Abstract
Background and Objectives: Elderly patients constitute a large segment of healthcare receivers. Considering the functional deterioration of multiple organ systems with aging, achieving a safe perioperative approach is challenging. Our aim is to study the safety and effectiveness of a genuinely regimented co-induction technique in order to minimize anesthesia-related complications. Materials and Methods: One hundred and five patients were assigned to three groups according to the induction technique: propofol, sevoflurane and co-induction group. Inclusion criteria: patients with age ≥65 and American Society of Anesthesiologists physical status classification (ASA) II-III who underwent endoscopic urological procedures. The propofol group received a dose of 1.5 mg kg−1 of propofol over two minutes for induction. The sevoflurane group received 8% of sevoflurane and 100% oxygen through a plastic facemask with the fresh gas flow set at 8 L min−1. The co-induction group received 4% sevoflurane through plastic facemask for two minutes, followed by a 0.75 mg kg−1 dose of propofol. After ensuring full range jaw relaxation, the laryngeal mask airway (LMA) was inserted. Results: Overall, the co-induction technique had a favorable profile in terms of respiratory adverse events, while the sevoflurane group had a favorable profile in terms of hemodynamic stability. Furthermore, 24 (68.6%) patients receiving inhalational sevoflurane had episodes of transient apnea, which constitutes 77.4% of the 31 episodes of transient apnea in the studied sample (p < 0.001). Moreover, six (17.1%) patients in the sevoflurane group had an episode of partial laryngospasm (p = 0.034). Compared with the co-induction group, we found that the propofol group had significantly less systolic and diastolic blood pressures in the second minute, with p values of (0.018) and (0.015), respectively. Conclusions: The co-induction technique utilizing 4% sevoflurane at 8 L min−1 flow of oxygen inhaled over two minutes followed by 0.75 mg kg−1 of propofol achieved less respiratory adverse events compared with the sevoflurane group, and less hemodynamic instability compared with the propofol group.
Highlights
The co-induction technique refers to the employment of a combination of drugs to achieve a greater effect than each drug alone [1]
We considered the onset of audible inspiratory wheezes “stridor” that were abolished upon applying minimal positive expiratory pressure, and sudden inspiration at mid-expiration followed by a pause in respiration of ≥5 s [24]
140.0 minutes (p = 0.008) when compared with the inhalational sevoflurane induction group, while130.0 when compared with the co-induction group, we found that the propofol group only had significantly less systolic blood pressure (SBP) in the second minute (p = 0.018)
Summary
The co-induction technique refers to the employment of a combination of drugs to achieve a greater effect than each drug alone [1]. It is an approach that can greatly benefit elderly patients and patients with chronic diseases involving major organs in whom anesthesia could confer a greater risk if hemodynamics are altered. Compared with other intravenous anesthetics, propofol provides optimal suppression of airway reflexes during laryngeal mask insertion with rapid onset of action and smooth recovery and has a relatively stable hemodynamic profile if dosed and administered properly [7,8,9,10]. Our aim is to study the safety and effectiveness of a genuinely regimented co-induction technique in order to minimize anesthesia-related complications
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