Additional Doses Of Propofol Research Articles

Comparison of effects of dexmedetomidine with ketofol and ketofol alone on quality of sedation in pediatric patients undergoing magnetic resonance imaging: A prospective randomized controlled double-blind trial

Background and Aim: Patient movement during magnetic resonance imaging (MRI) is the most frequent cause of artifacts and poor scan quality. Children cannot lie still. Thus, anesthesia is required to keep the child calm and immobile. This randomized double-blinded clinical trial compares the clinical effects of the addition of dexmedetomidine as premedication with ketofol on the quality of sedation. We hypothesized that the addition of dexmedetomidine would improve the quality of sedation. Methods: A total of 132 children aged 6 months to 10 years were randomized into groups DK (dexmedetomidine–ketofol) and K (ketofol). DK received an intravenous bolus of dexmedetomidine (0.5 mcg/kg) as premedication 10 minutes prior. Both the groups were induced with ketofol (0.5 mg/kg), and sedation was maintained with propfol infusion (100 mcg/kg/min). The primary objective was the quality of sedation as assessed by the University of Michigan Sedation Scale. Image quality, requirement of rescue propofol dose, recovery, and adverse events were also studied. Data are given as median [interquartile range (IQR)] or frequency. Results: All 132 children completed MRI scans. The DK group showed significantly better quality of sedation, 71% versus 47% of children, a median difference of 1 (-0.569 to -0.0969), P < .005, a better quality of scan, a reduced number of additional doses of propofol, and a decreased total dose of propofol. Hemodynamic parameters and recovery times for the two groups were similar. There were no significant side effects in both groups. Conclusion: The quality of sedation and the quality of the MRI scan are greatly improved by administering dexmedetomidine (0.5 mcg/kg) 10 minutes before to induction. Additionally, this technique decreases the need of propofol and gives better hemodynamic stability without delaying the recovery time.

Comparison of propofol-esketamine versus propofol-sufentanil for deep sedation and analgesia in children with autism: A randomized double-blind clinical trial.

Propofol sedation, routinely used for endoscopic procedures, is safe and acceptable for children. Adjuvants, such as esketamine or sufentanil, are commonly added to improve the efficacy and safety of propofol sedation. This study aimed to compare the clinical efficacy and safety of propofol-esketamine (PE) versus propofol-sufentanil (PS) for deep sedation and analgesia in children with autism undergoing colonoscopy procedure. One hundred and twenty-four children with autism undergoing colonoscopy procedure were included in the study. Patients were randomly assigned to receive one of the two adjuvants: esketamine (0.3 mg/kg) or sufentanil (0.2 μg/kg), subsequently administered propofol 2.0 mg/kg to induce anesthesia. Additional doses of propofol (0.5-1.0 mg/kg) were administered as needed to ensure patient tolerance for the remaining duration of the procedure. Movement during the procedure, hemodynamic variables, the total dose of propofol, recovery time, and adverse events were recorded. The PE group exhibited a significantly lower incidence of severe movement during the procedure compared with the PS group (14.52% vs. 32.26%, p = 0.020). The PE group showed significantly lower incidence of respiratory depression, hypotension, and severe injection pain of propofol than the PS group during the procedure (all p < 0.05). The mean arterial pressure (MAP) decreased significantly after anesthesia induction in the PS group and remained lower than baseline (all p < 0.05). Compared with the combination of low-dose sufentanil (0.2 μg/mg) with propofol, the low-dose esketamine (0.3 mg/kg) combined with propofol provided more stable hemodynamics, higher quality of sedation, and fewer adverse events in children with autism undergoing colonoscopy procedure.

Dose-response study of propofol combined with two different doses of esketamine for laryngeal mask airway insertion in women undergoing hysteroscopy

