The haemodynamic effects of propofol in combination with ephedrine in elderly patients (ASA groups 3 and 4)

The marked vasodilator and negative inotropic effects of propofol are disad vantages in frail elder ly patients. We investigated the safety and efficac y of adding different doses of ephedrine to propofol in order to obtund the hypotensive response. The haemodynamic effects of adding 15 20 or 25 mg of ephedrine to 200 mg of propofol were compared to control in 40 ASA 3/4 pat ients over 60 years presenting for genito-urinary surgery. The addition of ephedrine to propofol appears to be an effective method of obtunding the hy potensive response to propofol at all doses used in this study However; mar ked tachycardia associated with the use of ephedrine in combination with pr opofol occurred in the majority of patients, occasionally reaching high lev els in individual patients. Due to the risk of this tachycardia inducing my ocardial ischemia, we would not recommend the use in elderly patients of an y of the ephedrine/propofol mixtures studied.