3):224–30.CrossRefGoogle Scholar
  16. 16.
    Soleimanpour H, Taheraghdam A, Ghafouri RR, Taghizadieh A, Marjany K, Soleimanpour M. Improvement of refractory migraine headache by propofol: case series. Int J Emerg Med. 2012;5(1):19.CrossRefGoogle Scholar
  17. 17.
    Moshtaghion H, Heiranizadeh N, Rahimdel A, Esmaeili A, Hashemian H, Hekmatimoghaddam S. The efficacy of propofol vs. subcutaneous sumatriptan for treatment of acute migraine headaches in the emergency department: a double-blinded clinical trial. Pain Pract. 2015;15(8):701–5.CrossRefGoogle Scholar
  18. 18.
    Mosier J, Roper G, Hays D, Guisto J. Sedative dosing of propofol for treatment of migraine headache in the emergency department: a case series. West J Emerg Med. 2013;14(6):646–9.CrossRefGoogle Scholar
  19. 19.
    Sheridan D, Spiro D, Nguyen T, Koch T, Meckler G. Low-dose propofol for the abortive treatment of pediatric migraine in the emergency department. Pediatr Emerg Care. 2012;28(12):1293–6.CrossRefGoogle Scholar
  20. 20.
    Pescatore R. What to D.O. Emerg Med News. 2018;40(2):1.CrossRefGoogle Scholar
  21. 21.
    Silberstein SD, Dodick DW, Saper J, Huh B, Slavin KV, Sharan A, et al. Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia. 2012;32(16):1165–79.CrossRefGoogle Scholar
  22. 22.
    Giampetro D, Ruiz-Velasco V, Pruett A, Wicklund M, Knipe R. The effect of propofol on chronic headaches in patients undergoing endoscopy. Pain Res Manag. 2018;2018:6018404.CrossRefGoogle Scholar
  23. 23.
    Simmonds MK, Rashiq S, Sobolev IA, Dick BD, Gray DP, Stewart BJ, et al. The effect of single-dose propofol injection on pain and quality of life in chronic daily headache: a randomized, double-blind, controlled trial. Anesth Analg. 2009;109(6):1972–80.CrossRefGoogle Scholar
  24. 24.
    Anker-Moller E, Spangsberg N, Arendt-Nielsen L, Schultz P, Kristensen MS, Bjerring P. Subhypnotic doses of thiopentone and propofol cause analgesia to experimentally induced acute pain. Br J Anaesth. 1991;66(2):185–8.CrossRefGoogle Scholar
  25. 25.
    Orser B, Bertlik M, Wang L, MacDonald J. Inhibition by propofol (2,6-diisopropylphenol) of the N-methyl-D-aspartate subtype of glutamate receptor in cultured hippocam- pal neurones. Br J Pharmacol. 1995;116(2):1761–8.CrossRefGoogle Scholar
  26. 26.
    Grasshoff C, Gillessen T. Effects of propofol on N-methyl-D-aspartate receptor-mediated calcium increase in cultured rat cerebrocortical neurons. Eur J Anaesthesiol. 2005;22(6):467–70.CrossRefGoogle Scholar
  27. 27.
    Kingston S, Mao L, Yang L, Arora A, Fibuch EE, Wang JQ. Propofol inhibits phosphorylation of N-methyl-D-aspartate receptor NR1 subunits in neurons. Anesthesiology. 2006;104(4):763–9.CrossRefGoogle Scholar
  28. 28.
    Bandschapp O, Filitz J, Ihmsen H, Berset A, Urwyler A, Koffert W, et al. Analgesic and antihyperalgesic properties of propofol in a human pain model. Anesthesiology. 2010;113:421–8.CrossRefGoogle Scholar
  29. 29.
    Singler B, Troster A, Manering N, Schuttler J, Koppert W. Modulation of remifentanil-induced postinfusion hyperalgesia by propofol. Anesth Analg. 2007;104(6):1397–403, table of contents.CrossRefGoogle Scholar
  30. 30.
    Chen RM, Chen TG, Chen TL, Lin LL, Chang CC, Chang HC, et al. Anti-inflammatory and antioxidative effects of propofol on lipopolysaccharide-activated macrophages. Ann N Y Acad Sci. 2005;1042:262–71.CrossRefGoogle Scholar
  31. 31.
    Qiu Q, Choi SW, Wong SS, Irwin MG, Cheung CW. Effects of intra-operative maintenance of general anaesthesia with propofol on postoperative pain outcomes – a systematic review and meta-analysis. Anaesthesia. 2016;71(10):1222–33.CrossRefGoogle Scholar
  32. 32.