ObjectiveTo prospectively determine the median effective dose (ED50) of propofol for inhibiting a response to laryngeal mask airway (LMA) insertion when combined with different doses of esketamine in female patients. MethodsA total of 58 female patients (aged 20–60 years, ASAⅠ–Ⅱ) scheduled for elective hysteroscopy were enrolled and randomly divided into 2 groups, one of which was administered 0.2 mg/kg of esketamine (K1 group, n = 28) and the other 0.3 mg/kg of esketamine (K2 group, n = 30). The 2 groups received the corresponding doses of esketamine intravenously, followed by an intravenous injection of propofol (injection time was 30 s). The initial dose of propofol was 2 mg/kg, and the dose ratio of propofol in the adjacent patients was 0.9. If a positive reaction occurred due to LMA insertion, the dose ratio in the next patient was increased by 1 gradient; if not, the dose ratio was decreased by 1 gradient. The ED50, 95 % effective dose (ED95) and 95 % confidence interval (CI) of propofol for inhibiting a response to LMA insertion in the 2 esketamine groups were calculated using probit analysis. ResultsThe ED50 of propofol for inhibiting a response to LMA insertion in female patients was 1.95 mg/kg (95 % CI, 1.82–2.08 mg/kg) in the K1 group and 1.60 mg/kg (95 % CI, 1.18–1.83 mg/kg) in the K2 group. The ED95 of propofol for inhibiting a response to LMA insertion in female patients was 2.22 mg/kg (95 % CI, 2.09–2.86 mg/kg) in the K1 group and 2.15 mg/kg (95 % CI, 1.88–3.09 mg/kg) in the K2 group. ConclusionPropofol combined with 0.3 mg/kg of esketamine has low ED50 and ED95 effective doses for inhibiting an LMA insertion response in female patients undergoing hysteroscopy and surgery. There were no significant adverse effects, but the additional dose of propofol and airway pressure were significantly higher than those in the group administered 0.2 mg/kg of esketamine. Based on the results, we recommend the combination of propofol with 0.2 mg/kg esketamine for optimal conditions during LMA insertion in women undergoing hysteroscopy.

A Comparison of the Sedative Effect of Dexmedetomidine and Midazolam on Patients Undergoing Gastrointestinal Endosonography Outside the Operating Room.

Patients may experience anxiety, discomfort, and pain during endoscopy, which cannot be tolerated without sedative drugs. This study aimed to compare the sedative effects of dexmedetomidine and midazolam on patients undergoing endosonography outside the operating room. This randomized, double-blind clinical trial was conducted on 126 patients aged 18 - 65 years old with American Society of Anesthesiologists (ASA) physical status I - II undergoing elective endosonography. Patients were randomly divided into 2 groups. The dexmedetomidine group received dexmedetomidine (1 μg/kg) for 25 minutes with propofol (0.5 mg/kg) and fentanyl (1 μg/kg) at the start of the procedure. The midazolam group received midazolam (0.03 mg/kg) with propofol (0.5 mg/kg) and fentanyl (1 μg/kg). Heart rate, mean arterial pressure (MAP), and oxygen saturation (SpO2) were recorded before and 5, 10, and 15 minutes after starting the procedure. The Ramsay Sedation Scale (RSS) and the need for an additional dose of propofol were recorded during the procedure. The Numeric Pain Rating scale (Ambesh score) scores were recorded at the beginning, immediately after, and 1 hour after the procedure. Nausea and vomiting were assessed using the Visual Analogue Scale in cooperation with the patient. The dexmedetomidine group had significantly higher SpO2 and RSS scores during sedation than the midazolam group (P = 0.02). Overall, specialist satisfaction was higher in the dexmedetomidine group than in the midazolam group. There was no clinically significant difference in pain score and nausea and vomiting frequencies between the 2 groups. Dexmedetomidine is more effective than midazolam for sedation during gastrointestinal endosonography.

Ketamine as the main analgesic agent during analgesia-based sedation for elective colonoscopy - A randomised, double-blind, control study.

The aim of the study was to compare the analgesic effects of ketamine over fentanyl combined with propofol in analgesia-based elective colonoscopy with purpose of patient safety and satisfaction. This is a double-blinded prospective randomized controlled trial. Ninety patients were included and randomized to either fentanyl-propofol (Group FP, n: 30), ketamine-propofol (Group KP, n: 30) or propofol-control group (Group C, n: 30). Group FP patients received fentanyl and propofol, Group KP received ketamine and propofol and Group C, propofol. In all groups, incremental doses of propofol were used to maintain a Ramsay sedation score (RSS) of 5. Respiratory depression and hemodynamic parameters were monitored for the first minute and every 5 min during endoscopy. Fifteen minutes after the procedure, the degree of pain was assessed using a visual analog scale (VAS), the quality of recovery according to the Aldrete score (ARS), complications during and after the procedure and additional doses of propofol were recorded. Mean arterial pressure (MAP) at 5 and 30 min (p < 0.05), heart rate (HR) at 15, 25 and 30 min (p < 0.05) and peripheral oxygen saturation (SpO2) at 30 min (p < 0.05) were statistically significant for Group FP. Desaturation (*p = 0.033), and weakness (*p = 0.004) was also significant for Group FP at 20, 25 and 30 min (p < 0.05). Pain was lower assessed for the Group KP according to the VAS (**p = 0.025). In analgesia-based colonoscopy, ketamine provides appropriate analgesia and less incidence of complications compared to fentanyl.

