Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-23T13:04:25.684Z Has data issue: false hasContentIssue false
  • English
  • Français

Melatonin premedication and the induction dose of propofol

Published online by Cambridge University Press:  01 May 2007

A. Turkistani ,
K. M. Abdullah ,
A. A. Al-Shaer ,
K. F. Mazen  and
K. Alkatheri
A. Turkistani
Affiliation:
King Saud University, King Khalid University Hospitals, Department of Anesthesiology, Riyadh, Saudi Arabia
K. M. Abdullah*
Affiliation:
King Saud University, King Khalid University Hospitals, Department of Anesthesiology, Riyadh, Saudi Arabia
A. A. Al-Shaer
Affiliation:
King Saud University, King Khalid University Hospitals, Department of Anesthesiology, Riyadh, Saudi Arabia
K. F. Mazen
Affiliation:
King Saud University, King Khalid University Hospitals, Department of Anesthesiology, Riyadh, Saudi Arabia
K. Alkatheri
Affiliation:
King Saud University, King Khalid University Hospitals, Department of Anesthesiology, Riyadh, Saudi Arabia
*
Correspondence to: Khaled M. Abdullah, Department of Anesthesiology, Faculty of Medicine, Ain Shams University, King Khaled University Hospital, Riyadh 11472, POB 7805 (41), Saudi Arabia. E-mail: [email protected]; Tel: +966 1 4671599; Fax: +966 1 4679364
Get access

Summary

Background and objectives

Melatonin (N-acetyl-5-methoxytryptamine) is the main indolamine secreted by the pineal gland. Many studies showed that premedication with melatonin is associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills and without prolonging recovery. We hypothesized that melatonin decreases the amount of propofol required to produce an adequate depth of hypnosis at induction time.

Methods

After approval from the research committee of the anaesthesia department, informed written consent was taken from 45 adult patients undergoing different surgical procedures. They were allocated randomly into three groups according to the premedication. At 100 min preoperatively, premedication was given in the form of oral melatonin 3 mg (M3 group), oral melatonin 5 mg (M5 group) or no premedication (P group). After preoxygenation an anaesthesiologist who was blinded to the premedication injected propofol 10 mg over 5 s every 15 s until the bispectral index (BIS) score fell to 45. The total dose of propofol required to achieve a BIS score of 45 was recorded. Response to verbal commands and eyelash reflex was evaluated and correlated to the BIS score and propofol dosage. When a BIS score of 45 was reached, tracheal intubation was accomplished after administration of a narcotic and muscle relaxant.

Results

The mean (standard devitation (SD)) induction dose of propofol producing a BIS score of 45 was 134 (25) mg in the placebo group vs. 115 (19.5) and 114 (20.9) mg in the M3 and M5 groups, respectively (P < 0.05). The propofol dose required to achieve loss of eyelash reflex and loss of response to verbal commands was more in the placebo group. Anxiety score as assessed by visual analogue scale (VAS) scored more in the placebo group than both melatonin groups. Time spent in the recovery room did not differ between the three groups.

Conclusion

Melatonin premedication, in an oral dose of either 3 or 5 mg, reduced the required dose of propofol to achieve a BIS score of 45, reflecting a sufficient level of hypnosis for tracheal intubation without prolongation of postoperative recovery room stay.

