Propofol Increasing HR?

[MallysMama]

Has anyone ever seen or heard of propofol causing an INCREASE in heart rate??

I had a neuro pt last night...and HR was 80-90 when I got there. I was struggling to keep BP under control and my charge nurse suggested going up on the propofol (was only at 10mcgs) and medicate for pain. This pt had a very poor neuro exam and I was hesitant to over sedate. But I did as she suggested.

It didn't take long before HR was 100-120s. Thought maybe it just wasn't helping...so I increased it again. Anywho- over the course of the night I eventually got up to 40mcgs. And HR got up to 140. I was so frustrated- not knowing the cause! I eventually decided to totally turn the prop off (instead of just holding for a few minutes for neuro check)... And within 15 minutes HR was back to 90!! Coincidence?!

I asked a rounding cardiologist (who was unfamiliar with the patient)...and he said he'd never heard of it causing an increase. It did lower the BP- but not by much...so didn't feel it was inversely related.

Any thoughts?

[SCBlueICU]

I've never seen it personally, but I have a thought. I wonder if the patient's body was trying to keep the neuro perfusion pressure up, so when you dilated blood vessels with sedatives, the body increased HR to increase CO in order to keep the pressure where it wanted it to be in order to perfuse the brain adequately. That's just off the cuff, not sure that is what happened. Interesting!

[GingerTravelRN]

Coincidence. Would have to know what else they were on, but propofol on it's own shouldn't make someone tachy.

[MallysMama]

Only other fluid running was NS@100mls. Fosphenytoin q8h. And I gave his second and last Cefazolin. Gave Protonix IV that morning too. Gave morphine 2mg and Hydralazine 10mg twice during the night.

Still just coincidence? Or maybe brain surgery related?

[MallysMama]

I've never seen it personally, but I have a thought. I wonder if the patient's body was trying to keep the neuro perfusion pressure up, so when you dilated blood vessels with sedatives, the body increased HR to increase CO in order to keep the pressure where it wanted it to be in order to perfuse the brain adequately. That's just off the cuff, not sure that is what happened. Interesting!

I like this thought! That could definitely be a possibility. And so when I stopped sedating the crap out of the patient- his HR could finally go back to normal!

[Fumanchuesday]

Before I read that you gave Hydralazine, I was gonna ask if you gave some. Hydralazine is known to raise HR. Nothing a little labetalol cant fix though.

[Biffbradford]

Interesting. I once had a heart patient on Dobutamine but the cardiac index was still a lousy 1.8. Surgeon suggested turning it off, that on rare occasion is has an opposite affect, I did ... and the index immediately came up to 2.5. Hah!

[MallysMama]

Before I read that you gave Hydralazine, I was gonna ask if you gave some. Hydralazine is known to raise HR. Nothing a little labetalol cant fix though.

It's possible the Hydralazine was making it worse...but it was already in the 120s when I gave it for an elevated BP.

[Esme12, ASN, BSN, RN]

It can cause tachycardia with induction IVpush so it stands to reason it could cause tachycardia....was the patient on any paralytics?

[MallysMama]

Nope- no paralytics.

I didn't know a propofol push could cause an elevated HR. So why doesn't a gtt list it as a possible side effect? It's the same med.

[iluvgusgus]

Our hydralazine orders are usually hold for HR >100. So that might have been what did it....

[DogLover17]

My post-op CABG last week had a very similar issue (no hydralazine though) and the NP thought it could be from the propofol. When I asked her for a broader understanding why she didn't give me an answer. A few days later I found out he was a very heavy drinker and withdrawing....so my answer is that no, I haven't actually seen this, but I thought I had!