Comparison of propofol-fentanyl and propofol-ketamine for sedoanalgesia in percutaneous endoscopic gastrostomy procedures.

Percutaneous endoscopic gastrostomy (PEG) procedures are performed under sedation in critically ill patients who cannot be fed orally. We compared the efficacy and safety of propofol-fentanyl and propofol-ketamine for deep sedation in patients undergoing PEG. Retrospective Study. The study was conducted from 1 January 2013 to 31 December 2018 in Adıyaman University. The patients given propofol-fentanyl (0.5-1.2 mg/kg and 0.2-1 μg/kg, respectively) for sedo-analgesia were designated Group F, and those who received propofol-ketamine (0.2-0.6 mg/kg and 0.5-1 mg/kg, respectively) were placed in Group K. The demographic and hemodynamic characteristics, recovery times, perioperative complications, and need for additional doses were recorded. Seventy-one patients who underwent PEG were analyzed. The age, sex, American Society of Anesthesiologists (ASA) score, comorbidities, duration of anesthesia, and duration of the PEG procedure were similar in the two groups. Recovery time was longer in Group K. The total propofol dose was 64 mg in Group F and 35 mg in Group K. Additional doses of propofol were administered to 12 patients in Group F, compared to none in Group K. The mean blood pressure values were higher in Group K at all-time points. The perioperative complication rate was higher in Group F. Desaturation was observed in 9 (22.5%) patients in Group F and in 3 (9.6%) patients in Group K. Hypotension was observed in 4 (10%) patients in Group F. Propofol-ketamine should be preferred for sedoanalgesia during PEG procedures because of the lower dose of propofol, more stable blood pressure, and greater peripheral oxygen saturation. In addition, we believe ketamine-propofol is safer based on its low complication rate.

A comparison of different doses of fentanyl for patients undergoing elective colonoscopy: a randomized double-blind clinical trial.

Aim To investigate analgesic and side effects of different doses of fentanyl in combination with propofol for colonoscopy. Methods This prospective randomized double-blind study conducted between 2019 and 2020 included 64 patients. Patients were randomized: Group 1 (fentanyl 0.5 μg/kg) and Group 2 (fentanyl 1.0 μg/kg) both in combination with propofol. Ramsay sedation score (RSS) was obtained at 5 with an additional dose of propofol. The primary outcome was the patient's postprocedural pain and adverse events during and after the procedure. Results The RSS means were statistically lower for Group 2 at the beginning and every 5 minutes of the procedure. Mean arterial pressure (MAP) for Group 2 (first, 5, 25 and 30 min) was significantly lower (p=0.000, and heart rate (HR) was significantly higher for Group 1 (during the entire procedure) (p=0.000) than in another group; peripheral oxygen saturation (SpO2 ) was significantly lower for measurements within both groups (Group 1, 5, 10, 15 min; Group 2, 5, 10,15 min) (p=0.000 and p=0.000, respectively). Anxiety (p=0.010), weakness (p=0.000) and confusion (p=0.023) proved to be significantly higher for Group 1, and hypotension (p=0.001) for Group 2 than in another group. No statistical significance of Visual Analogue Pain Scale (VAS) (p=0.501) and Aldrete recovery score (ARS) (p=0.845) was found. Conclusion There was no significance in postprocedural abdominal pain between the group of patients administered fentanyl at a dose of 0.5 μg/kg and the group of patients administered fentanyl at a dose of 1.0 μg/kg; however, prevalence of complications was more significant in the group with a fentanyl at a dose of 0.5 μg/kg.

Remimazolam Tosilate Sedation with Adjuvant Sufentanil in Chinese Patients with Liver Cirrhosis Undergoing Gastroscopy: A Randomized Controlled Study.

