Sedative drugs that decrease ICP via an effect on cerebral metabolism and CBF include most of the intravenous anesthetic agents except keta-mine. All have a depressant effect on the central nervous system, resulting in a dose-related decrease in level of consciousness and metabolic rate. Propofol has a similar metabolic and vascular profile to barbiturates, causing a dose-related decrease in cerebral metabolic rate and coupled decrease in CBF, resulting in a reduction in ICP in patients with cerebral metabolic activity. However, in some studies the decrease in CBF exceeded the concomitant decrease in metabolic rate. Its pharmacokinetic profile, with a short half-life, makes it a particularly suitable sedative agent in neurosurgical patients, allowing prompt neurological assessment within 2-3 hours of discontinuation of the infusion in usual doses (50-150 ^g/kg/min). In a multicenter trial, propofol was efficacious in reducing ICP although the study failed to show an improvement in neurological outcome. In high doses (>300 ^g/kg/min), it can be used to induce pharmacological coma with burst-suppression on electroencephalogram to achieve maximal metabolic suppression for control of ICP. In children, when used as a continuous infusion for a prolonged period, propofol has been reported to be associated with the development of a metabolic syndrome that is characterized by acidosis, rhabdomyolysis, cardiac failure and a high mortality rate [7]. More recently, a similar syndrome has also been reported to occur in head-injured adults treated with propofol >5 mg/kg/h [8]. In both children and

Dynamic Six Pack Abs

Dynamic Six Pack Abs

Reasonable care has been taken to ensure that the information presented in this book is accurate. However, the reader should understand that the information provided does not constitute legal, medical or professional advice of any kind.

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