    Hans P, Deby-Dupont G, Deby C, Pieron F, Verbesselt R, Franssen C, et al. Increase in antioxidant capacity of plasma during propofol anesthesia. J Neurosurg Anesthesiol. 1997;9(3):234–6.CrossRefGoogle Scholar
  33. 33.
    Ito H, Watanabe Y, Isshiki A, Uchino H. Neuroprotective properties of propofol and midazolam, but not pentobarbital, on neuronal damage induced by forebrain ischemia, based on the GABAAreceptors. Acta Anaesthesiol Scand. 1999;43(2):153–62.CrossRefGoogle Scholar
  34. 34.
    Hasani A, Jashari H, Gashi V, Dervishi A. In: Racz DG, editor. Propofol and postoperative pain: systematic review and meta-analysis, pain management - current issues and opinions; 2012. ISBN: 978-953-307-813-7, InTech, Available from: http://www.intechopen.com/books/painmanagementcurrentissues-and-opinions/propofol-and-postoperative-pain-systematic-review-and-meta-analysis.
  35. 35.
    Cheng SS, Yeh J, Flood P. Anesthesia matters: patients anesthetized with propofol have less postoperative pain than those anesthetized with isoflurane. Anesth Analg. 2008;106(1):264–9, table of contentsCrossRefGoogle Scholar
  36. 36.
    O'Connor TC, Abram SE. Inhibition of nociception-induced spinal sensitization by anesthetic agents. Anesthesiology. 1995;82(1):259–66.CrossRefGoogle Scholar
  37. 37.
    Jewett BA, Gibbs LM, Tarasiuk A, Kendig JJ. Propofol and barbiturate depression of spinal nociceptive neurotransmission. Anesthesiology. 1992;77(6):1148–54.CrossRefGoogle Scholar
  38. 38.
    Sun X, Yang C, Li K, Ding S. The impact of anesthetic techniques on survival for patients with colorectal cancer: evidence based on six studies. Hepatogastroenterology. 2015;62(138):299–302.PubMedGoogle Scholar
  39. 39.
    Woodley SJ, Kendig JJ. Substance P and NMDA receptors mediate a slow nociceptive ventral root potential in neonatal rat spinal cord. Brain Res. 1991;559(1):17–21.CrossRefGoogle Scholar
  40. 40.
    Nicoll RA, Alger BE. Presynaptic inhibition: transmitter and ionic mechanisms. Int Rev Neurobiol. 1979;21:217–58.CrossRefGoogle Scholar
  41. 41.
    Hofer CK, Zollinger A, Bu¨chi S, Klaghofer R, Serafino D, Bu¨hlmann S, et al. Patient well-being after general anaesthesia: a prospective, randomized, controlled multi-centre trial comparing intravenous and inhalation anaesthesia. Br J Anaesth. 2003;91(5):631–7.CrossRefGoogle Scholar
  42. 42.
    Briggs LP, Dundee JW, Bahar M, Clarke RS. Comparison of the effect of diisopropyl phenol (ICI 35, 868) and thiopentone on response to somatic pain. Br J Anaesth. 1982;54(3):307–11.CrossRefGoogle Scholar
  43. 43.
    Ogurlu M, Sari S, Kucuk M, Bakis M, Ugur B, Eshraghi YE, et al. Comparison of the effect of propofol and sevoflurane anaesthesia on acute and chronic postoperative pain after hysterectomy. Anaesth Intensive Care. 2014;42(3):365–70.CrossRefGoogle Scholar
  44. 44.
    Ozkose Z, Ercan B, Unal Y, Yardim S, Kaymaz M, Dogulu F, et al. Inhalation versus total intravenous anesthesia for lumbar disc herniation: comparison of hemodynamic effects, recovery characteristics, and cost. J Neurosurg Anesthesiol. 2001;13(4):296–302.CrossRefGoogle Scholar
  45. 45.
    Mukherjee K, Seavell C, Rawlings E, Weiss A. A comparison of total intravenous with balanced anaesthesia for middle ear surgery: effects on postoperative nausea and vomiting, pain, and conditions of surgery. Anaesthesia. 2003;58(2):176–80.CrossRefGoogle Scholar
  46. 46.
    Flood P, Sonner J, Gong D, Coates K. Isoflurane hyperalgesia is modulated by nicotinic inhibition. Anesthesiology. 2002;97:192–8.CrossRefGoogle Scholar
  47. 47.
