Effects Of Anesthetic Induction Research Articles

Effect of Anesthesia Induction with Midazolam on Hemodynamics in Abdominal Hysterectomy Surgeries

Objective: The primary task of anesthesiology is to control the patient's hemodynamic values, including blood pressure and heart rate, from pre-operative to post-operative. Many drugs are used alone or in combination for induction and maintenance of anesthesia. Various hemodynamic responses may develop to these drugs. In our study, we aimed to compare the effects of midazolam and propofol used alone in intravenous anesthesia induction on hemodynamics in patients undergoing abdominal hysterectomy. Materials and Methods: A total of 60 ASA I-II patients scheduled for abdominal hysterectomy were included in the study. During anesthesia induction, midazolam (0.2 mg/kg) was administered to Group M (n:30) and propofol 1% (2 mg/kg) was administered to Group P (n:30). Noninvasive systolic blood pressure, diastolic blood pressure, mean blood pressure and minute heart rate values were recorded. Results: Systolic blood pressure was significantly lower in group P than in M during intubation, skin incision, extubation and recovery. Conclusion:As a result, anesthesia induction with intravenous 0.2 mg/kg midazolam may cause higher systolic blood pressure values than 2 mg/kg propofol. It should not be overlooked that the hemodynamic response that will occur after the use of midazolam during anesthesia monitoring will vary depending on the anesthetic drugs and doses used together.

Effect of anesthesia induction with butorphanol on postoperative nausea and vomiting: A randomized controlled trial

BACKGROUND Postoperative nausea and vomiting (PONV) are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery. AIM To investigate the effect of butorphanol on PONV in this patient population. METHODS A total of 110 elderly patients (≥ 65 years old) who underwent gastrointestinal laparoscopic surgery were randomly assigned to receive butorphanol (40 μg/kg) or sufentanil (0.3 μg/kg) during anesthesia induction in a 1:1 ratio. The measured outcomes included the incidence of PONV at 48 h after surgery, intraoperative dose of propofol and remifentanil, Bruggrmann Comfort Scale score in the postanesthesia care unit (PACU), number of compressions for postoperative patient-controlled intravenous analgesia (PCIA), and time to first flatulence after surgery. RESULTS The results revealed a noteworthy reduction in the occurrence of PONV at 24 h after surgery in the butorphanol group, when compared to the sufentanil group (T1: 23.64% vs 5.45%, T2: 43.64% vs 20.00%, P < 0.05). However, no significant variations were observed between the two groups, in terms of the clinical characteristics, such as the PONV or motion sickness history, intraoperative and postoperative 48-h total infusion volume and hemodynamic parameters, intraoperative dose of propofol and remifentanil, number of postoperative PCIA compressions, time until the first occurrence of postoperative flatulence, and incidence of PONV at 48 h post-surgery (all, P > 0.05). Furthermore, patients in the butorphanol group were more comfortable, when compared to patients in the sufentanil group in the PACU. CONCLUSION The present study revealed that butorphanol can be an efficacious substitute for sufentanil during anesthesia induction to diminish PONV within 24 h following gastrointestinal laparoscopic surgery in the elderly, simultaneously improving patient comfort in the PACU.

Effect of anesthetic induction with propofol, alfaxalone or ketamine on intraocular pressure in cats: a randomized masked clinical investigation

ObjectiveTo compare the effect of propofol, alfaxalone and ketamine on intraocular pressure (IOP) in cats. Study designProspective, masked, randomized clinical trial. AnimalsA total of 43 ophthalmologically normal cats scheduled to undergo general anesthesia for various procedures. MethodsFollowing baseline IOP measurements using applanation tonometry, anesthesia was induced with propofol (n = 15), alfaxalone (n = 14) or ketamine (n = 14) administered intravenously to effect. Then, midazolam (0.3 mg kg−1) was administered intravenously and endotracheal intubation was performed without application of topical anesthesia. The IOP was measured following each intervention. Data was analyzed using one-way anova and repeated-measures mixed design with post hoc analysis. A p-value <0.05 was considered significant. ResultsMean ± standard error IOP at baseline was not different among groups (propofol, 18 ± 0.6; alfaxalone, 18 ± 0.7; ketamine, 17 ± 0.5 mmHg). Following induction of anesthesia, IOP increased significantly compared with baseline in the propofol (20 ± 0.7 mmHg), but not in the alfaxalone (19 ± 0.8 mmHg) or ketamine (16 ± 0.7 mmHg) groups. Midazolam administration resulted in significant decrease from the previous measurement in the alfaxalone group (16 ± 0.7 mmHg), but not in the propofol group (19 ± 0.7 mmHg) or the ketamine (16 ± 0.8 mmHg) group. A further decrease was measured after intubation in the alfaxalone group (15 ± 0.9 mmHg). Conclusions and clinical relevancePropofol should be used with caution in cats predisposed to perforation or glaucoma, as any increase in IOP should be avoided.