BackgroundThis prospective, randomized, controlled study evaluated the efficacy and safety of remimazolam tosilate sedation with adjuvant sufentanil, relative to propofol, for Chinese patients with liver cirrhosis undergoing gastroscopy.Material/MethodsPatients with liver cirrhosis (n=148) aged 18–65 years and undergoing gastroscopy were randomly and equally allocated to receive either 0.107 mg/kg remimazolam tosilate (remimazolam group) or 2 mg/kg propofol. Patients received intravenous sufentanil 0.15 μg/kg before the study drug. If necessary, an additional dose of propofol 20 mg was used and repeated. The primary outcome was the satisfaction rating (satisfactory, fair, or unsatisfactory) of the endoscopist with the sedation. Secondary outcomes were complications (respiratory depression, apnea, body movement, bradycardia, hypotension, nausea or vomiting, somnolence, dizziness, and fever) and patient satisfaction.ResultsCompared with the propofol group, the remimazolam group required a longer time to sedation and a shorter time to emergence. The percentage of remimazolam sedations the endoscopist rated satisfactory (90.5%) was higher than that for propofol (77.0%; P=0.026). Patients given remimazolam experienced lower rates of respiratory depression, body movement, and hypotension (2.7, 8.1, 4.1%, respectively), than did the propofol group (17.6, 23.0, 14.9%; P=0.003, 0.013, 0.025). The 2 groups were comparable regarding the other secondary outcomes.ConclusionsFor Chinese patients with liver cirrhosis undergoing gastroscopy, remimazolam tosilate with adjuvant sufentanil provides a satisfactory level of sedation with a good safety profile.

Adenoma Detection Rate in Colonoscopic Screening with Ketamine-based Sedation: A Prospective Observational Study.

Objective:This study aimed to determine the relationship between one of the most commonly used anesthesia techniques, ketaminebased sedation, on the value of adenoma detection rate (ADR) during colonoscopy screening.Methods:This prospective, observational study included 140 patients, who underwent a standard colonoscopy preparation before the procedure. Sedation regimens included ketamine at 0.5 mg/kg and propofol at 0.5 mg/kg. Additional doses of propofol were administered at 0.5 mg/kg to maintain the Ramsey Sedation scale. Baseline characteristics, ADR, bowel preparation quality according to the Chicago bowel preparation (CHBP) scale, cecal intubation, colonoscopy removal, and complications were analyzed.Results:The mean age of patients was 55.76 years; 40 (28.6%) were males and 100 (71.4%) were females. The ADR was 43.57%, wherein 15.71% in males and 27.86% in females. There were 43.6% adenomas, 17.9% biopsies, and 22.9% polypectomies. The largest location of adenomas/polyps were in the rectum and sigmoid and ascending colon (p=0.11), a biopsy of the sigmoid colon and ileum (p<0.05), polypectomy of the rectum and sigmoid and ascending colon (p<0.05). The cecal intubation was 93.6% with a withdrawal time that is >6 min in most patients (80%) (p<0.05). The CHBP scale showed good bowel preparation (p<0.05) without complications.Conclusions:Ketamine-based sedation is in good overall correlation with ADR. Therefore, the sedation technique should be included for ADR assessment in the future.

Proper use of fentanyl facilitates anesthesia during pulmonary vein isolation.

Although intraoperative anesthetic management of extensive encircling pulmonary vein isolation (PVI) is essential for the safe performance of this procedure, there is no standardized approach for the use of sedation and analgesia. Therefore, the present study aimed to clarify the optimal fentanyl dosage and timing of administration for the anesthetic management during PVI. A total of 364 patients with atrial fibrillation (AF) who underwent PVI at our institution between June 2017 and October 2020 were recruited. All patients were anesthetized with propofol for induction and maintenance under controlled ventilation via the supraglottic airway without neuromuscular blocking drugs. Among them, 234 patients received less frequent injections (Group 1) and 130 received a scheduled injection of 50mg of fentanyl (Group 2) in addition to propofol during PVI. We compared the total and additional propofol doses, frequency of additional propofol, and procedure time between the two groups. The mean patient age was 67.2years, and 69% were male. The total propofol dose was significantly lower in Group 2 than in Group 1 (17.0 ± 5.2mg/kg vs. 19.0 ± 5.5mg/kg, p < 0.01). The loading dose and frequency of additional propofol were also significantly lower in Group 2 than in Group 1. The procedure time was significantly shorter in Group 2 than in Group 1 (119 ± 36min vs. 132 ± 31min, p < 0.01). During PVI, proper use of fentanyl decreased the propofol dose, additional propofol frequency, and procedure time.

