Anesthetic Induction Agents Research Articles

Comparative study between lidocaine, magnesium sulfate and dexmedetomidine in alleviation of pain induced by intravenous injection of propofol

Background Propofol is the most widely used intravenous anaesthetic agent for induction and maintenance of anaesthesia. Pain on injection of propofol is a common problem. Propofol injection pain, despite various interventions, still occurs during the anaesthesia induction and causes intense discomfort and anxiety in patients. Objective Compare the efficacy of lidocaine, magnesium sulfate and dexmedetomidine drugs in reduction of pain of propofol. Also, study the effects of these drugs on cardiovascular system. Subjective This prospective controlled randomized double-blind study was carried out on 90 adult patients ASA status I or II, haemodynemically stable and Scheduled for elective surgery under general anaesthesia by propofol intravenous induction. Results The pain level during administration showed a significant decrease in group D (dexmedetomidine) less than both group L and M and there was no significant effect of the three drugs on haemodynamic parameters. Conclusions Dexmedetomidine is an effective and safe way to reduce the intensity and incidence of propofol injection pain. Magnesium and lidocaine pretreatment are equally effective in attenuating propofol-induced pain with some priority of magnesium sulphate more than lidocaine. There were no significant effects of the drugs on haemodynamics parameters

A dose characterization study evaluating the pharmacodynamics and safety of a concentrated alfaxalone solution (4%) as an intramuscular sedative in dogs.

Alfaxalone is a commonly employed veterinary anaesthetic induction and sedation agent. A 4% w/v preserved, aqueous formulation of alfaxalone 'RD0387' (A4%) has recently been developed. To evaluate the sedative effects of A4%, three doses, 5 mg kg-1 (A5); 7.5 mg kg-1 (A7.5) and 10 mg kg-1 (A10) were administered intramuscularly into the epaxial musculature of six healthy adult mixed-breed dogs in an experimental, randomized, blinded, crossover study. Sedation time variables, quality of sedation (including onset of sedation and recovery), physiological variables, response to cephalic vein catheterization and frequency of undesirable events were recorded. Continuous variables were analysed between treatments (one-way ANOVA or restricted maximum likelihood modelling) and within treatments compared with baseline (Tukey's test). Categorical data were analysed between treatments (Kruskal-Wallis' test) and within treatments from baseline (Dunn's test). Significance was set at p < .05. All dogs became sedated (laterally recumbent) and sedation onset was significantly faster in groups A7.5 (9.8 ± 5.3 min) and A10 (9.1 ± 5.6 min) compared to A5 (25.6 ± 16.1 min) (p = .033, p = .027, respectively). Duration of sedation was significantly longer in A10 (168.5 ± 70.6 min) and A7.5 (143.8 ± 58 min) compared to A5 (63.8 ± 28.2 min) (p = .005 and p = .003, respectively). Dogs in A10 had a superior quality of onset of sedation compared to A5 (p = .028). Sedation scores and quality of recovery from sedation were not significantly different between doses. Two dogs (2/6) in A5 were insufficiently sedated for cephalic catheterization. Ataxia was the most frequently observed undesirable event with an overall frequency of 78% (14/18) and 89% (16/18) during sedation onset and recovery, respectively. Overall, A4% administered IM in dogs at 7.5 and 10 mg kg-1 resulted in sufficient sedation for IV catheterization in dogs. To improve the speed and quality of the sedation, it is recommended that future research focuses on combining A4% with other sedative or analgesic drugs.

An Unusual Case of Delayed Midazolam Anaphylaxis and a Review of the Current Literature.