Effect of anesthesia induction on cerebral tissue oxygen saturation in hypertensive patients: an observational study

ObjectiveIn hypertensive patients, the autoregulation curve shifts rightward, making these patients more sensitive than normotensive individuals to hypotension. Hypotension following the induction of anesthesia has been studied in normotensive patients to determine its effects on brain tissue oxygenation, but not enough studies have examined the effect of hypotension on brain oxygenation in hypertensive patients. The current study aimed to use near-infrared spectroscopy to evaluate brain tissue oxygen saturation after the induction of anesthesia in hypertensive patients, who may have impaired brain tissue oxygen saturation. MethodsThe study included a total of 200 patients aged > 18 years old with ASA I–III. Measurements were taken while the patient was breathing room air, after the induction of anesthesia, when the lash reflex had disappeared following the induction of anesthesia, after intubation, and in the 5th, 10th, and 15th minutes of surgery. The patients were divided into nonhypertensive and hypertensive groups. ResultsThere was a significant difference in age between the groups (p = 0.000). No correlation was found between cerebral tissue oxygen saturation and age (r = 0.015, p = 0.596). Anesthesia induction was observed to decrease mean arterial blood pressure in both groups (p = 0.000). Given these changes, there was no significant difference in brain tissue oxygen saturation between the nonhypertensive and hypertensive groups (p > 0.05). ConclusionThere was no difference between hypertensive and normotensive groups in terms of the change rates in cSO2 values. However, there was a difference between the groups in terms of cSO2 values.

Effects of Anesthesia Induction with High-dose Remifentanil and Low-dose Midazolam on Hemodynamics in Patients Undergoing Cardiovascular Surgery

Effects of Anesthesia Induction with High-dose Remifentanil and Low-dose Midazolam on Hemodynamics in Patients Undergoing Cardiovascular Surgery

A RETROSPECTIVE STUDY TO COMPARE INFUSION OF PROPOFOL AND KETAMINE-PROPOFOL MIXTURE (KETOFOL) AS ANESTHETIC MAINTENANCE AGENTS IN PATIENTS UNDERGOING VARIOUS SURGICAL PROCEDURES IN TERTIARY CARE CENTRES

Introduction: The existing evidence suggests that the use of low doses and titers of ketamine can be effective in reducing the cardiovascular effects of propofol; nevertheless, this administration method can increase the chance of waking up during anesthesia. Some studies have reported the effect of anesthesia induction using a single propofol dose and low ketamine doses on the hemodynamic stability of patients in short-term outpatient operations in emergency departments. The aim of this study is to compare the effect of ketofol and propofol , to evaluate the intra and post-operative hemodynamic effects of ketofol infusion in comparison with propofol infusion.&#x0D; Methods: This Retrospective study involved Prior Consent from the Hospital Authorities &amp; was found to be within ethical standards. Data of 100 surgeries were selected which were managed with propofol ( 50 surgeries ) &amp; ketofol ( 50 surgeries) separately admitted to the local surgical units in last 5 years. The two groups were compared in terms of heart rate, systolic, diastolic and mean blood pressure, severity of pain and nausea, vomiting frequency and the doses of analgesics and antiemetic drugs used.&#x0D; Results: 38 (76%) out of 50 of the patients were male in the propofol group and 31 ( 62%) out of 50 were male in the ketofol group and the difference was not Significant .The mean age of the patients was 39.68 ± 7.32 years in the ketofol and 34.14 ± 7.61 years in the propofol groups . There was no statistical difference between the two groups regarding age and sex distribution. There was no difference between the two groups regarding systolic, diastolic and mean arterial blood pressure before induction and after. The intensity of nausea was not significantly different between the two groups. Postoperative pain severity and drug dosage were not significantly different between the two study groups.&#x0D; Conclusion: The infusion of a mixture of ketamine and propofol improves hemodynamic stability in addition to better analgesia compared to the infusion of propofol alone. But it led to heightened risk of nausea and vomiting. Future studies are recommended to address these issues. In addition, further studies are warranted to investigate the use of sub-hypnotic doses of ketamine + ketofol combination for infusion in surgical procedures. When these parameters are considered, ketofol might be used as an alternative to propofol.&#x0D; Keyword: Ketofol, Propofol, Retrospective Study. Comparative study, Ketamine

The effects of anesthesia induction and positive pressure ventilation on right-ventricular function: an echocardiography-based prospective observational study