The Effect of Preoperative Anxiety and Pain Sensitivity on Preoperative Hemodynamics, Propofol Consumption, and Postoperative Recovery and Pain in Endoscopic Ultrasonography.

IntroductionThe present study investigates how preoperative anxiety and pain sensitivity affect the consumption of anesthetics, time elapsed until the desired sedation level is achieved, preoperative hemodynamics, postoperative recovery time, and postoperative pain.MethodsThe present study includes 80 ASA 1–2 patients aged between 20 and 65 who were scheduled for endoscopic ultrasonography (EUS) under sedation. Patients were instructed to fill out the Spielberger State-Trait Anxiety Inventory (STAI) and Pain Sensitivity Questionnaire (PSQ) before the procedure. For sedation, 0.03 mg kg−1 intravenous midazolam, 1 mg kg−1 lidocaine, 1 µ kg−1 fentanyl, and then a bolus dose of 1 mg kg−1 propofol were infused over a period of 60 s. The time elapsed until the bispectral index (BIS) value reached 75 was recorded. For anesthesia maintenance, 2 mg kg−1 h−1 propofol infusion was administered. In the case of sedation failure, an additional dose of 0.1 mg kg−1 propofol (IV) was administered to ensure sedation depth with a BIS level of 65–75, and the propofol infusion was halted once the BIS value dropped below 65.ResultsSTAI-S and STAI-T scores were significantly positively correlated with PSQ minor pain and PSQ total scores. The time elapsed until reaching a BIS level of 75, propofol infusion dose used during sedation, and the need for additional doses of propofol, heart rate (HR), and duration of post-anesthesia care unit stay were significantly positively correlated with both preoperative anxiety and preoperative pain sensitivity. In terms of postoperative pain, the visual analog scale (VAS) at 1 h was more highly correlated with STAI-S and STAI-T than with PSQ. The VAS 2 h was only correlated with STAI-S and STAI-T.ConclusionThe significant linear correlation between preoperative anxiety and pain sensitivity and anesthesia need can facilitate better preoperative management by predicting individual anesthetic consumption.Trial RegistrationThe study was registered with the number NCT03114735 on ClinicalTrials.gov.

Efficacy of Low-Dose Suxamethonium in Reducing Induction Dose of Propofol for Laryngeal Mask Airway Insertion in Nigerian Adults

Background: Propofol is commonly used as a sole induction agent during laryngeal mask airway (LMA) insertion, and additional doses are often required with systemic consequences. Objective: Our study evaluated the effect of 0.1 mg/kg suxamethonium on the dose of induction of propofol when used during insertion of LMA. Methodology: Eighty patients aged between 18 and 60 years were included in this prospective study. Patients undergoing elective procedures under general anaesthesia with LMA and spontaneous ventilation were randomized into two groups. Patients in both groups were induced with an initial dose of 2.5 mg/kg of propofol; the control group (group P) and the second group (group S) received 5 ml of normal saline and 0.1 mg/kg of suxamethonium made up to 5 ml, respectively. The need for additional doses of propofol following insertion of LMA was then assessed based on insertion conditions (ease of insertion, severity of airway response in terms of coughing, gagging, laryngospasm, and patient movement). The total dose of propofol required before successful insertion was recorded, as well as the incidence and duration of apnea post-induction. The pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were assessed at 0, 1, 3 and 5 min after insertion of LMA for each group. Results: The total dose of propofol required for successful LMA insertion was significantly lower in group S (2.82 ± 0.39 mg/kg) compared to group P (3.13 ± 0.49 mg/kg), P = 0.002. Haemodynamic parameters (SBP, DBP, MAP, PR, and SpO2) were well-controlled post-LMA insertion and were comparable between the two groups. Furthermore, no incidence of hypotension or bradycardia requiring intervention was observed at different time intervals, throughout the study period, in both groups. Conclusion: The dose of propofol is lesser when low-dose suxamethonium (0.1 mg/kg) precedes its use for induction during LMA insertion, and there is a reduction in the duration of apnea; however, it causes a higher apnea incidence. Vital signs were similar in the two study groups.