Midazolam is a commonly used, well-tolerated, anxiolytic, sedative, anesthesia induction agent, and an adjunct for procedural sedation that is used widely in the emergency department. The ability to administer midazolam via multiple routes, including intranasal, makes it a particularly common choice for use in children. Intranasal administration is safe, easy, and well tolerated and has been shown to be an effective method of obtaining anxiolysis and/or sedation. Adverse drug reactions, including allergic reactions, can occur with any medication. However, anaphylaxis is an uncommon phenomenon from midazolam. Despite being one of the most common medications used in the emergency department and operating room, there are only a handful of unequivocal cases of anaphylaxis secondary to midazolam. The rarity of this presentation may lead to delays in care and potential adverse outcomes as a result. We present one such case of a 10-year-old patient who experienced anaphylaxis after administration of intranasal midazolam to facilitate a computed tomography scan.

Effect of pre-treatment on induction of anaesthesia with etomidate: A comparison between dexmedetomidine and midazolam–fentanyl combination

Background: Because of its prompt onset of action and clearance, the use of etomidate as an anaesthetic induction agent is increasing in clinical practice. However, etomidate-induced myoclonus (EIM) remains a prevalent issue. Such myoclonic activity can be prevented by the administration of drugs that inhibit subcortical neuronal activity. Aims: This study was designed to compare the effects of pre-treatment with dexmedetomidine and fentanyl–midazolam combination on EIM as well as on attenuation of pharyngolaryngeal reflex. Materials and Methods: One hundred adult patients with the American Society of Anesthesiologists Grades 1 or 2 posted for elective surgery were enrolled and were randomly divided into two groups of 50 patients each. Group D received dexmedetomidine (1 μg/kg) in over 10 min and Group F received midazolam (0.02 mg/kg) + fentanyl (2 μg/kg) intravenously. Haemodynamic variables, incidence and severity of myoclonus were recorded. Results: The incidence of EIM was lower in Group F (26%) when compared to Group D (40%), but the difference was not statistically significant (P = 0.28). Eighteen per cent of the subjects in Group F had Grade 1 myoclonus as compared to 32% of Group D, whereas 8% of the subjects in Group F had Grade 2 myoclonus as compared to 6% of Group D. None of the patients in Group F experienced myoclonus of Grade 3, whereas 2% of the subjects had Grade 3 myoclonus. Conclusion: Administration of a combination of fentanyl and midazolam, along with dexmedetomidine as a pre-treatment, has been found to be an effective strategy for mitigating the incidence of myoclonus.

Determination of Sufentanil in Human Plasma Using Ultra-high Performance Liquid Chromatography Coupled with Tandem Mass Spectrometry (UPLC–MS/MS)

Background: Sufentanil, an opioid analgesic, is used as an induction agent for general anesthesia during surgery. Sufentanil is more active than other anesthetics and has a narrow therapeutic range. Therefore, a precise dosage regimen is necessary when administering sufentanil. Objective: This study aimed to develop a bioanalytical method for the determination of sufentanil within the sensitive concentration range more than that in a previous study utilizing protein precipitation (PP) and determine the plasma concentration of sufentanil. Methods: A method for quantitating sufentanil was developed using ultra–high performance liquid chromatography coupled with mass spectrometry (UPLC–MS/MS) and detection by electrospray ionization (ESI). The internal standard was sufentanil-d5. Chromatographic separation was performed using an Acquity UPLC HSS T3 column (50 × 2.1 mm, 1.8 μm) from Waters (Milford, MA, USA). Protein precipitation (PP) was used for sample preparation, and gradient elution was conducted using a mobile phase consisting of 1 mL of 2M ammonium acetate in 99% formic acid in 1 L of water or in 1 L of acetonitrile. The total run time for the analysis was 5 min, and the flow rate was 0.4 mL/min. Results: Standard curves were linear over ranges of 0.025–30 ng/mL for sufentanil with a correlation coefficient (r2) greater than 0.9998. The lower limit of quantification (LLOQ) was 0.025 ng/mL. The intra– and inter–day accuracies were 97.66%–108.8% and 101.25%–103.17%, respectively, and the precision did not exceed 15% for sufentanil. Conclusion: This study developed a validated, simple, sensitive, and convenient UPLC–MS/MS method for quantifying sufentanil in human plasma. This method was applied to determine sufentanil concentration in the plasma of patients undergoing surgery. The bioanalytical method using PP showed a sufficiently sensitive concentration range. This method could be applied to various pharmacokinetic studies of sufentanil.