BackgroundGeneral anesthesia induction with the initiation of positive pressure ventilation creates a vulnerable phase for patients. The impact of positive intrathoracic pressure on cardiac performance has been studied but remains controversial. 3D echocardiography is a valid and MRI-validated bed-side tool to evaluate the right ventricle (RV). The aim of this study was to assess the impact of anesthesia induction (using midazolam, sufentanil and rocuronium, followed by sevoflurane) with positive pressure ventilation (PEEP 5, tidal volume 6–8 ml/kg) on 2D and 3D echocardiography derived parameters of RV function.MethodsA prospective observational study on fifty-three patients undergoing elective cardiac surgery in a tertiary care university hospital was designed. Transthoracic echocardiography exams were performed before and immediately after anesthesia induction and were recorded together with hemodynamic parameters and ventilator settings.ResultsAfter anesthesia induction TAPSE (mean difference − 1.6 mm (95% CI − 2.6 mm to − 0.7 mm; p = 0.0013) as well as the Tissue Doppler derived tricuspid annulus peak velocity (TDITVs’) were significantly reduced (mean difference − 1.9% (95% CI: − 2.6 to − 1.2; p < 0.0001), but global right ventricular ejection fraction (RVEF; p = 0.1607) and right ventricular stroke volume (RVSV; p = 0.1838) did not change.ConclusionsThis data shows a preserved right ventricular ejection fraction and right ventricular stroke volume after anesthesia induction and initiation of positive pressure ventilation. However, the baso-apical right ventricular function is significantly reduced. Larger studies are needed in order to determine the clinical impact of these findings especially in patients presenting with impaired right ventricular function before anesthesia induction.Trial registrationRetrospecitvely registered, 6th June 2016, ClinicalTrials.gov Identifier NCT02820727.

Effect of Anesthesia on Cardiac Hemodynamics in patients undergoing durable LVAD Implantation: The EACHLVAD Study

Purpose Right ventricular (RV) dysfunction is often unmasked or exacerbated during implantation of a left ventricular assist device (LVAD). Prior to LVAD implantation, the effect of anesthesia induction on RV performance is unknown. We assessed for early hemodynamic changes in the RV after induction, prior to initiation of cardiopulmonary bypass (CPB), in the presence or absence of preoperative temporary mechanical circulatory support (tMCS). Methods We prospectively collected hemodynamic measurements in patients undergoing LVAD implantation at a large academic institution between 9/2017 and 9/2018. Preoperative RV hemodynamics were compared to RV hemodynamics post-induction and intubation but prior to CPB, including central venous pressure (CVP), mean pulmonary artery pressure (mPAP), and pulmonary artery pulsatility index (PAPi). Serial hemodynamics and vasoactive inotropic score (VIS) were analyzed over time using random effects models, adjusting for induction agents and use of pre-operative tMCS. Results There were 41 patients included in this analysis, with 4 intubated prior to induction. There was a significant increase in CVP (3.6 mmHg, p intra-aortic balloon pumps were 14 of 17 tMCS cases and had similar reduction in PAPi at all time points (-2.5, p Conclusion RV hemodynamics acutely worsen after anesthesia induction prior to bypass initiation in LVAD recipients. Patients with preoperative tMCS have worse RV hemodynamics at each timepoint but less significant decline over time.

Effect of Anesthetic Induction with Propofol Versus Thiopental on Outcomes of Newborns and Women Undergoing Cesarean Section: A Propensity Score Matching Analysis

Effect of Anesthetic Induction with Propofol Versus Thiopental on Outcomes of Newborns and Women Undergoing Cesarean Section: A Propensity Score Matching Analysis

Comparison of effects of anesthesia induction with different anesthetics on intraocular pressure

Objective To compare the effects of propofol,nidazolarm versus etomidate combined with sufentanil for anesthesia induction on intraocular pressure.Methods Forty-five ASA Ⅰ or Ⅱ patients,aged 20-40 yr,scheduled for surgery under general surgery,were randomly divided into 3 groups(n =15 each):propofol group(group P); midazolam group(group M)and etomidate group(group E).Anesthesia was induced with iv injection of propofol 2 mg/kg,midazolam 0.2 mg/kg,and etomidate 0.3 mg/kg in P,M and E groups respectively,and then with iv injection of sufentanil 0.2 μg/kg and cisatracurium 0.2 mg/kg in all the groups.The patients were then tracheal intubated.Intraocular pressure(IOP)and MAP were recorded at 1 m in before induction of anesthesia (T0),before intubation(T1),and at 0,1 and 2 min after intubation(T2-4).Results Compared with group P,the incidence of intraocujar hypotension was significantly decreased in group M(P ＜ 0.01).Compared with group E,the incidence of intraocular hypertension was significantly decreased in P and M groups(P ＜ 0.05),The correlation coefficient between MAP and IOP was 0.831,0.889 or 0.806 in group P,M or E respectively(P ＜0.05),and there was no significant difference in the correlation coefficient among the three groups(P ＞ 0.05).Conclusion Midazolam combined with sufentanil for anesthesia induction exerts less influence on lOP and the degree of MAP fluctuations is a major factor contributing to the change in IOP. Key words: Intraocular pressure; Propofol; Midazolam; Etomidate; Anesthesia, general

