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  • 1
    Electronic Resource
    Electronic Resource
    Trace Element Homeostasis During Continuous Sedation With Propofol Containing EDTA Versus Other Sedatives in Critically Ill Patients (2000)
    Springer
    Intensive care medicine 26 (2000), S. S413 
    Details
    ISSN: 1432-1238
    Keywords: Key words Sedation ; Propofol ; EDTA ; Trace ; Element ; Metal
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate changes in serum and urinary zinc, cobalt, copper, iron, and calcium concentrations in critically ill patients receiving propofol containing disodium edetate (disodium ethylenediaminetetraacetic acid [EDTA]) versus sedative agents without EDTA. Design: This was a randomised, open-label, parallel-group study with randomisation stratified by baseline Acute Physiology and Chronic Health Evaluation (APACHE II) scores. Setting: Intensive care units (ICU) in 23 medical centres. Patients: Medical, surgical, or trauma ICU patients 17 years of age or older who required mechanical ventilator support and sedation. Interventions: A total of 106 patients received propofol containing 0.005 % EDTA (propofol EDTA), and 104 received other sedative agents without EDTA (non-EDTA). Only the first 108 patients were assessed for urinary trace metal excretion. Twenty-four–hour urine samples were collected on days 2, 3, and 7 and every 7 days thereafter for determination of zinc, cobalt, copper, iron, and calcium excretion; EDTA levels; urine osmolality; albumin levels; and glucose levels. The first 143 patients were assessed for serum concentration of zinc, cobalt, copper, iron, and calcium; creatinine; blood urea nitrogen; and albumin at baseline and once during each 24-hour urine collection. Measurements and Results: For the assessment of trace metals, patients receiving propofol EDTA demonstrated increased mean urinary excretion of zinc, copper, and iron compared with the normal range. All patients receiving sedatives demonstrated increased urinary excretion of zinc and copper above normal reference values. Compared with the non-EDTA sedative group, the propofol EDTA group demonstrated increased urinary excretion of zinc and iron. Mean serum concentrations of zinc and total calcium were decreased in both patient groups. Serum zinc concentrations increased from baseline to day 3 in the non-EDTA sedative group but not in the propofol EDTA group. Renal function, measured by blood urea nitrogen, serum creatinine, and creatinine clearance, did not deteriorate during ICU sedation with either regimen. Conclusion: This study showed that critical illness is associated with increased urinary losses of zinc, copper, and iron. Propofol EDTA– treated patients had greater urinary losses of zinc and iron and lower serum zinc concentrations compared with the non-EDTA sedative group. No adverse events indicative of trace metal deficiency were observed in either group. The clinical significance of trace metal losses during critical illness is unclear and requires further study.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003785
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  • 2
    Electronic Resource
    Electronic Resource
    Safety and Efficacy of Propofol With EDTA When Used for Sedation of Surgical Intensive Care Unit Patients (2000)
    Springer
    Intensive care medicine 26 (2000), S. S452 
    Details
    ISSN: 1432-1238
    Keywords: Key words Propofol ; Disodium edetate ; Critical illness ; Calcium ; Magnesium ; Homeostasis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To compare propofol with disodium edetate (EDTA) and propofol without EDTA when used for the sedation of critically ill surgical intensive care unit (ICU) patients. Design: Prospective, randomised, multicentre trial. Patients: A total of 122 surgical ICU patients who required intubation and mechanical ventilation. Interventions: Patients were randomised to receive either propofol or propofol plus EDTA (propofol EDTA) by continuous infusion for sedation. Measurements and Results: The addition of EDTA to propofol had no effect on calcium or magnesium homeostasis, renal function, haemodynamic function, or efficacy when used for the sedation of surgical patients in the ICU. The most common adverse events were hypotension, atrial fibrillation, and hypocalcaemia. In this trial, a greater number of serious adverse events and adverse events leading to withdrawal occurred in the propofol group relative to the propofol EDTA group. There was a significantly lower crude mortality rate at 7 and 28 days for the propofol EDTA group compared with the propofol group. There were no statistically significant differences between groups with respect to depth of sedation. Conclusion: The propofol EDTA formulation had no effect on calcium or magnesium homeostasis, renal function, or sedation efficacy compared with propofol alone when used for sedation in critically ill surgical ICU patients. There was a significant decrease in mortality in the propofol EDTA group compared with the propofol group. Further investigations are needed to validate this survival benefit and elucidate a possible mechanism.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003789
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  • 3
    Electronic Resource
    Electronic Resource
    Propofol-Containing Sedatives Increase Levels of Parathyroid Hormone (2000)
    Springer
    Intensive care medicine 26 (2000), S. S405 
    Details
    ISSN: 1432-1238