Remimazolam versus propofol for procedural sedation: a meta-analysis of randomized controlled trials.

To improve patient tolerability and satisfaction as well as minimize complications, procedural sedation has been widely used. Propofol is the most widely used agent for induction of anesthesia and sedation by anesthesiologists. With a different mechanism compared to propofol, remimazolam is a new short-acting GABA-A receptor agonist. It is an ester-based benzodiazepine. This meta-analysis aims to clarify the efficacy and safety of remimazolam versus propofol for procedure sedation. Electronic databases were searched for randomized controlled trials (RCTs) comparing efficacy or safety of remimazolam versus propofol. Meta-analysis were conducted using RStudio with "metafor" package with random-effects model. A total of twelve RCTs were included in the meta-analysis. The pooled results demonstrated that patients with remimazolam for procedural sedation had lower risk of bradycardia (OR 0.28, 95% CI [0.14-0.57]), hypotension (OR 0.26, 95% CI [0.22-0.32]), and respiratory depression (OR 0.22, 95% CI [0.14-0.36]). There was no difference in the risk of developing postoperative nausea and vomiting (PONV) (OR 0.65, 95% CI [0.15-2.79]) and dizziness (OR 0.93, 95% CI [0.53-1.61]) between the remimazolam and propofol groups. Using remimazolam for procedural sedation is significantly associated with less injection pain compared to propofol (OR 0.06, 95% CI [0.03-0.13]). Regarding the sedation efficacy, there was no difference in sedation success rate or time to loss of consciousness, recover and discharge between the remimazolam and the propofol groups. Based on our meta-analysis, patients receiving procedural sedation with remimazolam had lower risk of bradycardia, hypotension, respiratory depression and injection pain compared with propofol. On the other hand, there was no difference in sedation success rate, risk of PONV, dizziness, time to LOC, recovery and discharge between these two sedatives. CRD42022362950.

Propofol and thiopental for intravenous induction in neonates: study protocol for a dose-finding trial.

Propofol and thiopental are commonly used induction agents in neonatal anesthesia. Even though both hypnotics have been used off-label for many years, pharmacological knowledge regarding these agents is scarce in neonates. The significant variability in neonates' body composition, organ function, and maturation makes pharmacological studies highly relevant albeit challenging. As a result, there is currently limited data about the anesthetic induction dose of thiopental and propofol in neonates. In addition, a knowledge gap exists concerning the pharmacodynamics of induction doses. To determine the median effective anesthetic induction dose of propofol and thiopental in neonatal patients of different gestational and postnatal ages and evaluate the pharmacodynamics of the anesthesia induction doses on the neonatal systemic and cerebral hemodynamics. This is a single-center, prospective, open-label, interventional, dose-finding study, including neonatal patients from birth up to 28 postnatal days undergoing general anesthesia for surgical or diagnostic procedures. The patients will be stratified according to their gestational and postnatal age and allocated to one of the two trial arms: anesthesia induction with propofol or anesthesia induction with thiopental. We will use Dixon's up-and-down method to estimate the median effective anesthesia induction dose of both agents in neonates of different gestational and postnatal ages. In addition, we will study the relationship between anesthesia induction doses and changes in systemic and cerebral hemodynamics. Alterations in the systemic and cerebral regional hemodynamics secondary to anesthesia induction may be harmful in neonates, especially premature and critically ill newborns, due to their immature organ systems, reduced physiological reserves, and impaired cerebral autoregulation. Perfusion homeostasis is considered one of the significant and modifiable determinants of anesthesia-related neurocognitive outcomes. Therefore, dose-finding and safety pharmacological studies of the anesthetic induction agents in neonates are urgently needed and acknowledged as a high priority by the European Medicine Agency. Estimating adequate induction doses to ensure optimal depth of anesthesia while avoiding systemic and cerebral hemodynamic disturbances will help ensure safe anesthesia and potentially improve anesthesia-related outcomes in this group of patients. This article is protected by copyright. All rights reserved.