    Cho AR, Kwon JY, Kim KH, Lee HJ, Kim HK, Kim ES, et al. The effects of anesthetics on chronic pain after breast cancer surgery. Anesth Analg. 2013;116(3):685–93.CrossRefGoogle Scholar
  48. 48.
    Shin SW, Cho AR, Lee HJ, Kim HJ, Byeon GJ, Yoon JW, et al. Maintenance anaesthetics during remifentanil-based anaesthesia might affect postoperative pain control after breast cancer surgery. Br J Anaesth. 2010;105(5):661–7.CrossRefGoogle Scholar
  49. 49.
    Kaye AD, Chung K, Vadivelu N, Cantemir C, Urman RD, Manchikanti L. Opioid induced hyperalgesia altered with propofol infusion. Pain Physician. 2014;17(2):E225–8.PubMedGoogle Scholar
  50. 50.
    Song JG, Shin JW, Lee EH, Choi DK, Bang JY, Chin JH, et al. Incidence of post-thoracotomy pain: a comparison between total intravenous anaesthesia and inhalation anaesthesia. Eur J Cardiothorac Surg. 2012;41(5):1078–82.CrossRefGoogle Scholar
  51. 51.
    Yoo YC, Bai SJ, Lee KY, Shin S, Choi EK, Lee JW. Total intravenous anesthesia with propofol reduces postoperative nausea and vomiting in patients undergoing robot-assisted laparoscopic radical prostatectomy: a prospective randomized trial. Yonsei Med J. 2012;53(6):1197–202.CrossRefGoogle Scholar
  52. 52.
    Ortiz J, Chang LC, Tolpin DA, Minard CG, Scott BG, Rivers JM. Randomized, controlled trial comparing the effects of anesthesia with propofol, isoflurane, desflurane and sevoflurane on pain after laparoscopic cholecystectomy. Braz J Anesthesiol. 2014;64(3):145–51.CrossRefGoogle Scholar
  53. 53.
    Pokkinen SM, Yli-Hankala A, Kalliomaki ML. The effects of propofol vs. sevoflurane on post-operative pain and need of opioid. Acta Anaesthesiol Scand. 2014;58(8):980–5.CrossRefGoogle Scholar
  54. 54.
    Zhang Y, Eger EI, Dutton RC, Sonner JM. Inhaled anesthetics have hyperalgesic effects at 0.1 minimum alveolar anesthetic concentration. Anesth Analg. 2000;91(2):462–6.PubMedGoogle Scholar
  55. 55.
    Akkurt BC, Temiz M, Inanoglu K, Aslan A, Turhanoglu S, Asfuroglu Z, et al. Comparison of recovery characteristics, postoperative nausea and vomiting, and gastrointestinal motility with total intravenous anesthesia with propofol versus inhalation anesthesia with desflurane for laparoscopic cholecystectomy: a randomized controlled study. Curr Ther Res Clin Exp. 2009;70(2):94–103.CrossRefGoogle Scholar
  56. 56.
    Li M, Mei W, Wang P, Yu Y, Qian W, Zhang ZG, et al. Propofol reduces early post-operative pain after gynecological laparoscopy. Acta Anaesthesiol Scand. 2012;56(3):368–75.CrossRefGoogle Scholar
  57. 57.
    Wang Q, Cao J, Zeng Y, Dai T. GABAA receptor partially mediated propofol-induced hyperalgesia at superspinal level and analgesia at spinal cord level in rats. Acta Pharmacol Sin. 2004;25(12):1619–25.PubMedGoogle Scholar
  58. 58.
    Anwar MM, Abdel-Rahman MS. Effect of propofol on perception of pain in mice: mechanisms of action. Comp Biochem Physiol A Mol Integr Physiol. 1998;120(2):249–53.CrossRefGoogle Scholar
  59. 59.
    Barash PG. Clinical anesthesia. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009.Google Scholar
  60. 60.
    Schneider U, Rada D, Rollnik JD, Passie T, Emrich HM. Propofol dependency after treatment of tension headache. Addict Biol. 2001;6(3):263–5.CrossRefGoogle Scholar
  61. 61.
    Wilson C, Canning P, Caravati EM. The abuse potential of propofol. Clin Toxicol (Phila). 2010;48(3):165–70.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ravi K. Grandhi
    • 1
  • Alaa Abd-Elsayed
    • 2
  1. 1.Department of AnesthesiologyMaimonides Medical CenterBrooklynUSA
  2. 2.Department of AnesthesiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

Personalised recommendations