Eutectic Mixture of Lidocaine and Prilocaine Decreases Movement and Propofol Requirements for Pediatric Lumbar Puncture During Deep Sedation: A Randomized, Placebo-Controlled, Double Blind Trial.

Deep sedation/general anesthesia is commonly used in pediatric oncology patients undergoing lumbar puncture (LP). Propofol is often used for sedation, with or without a narcotic. We hypothesized that eutectic mixture of lidocaine and prilocaine (EMLA) would allow for lower cumulative doses of propofol and less movement. We performed a prospective, randomized, double blind, placebo-controlled trial in children undergoing sedation for LP. Standard initial weight-based doses of propofol and fentanyl were administered, with either EMLA cream or a placebo cream applied topically. The primary outcome was the total dose of propofol administered to each patient. We also tracked patient movement and complications. Twenty-seven patients underwent 152 LPs. Patients randomized to EMLA cream (n=75) were significantly more likely to receive a lower dose of propofol (2.94 mg/kg, SE=0.25, vs. 3.22 mg/kg, SE=0.19; P=0.036) and to not require additional propofol doses (probability 0.49, SE=0.08 vs. 0.69, SE=0.06; P=0.001) compared with patients randomized to placebo cream (n=77). In addition, patients with EMLA cream were significantly less likely to demonstrate minor or major movement. EMLA cream results in less movement and less propofol administration in pediatric oncology patients undergoing sedation for LP.

Propofol Sedation Dose for MRI Examination in Autistic Children Compared with normal Children.

AbstractIntroduction; MRI examination is a standard procedure requested by physicians of neurologic sciences, for the patient with neurocognitive disorders. Propofol sedation was performed for this examination, and we had the suspicion that children with autism spectrum syndrome (AUT) required higher propofol dose than normal children.Materials and methods. During a six years period, the first group of 30 autistic patients aged 3 to 10 years, received propofol infusion for brain MR, the control group of 30 normal patients with the same age, and the same mid-time of examination MR was also performed.Results. 17 children of AUT group received 3±1 additional doses of propofol, 12 of them had to repeat MR sequences (adequate anesthesia) and the total dose of propofol 4,5 vs 3,6 compare to non-autistic children. Even and the recovery time is a little bit faster compared to the second group.Conclusion: Autistic patients require more propofol dose to achieve a desirable level of anesthesia. All anesthesiologists should be aware in such patients with mental disorders when using propofol anesthesia.

A Simulation Study of Propofol Effect-Site Concentration for Appropriate Sedation in Pediatric Patients Undergoing Brain MRI: Pharmacodynamic Analysis.

PurposeWe aimed to establish the propofol effect-site concentration (Ce) for appropriate sedation by pharmacodynamic analysis and to determine the propofol Ce during occurrence of sedation-related side effects in pediatric patients undergoing brain magnetic resonance imaging (MRI).Materials and MethodsIn 50 pediatric patients scheduled for brain MRI, sedation was induced with 2.0 mg/kg propofol; additional propofol doses were 0.5–1 mg/kg. Propofol Ce was simulated by inputting the propofol administration profiles of patients into a pediatric compartmental model (Choi model). The relationship between propofol Ce and probabilities of sedation and recovery were analyzed using a sigmoidal Emax model. The simulated propofol Ce for sedation-related side effects was investigated. Population model parameters were estimated using the Nonlinear Mixed-Effects Modelling software.ResultsThe mean values of propofol Ce50 for sedation during the preparation, scanning, and recovery phases were 1.23, 0.43, and 0.39 µg/mL. The simulated propofol Ce values during oxygen desaturation (SpO2 <90%) (3 patients; 6%), hypotension (16 patients; 32%), and bradycardia (12 patients; 24%) were 3.01±0.04, 2.05±0.63, and 2.41±0.89 µg/mL, respectively.ConclusionThe required propofol Ce50 for applying monitors during the preparation phase before the start of MRI was higher than the propofol Ce50 required during the scanning phase. During low-intensity stimulation phases, such as scanning, propofol bolus dose should be strictly titrated not to exceed the propofol Ce that can lead to oxygen desaturation because of the relatively low propofol Ce (Ce95, 1.43 µg/mL) required for sedation in most patients.