Effects of different respiratory maneuvers on esophageal sphincters in obese patients before and during anesthesia

Data on esophageal sphincters in obese individuals during anesthesia are sparse. The aim of the present study was to evaluate the effects of different respiratory maneuvers on the pressures in the esophagus and esophageal sphincters before and during anesthesia in obese patients. Seventeen patients, aged 28-68 years, with a BMI ≥ 35 kg/m², who were undergoing a laparoscopic gastric by-pass surgery, were studied, and pressures from the hypopharynx to the stomach were recorded using high-resolution solid-state manometry. Before anesthesia, recordings were performed during normal spontaneous breathing, Valsalva and forced inspiration. The effects of anesthesia induction with remifentanil and propofol were evaluated, and positive end-expiratory pressure (PEEP) 10 cmH₂O was applied during anesthesia. During spontaneous breathing, the lower esophageal sphincter (LES) pressure was significantly lower during end-expiration compared with end-inspiration (28.5 ± 7.7 vs. 35.4 ± 10.8 mmHg, P<0.01), but barrier pressure (BrP) and intra-gastric pressure (IGP) were unchanged. LES, BrP (P<0.05) and IGP (P<0.01) decreased significantly during anesthesia. BrP remained positive in all patients. IGP increased during Valsalva (P<0.01) but was unaffected by PEEP. Esophageal pressures were positive during both spontaneous breathing and mechanical ventilation. Esophageal pressures increased during PEEP from 9.4 ± 3.8 to 11.3 ± 3.3 mmHg (P<0.01). During spontaneous breathing, the LES pressure was the lowest during end-expiration but there were no differences in BrP and IGP. LES, BrP and IGP decreased during anesthesia but BrP remained positive in all patients. During the application of PEEP, esophageal pressures increased and this may have a protective effect against regurgitation.

Hemodynamic Effects of Anesthetic Induction with Eltanolone-Fentanyl Versus Thiopental-Fentanyl in Coronary Artery Bypass Patients

We evaluated the hemodynamic profile of eltanolone and fentanyl versus thiopental and fentanyl anesthetic induction in patients with documented coronary artery disease. Fifty patients scheduled for coronary artery bypass grafting were randomly assigned to two treatment groups (25 patients each). Anesthesia was induced by eltanolone (0.5 mg/kg) or by thiopental (3 mg/kg). Each patient also received 3 micrograms/kg fentanyl and 0.1 mg/kg vecuronium. Heart rate, arterial, pulmonary arterial, central venous, and pulmonary capillary wedge pressures, and cardiac output were determined in the awake state, 2 min after induction of anesthesia, and at 1 and 5 min after intubation, which was performed 3 min after induction. Between-group statistics showed significantly (P < 0.05) lower mean arterial pressure and systemic vascular resistance for eltanolone-treated patients at all measuring points. Pulmonary capillary wedge pressure was lower at 1 min after intubation; left ventricular stroke work index was lower at 1 and 5 min after intubation in the eltanolone group. We conclude that the lower mean arterial pressure with eltanolone as compared to thiopental is a result of greater peripheral vasodilation.

Noninvasive assessment of cardiac performance of intravenous benzodiazepines by systolic time intervals.

The effects of anesthetic induction by diazepam, flunitrazepam and midazolam on cardiac performance were evaluated in 33 ASA class I surgical patients (average age was 36 years). The patients were divided according to the 3 drug groups, and the effects of each drug assessed utilizing measurements of systolic time intervals. An increase in heart rate and decrease in blood pressure was observed following flunitrazepam and midazolam induction. There was no changes in PEPI (pre-ejection period index) and LVETI (left ventricular ejection time index) by benzodiazepines induction. The PEP/LVET ratio was increased by diazepam while the DPTI (diastolic pressure time index)/TTI (tension time index) was reduced by flunitrazepam and midazolam. However, these changes in PEP/LVET and DPTI/TTI were within normal limits. These data indicate that in healthy humans the induction dose of either diazepam, flunitrazepam or midazolam does not extremely influence either PEP/LVET for cardiac performance or DPTI/TTI for cardiac oxygen balance. The results also suggest that the simultaneous use of PEP/LVET and DPTI/TTI is more informative than any single variable for the evaluation of cardiac effects of anesthetics.

Effects of Anesthetic Induction on Myocardial Function and Metabolism

MILLER, D. R.; WELLWOOD, M.; TEASDALE, S. J.; LAIDLEY, D.; IVANOV, J.; YOUNG, P.; MADONIK, M.; MCLAUGHLIN, P.; MICKLE, D. A. G.; WEISEL, R. D. Author Information

Cardiovascular effects of anesthetic induction with ketamine

Cardiovascular effects of anesthetic induction with ketamine