Keywords

PREMEDICATIONMELATONINANAESTHESIA INTRAVENOUS, propofolELECTROENCEPHALOGRAPHY, bispectral index
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 5 , May 2007 , pp. 399 - 402
Copyright
Copyright © European Society of Anaesthesiology 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Guglielminotti, J, Descraques, C, Petitmaire, S et al. . Effects of premedication on dose requirements for propofol: comparison of clonidine and hydroxyzine. Br J Anaesth 1998; 80: 733–736.CrossRefGoogle ScholarPubMed
2.Buggy, DJ, Asher, MJ, Lambert, DG. Nimodipine premedication and induction dose of propofol. Anesth Analg 2000; 90: 445–449.CrossRefGoogle ScholarPubMed
3.Naguib, M, Baker, MT, Spadoni, G et al. . The hypnotic and analgesic effects of 2-bromomelatonin. Anesth Analg 2003; 97: 763–768.CrossRefGoogle ScholarPubMed
4.Weaver, DR, Stehle, JH, Stopa, EG et al. . Melatonin receptors in human hypothalamus and pituitary: implications for circadian and reproductive responses to melatonin. J Clin Endocrinol Metab 1993; 76: 295–301.Google Scholar
5.Tamarkin, L, Baird, CJ, Almeida, OF. Melatonin: a coordinating signal for mammalian reproduction? Science 1985; 227: 714–720.Google Scholar
6.Sugden, D. Psychopharmacological effects of melatonin in mouse and rat. J Pharmacol Exp Ther 1983; 227: 587–591.Google Scholar
7.Molina-Carballo, A, Munoz-Hoyos, A, Reiter, RJ et al. . Utility of high doses of melatonin as adjunctive anticonvulsant therapy in a child with severe myoclonic epilepsy: two years’ experience. J Pineal Res 1997; 23: 97–105.CrossRefGoogle Scholar
8.Reiter, RJ, Tan, DX, Poeggeler, B et al. . Melatonin as a free radical scavenger: implications for aging and age-related diseases. Ann NY Acad Sci 1994; 719: 1–12.CrossRefGoogle ScholarPubMed
9.Stankov, B, Fraschini, F, Reiter, RJ. Melatonin binding sites in the central nervous system. Brain Res Brain Rev 1991; 16: 245–256.Google Scholar
10.Acil, M, Basgul, E, Celiker, V et al. . Perioperative effects of melatonin and midazolam premedication on sedation, orientation, anxiety scores and psychomotor performance. Eur J Anaesthesiol 2004; 21 (7): 553–557.CrossRefGoogle ScholarPubMed
11.Naguib, M, Schmid, PG, Baker, M. The electroencephalographic effects of i.v. anesthetic doses of melatonin: comparative studies with thiopental and propofol. Anesth Analg 2003; 97: 238–243.CrossRefGoogle Scholar
12.Naguib, M, Hammond, DL, Schmid, PG et al. . Pharmacologic effects of intravenous melatonin: comparative studies with thiopental and propofol. Br J Anaesth 2003; 90: 504–507.CrossRefGoogle ScholarPubMed
13.Naguib, M, Samarkandi, AH. Premedication with melatonin: a double-blind, placebo-controlled comparison with midazolam. Br J Anaesth 1999; 82: 875–880.Google Scholar
14.Naguib, M, Samarkandi, AH. The comparative dose–response effects of melatonin and midazolam for premedication of adult patients: a double-blinded, placebo-controlled study. Anesth Analg 2000; 91: 473–479.Google Scholar
15.Aldrete, JA, Kroulik, D. A post anesthetic recovery score. Anesth Analg 1970; 49: 924–933.Google Scholar
16.Wilder-Smith, O, Ravussin, P, Decosterd, L et al. . Midazolam premedication reduces propofol dose requirements for multiple anesthetic endpoints. Can J Anesth 2001; 48: 439–445.CrossRefGoogle ScholarPubMed
17.Sugden, D. Psychopharmacological effects of melatonin in mouse and rat. J Pharmacol Exp Ther 1983; 227: 587–591.Google ScholarPubMed
18.Laurido, C, Pelissie, T, Soto-Moyano, R, Valladares, L, Flores, F, Hernandez, A. Effect of melatonin on rat spinal cord nociceptive transmission. Neuroreport 2002; 13: 89–91.CrossRefGoogle ScholarPubMed
19.Liu, J, Singh, H, White, P. Electroencephalogram bispectral analysis predicts the depth of midazolam-induced sedation. Anesthesiology 1996; 84: 64–69.CrossRefGoogle ScholarPubMed
20.Leslie, K, Sessler, DI, Schroeder, M et al. . Propofol blood concentration and the bispectral index predict suppression of learning during propofol/epidural anesthesia in volunteers. Anesth Analg 1995; 81: 1269–1274.Google ScholarPubMed
21.Kearse, LA, Rosow, C, Zaslavsky, A et al. . Bispectral analysis of the electroencephalogram predicts conscious processing of information during propofol sedation and hypnosis. Anesthesiology 1998; 88: 25–34.Google Scholar
22.Glass, P, Bloom, M, Kearse, L, Rosow, C, Sebel, P, Manberg, P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847.Google Scholar
23.Olofsen, E, Dahan, A. The dynamic relationship between end-tidal sevoflurane and isoflurane concentrations and bispectral index and spectral edge frequency of the electroencephalogram. Anesthesiology 1999; 90: 1345–1353.Google Scholar
24.Lallemand, M, Lentschener, C, Mazoit, J et al. . Bispectral index changes following etomidate induction of general anaesthesia and orotracheal intubation. Br J Anaesth 2003; 91: 341–346.Google Scholar
25.Ludbrook, L, Upton, R, Grant, C et al. . The effect of rate of administration on brain concentrations of propofol in sheep. Anesth Analg 1998; 86: 1301–1306.Google Scholar