Moderate hypothermia and its effects in reducing the applied dose of anesthetics for patients with opium dependence in cardiac surgery: A randomized controlled trial

BackgroundAn increasing number of patients addicted to opium are experiencing awareness during coronary artery bypass surgery (CABG) as a result of tolerance to anesthetics.ObjectivesThis research was primarily intended to determine the potential diminishing effects of moderate hypothermia on anesthetic dosage and recall of anesthesia during the procedure.MethodsIn this double-blind randomized controlled trial, a total of 80 CABG candidates with known addiction to opium were divided into two groups: one normothermic (N) and the other moderately hypothermic (H), both undergoing induction as well as close monitoring from September 2014 to January 2016. The candidates were initially set for a target bispectral index (BIS) score of between 40 and 60. As the score rose to 60, an additional dose of propofol was administered, alongside rise in blood pressure and tear-shedding. To enhance the accuracy of our evaluation of anesthetic depth, we also used two questionnaires to test candidates’ recall filled with the assistance of a colleague 24 hours following surgery. Independent-samples t-test and chi-square test were used by SPSS v 18 for data analysis.ResultsEighty patients were studied in two groups of normothermic (N) (n = 40) and hypothermic (H) (n = 40). Given similar demographic data as well as the duration of surgery, we arrived at a propofol dose of 122.52±13.11 cc for normothermic patients and 101.28±14.06 cc for hypothermic subjects (p=0.001). As for fentanyl, the total required sum came up to 39.60±21.04 cc and 31.72±5.81 cc for the above-mentioned groups in order (p=0.025). Moreover, the post-operative interview showed that there was no report of a patient with memory recall following surgery.ConclusionsModerate hypothermia can substantially reduce the need for anesthetics in patients with addiction to opium when undergoing CABG surgery.Trial registrationThis study is registered in Iranian Registry of Clinical Trials with registration number of IRCT2014050513159N5.FundingThis research was supported financially by the Research Council of Mashhad University of Medical Sciences (grant number 920405).

Propofol LCT vs propofol MCT-LCT: Randomized controlled trial

Background: Propofol formulation containing long chain triglycerides (LCT) elicits severe pain on intravenous injection. Newer formulation of propofol containing combination of medium and long chain triglycerides (MCT/LCT;50:50) with less concentration of free propofol may be beneficial in this aspect. Methods: This prospective, randomized, double blind study included 116 ASAI/II adult patients undergoing short surgical procedures under general anesthesia. Patients in group M received 3 cc of MCT/LCT propofol (Fresofol 1%, Fresenius Kabi) and group L received LCT propofol (Diprivan 1%, Astrazeneca), both over 3 seconds (@1cc/sec to assess pain on injection using the VRS score. Induction time and requirement of additional dose of propofol was also noted. Heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline, post intubation and 1, 3, 5 and 10 minutes thereafter. Serum triglyceride levels were measured 24 hours post-surgery and compared to preoperative levels. Results: Group M reported reduced pain score after IV propofol injection (1.37+2.40 vs 2.60+2.93) along with overall less incidence of pain (34.5% vs 53.4%). No difference was found in preoperative and 24 hours postoperative serum triglyceride levels in both groups. Three patients in group L developed thrombophlebitis as compared to one in group M. Induction time and hemodynamics were similar in both groups. Conclusion: MCT/LCT propofol produces less pain on intravenous injection. However, both formulations did not increase serum triglyceride levels after single induction dose. Keywords: Propofol, Anesthesia, Triglycerides, Long chain, Medium chain

Ketamine-propofol sedation versus propofol-pethidine sedation for minor plastic surgery procedures