    Keywords: Key words Propofol ; Disodium edetate ; Calcium ; Magnesium ; Parathyroid hormone ; Sedation ; Chelation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the effects of propofol and propofol containing disodium edetate (ethylenediaminetetraacetic acid [EDTA]) on the parathyroid-calcium axis in normal subjects. Design: Randomised, double-blind, age-stratified, crossover trial. Setting: Single centre. Patients: A total of 50 healthy subjects. Interventions: Each subject was randomised to receive propofol or propofol containing EDTA on day 1 and the alternate treatment between days 15 and 29, with a 2-week washout period in between. On the day of treatment, subjects received a bolus of trial medication (1 or 2 mg/kg) followed by a 60-minute observation period. At the end of 60 minutes, subjects received trial medication infused for 60 minutes at 1 of 4 randomised infusion rates (25, 50, 100, or 200 μg/kg per min). Subjects were monitored for an additional 60 minutes following the infusion. Measurements and Results: Blood pressure, heart rate, respiratory rate, oxygen saturation, blood ionised calcium concentration, serum total magnesium concentration, serum intact parathyroid hormone (PTH) level, and plasma EDTA level were assessed at periodic intervals during and following the bolus and continuous infusion of trial medication. Mean arterial pressure significantly decreased (p 〈 0.05) following the bolus injection of both trial medications and returned to baseline at 60 minutes; it significantly decreased again during the continuous infusion and returned to baseline during recovery. Heart rate and respiratory rate fluctuated in both groups with significant increases and decreases throughout the study period following the bolus injection; both returned to baseline during the recovery period in each group. Ionised calcium and total magnesium concentrations remained within normal limits and were unchanged in response to both study medications. PTH levels significantly increased following the bolus injection of both study drugs. The increase in PTH levels was greater with higher doses of study medication during the infusion period. There was no difference in the response of blood pressure, heart rate, respiratory rate, or PTH levels between propofol and propofol with EDTA. EDTA levels increased significantly during the infusion of propofol with EDTA, reaching mean levels of 240 ng/mL. Conclusions: The results of this study indicate that propofol increases PTH levels in normal subjects; however, propofol with EDTA does not alter ionised calcium or total magnesium concentrations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003784
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Cation Metabolism During Propofol Sedation With and Without EDTA in Patients With Impaired Renal Function (2000)
    Springer
    Intensive care medicine 26 (2000), S. S433 
    Details
    ISSN: 1432-1238
    Keywords: Key words Propofol ; Disodium edetate ; Cation ; Intensive care ; Renal impairment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To compare the effects of propofol with and without disodium edetate (EDTA) on cation metabolism in intensive care unit (ICU) patients with renal insufficiency who received propofol or propofol plus EDTA (propofol EDTA) for sedation and mechanical ventilation. Design: Double-blind, randomised, multicentre study. Setting: Medical and surgical ICUs from 5 hospitals. Patients: Thirty-nine ICU patients with acute and chronic renal impairment expected to require at least 24 hours of continuous sedation and respiratory failure necessitating mechanical ventilation. Interventions: Propofol or propofol EDTA administered for sedation by continuous intravenous infusion. Measurements and Results: The depth of sedation, as measured by the Modified Ramsay Sedation Scale, was similar in the 2 groups, when adjusted for dosing differences. The amount of propofol required to maintain adequate sedation was decreased in both groups compared to propofol requirements in ICU patients with normal renal function. EDTA levels were elevated at baseline in both groups. In the propofol EDTA group, the EDTA levels increased further by 20 % but decreased to below baseline EDTA levels at 48 hours after sedation. In the propofol group, EDTA levels decreased during sedation and remained below baseline levels at 48 hours after sedation. Patients in both groups were hypocalcaemic and hyperphosphataemic at baseline with low levels of 1,25-dihydroxyvitamin D and elevated parathyroid hormone (PTH) levels. Other than a slight difference in ionised serum calcium levels at 4 h after the start of sedation, there were no significant differences observed in serum calcium levels between the two groups. There were no significant differences in 1,25-dihydroxyvitamin D or PTH levels over time between the two groups. There was no significant effect on renal function in either group. Conclusions: The results of this study suggest that adding EDTA to propofol does not adversely affect cation homeostasis or renal function when used for sedation of ICU patients with renal insufficiency. Although EDTA levels increased over time from baseline levels in patients with renal insufficiency who receive propofol EDTA, this increase does not appear to be clinically significant, and EDTA levels return to below baseline levels within 48 hours of discontinuing the propofol EDTA infusion. The efficacy of propofol with and without EDTA also appears comparable in these patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003787
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  • 5
    Electronic Resource
    Electronic Resource
    Compartment syndrome in a patient monitored with an automated blood pressure cuff (1987)
    Springer
    Journal of clinical monitoring and computing 3 (1987), S. 139-141 
    Details
    ISSN: 1573-2614
    Keywords: Complications: compartment syndrome ; Blood pressure: monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Noninvasive blood pressure monitoring may be hazardous in patients with seizures or movement disorders. We report on a patient with hyperactivity and tremor in whom a compartment syndrome was apparently induced by an automated blood pressure cuff. As the patient moved, the device seems to have continued to cycle in an attempt to obtain a stable baseline reading. Pressure tubing to the self-inflating bladder on such devices should be disconnected between readings in situations where frequent, easy observation is not possible.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00858363
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    Paper (German National Licenses)
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