Objective The aim of the study was to compare the efficacy of ketamine-propofol (KP) sedation versus propofol-pethidine (PP) sedation for minor plastic surgery procedures. Patients and methods This prospective study was conducted by randomization of 60 patients undergoing minor plastic surgery procedures. Patients were randomly divided into two groups by means of the sealed envelope technique: the KP group ( n = 30) and the PP group ( n = 30). In the former group, patients received induction with a bolus dose of ketamine 1 mg/kg dissolved in 10 ml saline, and in the latter group patients received induction with a bolus dose of 1 mg/kg pethidine dissolved in 10 ml saline intravenously. In both groups propofol was given as 1 mg/kg propofol, intravenous, bolus dose, additional doses of propofol 30 mg IV were given if sedation score was less than 4 in both groups followed by 5 mg/kg/h intravenous infusion. Sedation score, pain score, mean arterial blood pressure, total dose of propofol, conversion to general anesthesia, postoperative patient satisfaction score, and incidence of postoperative complications such as hypotension, oxygen desaturation, and vomiting were all recorded. Results Intraoperative pain scores, mean arterial blood pressure, and postoperative patient satisfaction scores were significantly higher in the PP group compared with the KP group. The sedation score was significantly higher in the KP group than in the PP group. Total dose of propofol was significantly lower in the KP group than in the PP group. There was no significant difference between the study groups regarding conversion to general anesthesia. Recovery time was significantly longer in the KP group compared with the PP group. There were significant differences in the incidence of complications such as oxygen desaturation and postoperative vomiting among the study groups. Conclusion The KP combination provides an attractive combination for procedural sedation compared with PP combination in terms of better sedation, hemodynamic stability, and lower incidence of complications.

Propofol-ketamine and propofol-fentanyl combinations for nonanesthetist-administered sedation.

There is a need to compare propofol requirement between propofol-ketamine (PK) and propofol-fentanyl (PF) given as nonanesthetist-administered propofol sedation during pediatric esophagogastroduodenoscopy (EGD). The study was a parallel-group, randomized, double-blind comparison of the need for additional doses of propofol in the first minute after sedation induction between PK and PF, administered by rotating trainees in pediatrics for sedation during pediatric EGD. A total of 95 children with American Society of Anesthesiologists class I to III between 3 and 12 years undergoing EGD were included and randomized to either of the groups. After midazolam premedication, children received either 0.5 mg/kg ketamine (PK) or 1 μg/kg of fentanyl (PF) followed by a mandatory 1 mg/kg of propofol. Additional doses of propofol of 0.5 mg/kg each were given to achieve sedation induction (modified Ramsay scale level 6), and further doses were administered during the procedure as required. A total of 92 children (PK, n = 47; PF, n = 45) were analyzed. P < 0.05 was considered significant. There was no difference in the propofol dose required for successful scope introduction and also in the need for additional propofol doses and the total additional propofol doses required in the first minute after sedation induction. Propofol injection pain was higher in the PF group (odds ratio 1.78). The adverse events and recovery time were similar. There was no escalation of care, airway intubations, death, or disability. Nonanesthetist-administered propofol sedation is feasible in teaching hospitals. Propofol requirement is similar in both PK and PF combination regimens, but the lower frequency of propofol injection pain may favor the use of PK.

A comparison of different proportions of a ketamine-propofol mixture administered in a single injection for patients undergoing colonoscopy

IntroductionIn this study, we aimed to determine the appropriate proportion of ketamine-propofol (ketofol), which was prepared in two different proportions for colonoscopy procedures.Material and methodsThis is a prospective and randomized trial. Group 1 was administered a mixture of 100 mg ketamine and 200 mg propofol. Group 2 was administered 50 mg ketamine and 200 mg propofol. Additional doses of 0.5 mg/kg bolus propofol without ketamine were administered to both groups to stabilize the bispectral index at 70–80 and with a Ramsey sedation score of 3–4. The pulse rate, mean arterial pressure (MAP), peripheral oxygen saturation values, colonoscopy period, adverse events, recovery time, discharge time, additional propofol doses, total propofol doses, colonoscopist and patient satisfaction were recorded.ResultsIn group 2, the 1 min MAP mean was significantly lower than the initial, 10, 15 and 20 min MAP means (p = 0.014, p = 0.002). The 20 min PR mean of group 2 was statistically significantly higher than group 1 (p = 0.045). The 15 min PR mean of group 2 was significantly lower than the initial and the 1 min PR means (p = 0.023, p = 0.006). The total propofol dose mean of group 2 was significantly higher than group 1 (p = 0.0001). The presence of adverse events in group 2 was significantly lower than that in group 1 (p = 0.0001). The mean colonoscopist satisfaction in group 2 was significantly lower than that in group 1 (p = 0.047).ConclusionsIn colonoscopy, a ketofol mixture prepared in the proportion 1 : 2 provides appropriate hemodynamic conditions and sufficient sedation.