The Effect of Propofol on Peri-Induction Hemodynamics and Resuscitation in Operative Penetrating Trauma.

Hemorrhaging trauma patients may be disproportionately affected by choice of induction agent during rapid sequence intubation (RSI). Etomidate, ketamine, and propofol are safe in the trauma population-at-large but have not been assessed in patients with ongoing hemorrhage. We hypothesize that in hemorrhaging patients with penetrating injury, propofol deleteriously affects peri-induction hypotension compared to etomidate and ketamine. Retrospective cohort study. Primary outcome was the effect of induction agent on peri-induction systolic blood pressure. Secondary outcomes were the incidence of peri-induction vasopressor use and quantity of peri-induction blood transfusion requirements. Linear multivariate regression modeling assessed the effect of induction agent on the variables of interest. 169 patients were included, 146 received propofol and 23 received etomidate or ketamine. Univariate analysis revealed no difference in peri-induction systolic blood pressure (P = .53), peri-induction vasopressor administration (P = .62), or transfusion requirements within the first hour after induction (PRBC P = .24, FFP P = .19, PLT P = .29). Choice of RSI agent did not independently predict peri-induction systolic blood pressure or blood product administration. Rather, only presenting shock index independently predicted peri-induction hypotension. This is the first study to directly assess the peri-induction effects of anesthetic induction agent choice in penetrating trauma patients undergoing emergent hemorrhage control surgery. Propofol does not appear to worsen peri-induction hypotension regardless of dose. Patient physiology is most predictive of peri-induction hypotension.

Anaesthetic induction with alfaxalone in Jungle Carpet Python (Morelia Spilota Cheynei)

The aim of this investigation was to assess the clinical use of alfaxalone as a short-acting anaesthetic agent for induction to inhalation anaesthesia in jungle carpet pythons (Morelia spilota cheynei). Ten healthy, captive, sub-adult jungle carpet pythons (1.1±0.32 kg bw) were anaesthetised using a dose of 10mg/kg of alfaxalone, administered intravenously to the ventral tail vein. Heart rate (HR) and respiratory rate (RR) were recorded before administration (T0), and every 5 minutes until the snakes fully recovered from the anaesthesia. The induction time, time of tail-pinch reflex loss, tracheal tube insertion time, interval of deep anaesthesia, and the time of full recovery were recorded. The induction time occurred within 3.1±0.8 minutes. The tail-pinch reflex loss was lost within 5.6±0.7 minutes. The mean tracheal tube insertion time, the interval of deep anaesthesia, and the time of full recovery were 6.9±0.9 minutes, 18.8±4.7 minutes, and 36.7±11.4 minutes, respectively. A prolonged time of full recovery was recorded in two snakes (61.3 and 62.6 minutes, respectively). Their mean heart rate was statistically higher (P&lt;0.05) at T5, T15 and T20 when compared with the basal HR at T0. The respiratory rate of the snakes dropped at T5 and was statistically lower (P&lt;0.05) from T5 until T20 when compared with RR at all other time points. In two snakes apnoea was recorded at T5. Intravenous administration of alfaxalone proved to be a valuable method of induction, suitable for a subsequent inhalation anaesthesia in jungle carpet pythons.

Comparison of I-Gel insertion conditions with two different induction methods in children: a prospective observational study

Aim: Insufficient depth of anesthesia is one of the important causes of laryngospasm in pediatric patients undergoing surgery. Propofol is a widely used anesthetic agent for induction of anesthesia in children. Its use alone in induction may be insufficient to suppress laryngeal reflexes during laryngeal mask insertion and may lead to complications such as cough, hiccups, and laryngospasm. In this study, the effects of fentanyl-ketamine mixture and remifentanil used as co-induction in anesthesia induction in children on I-gel insertion conditions and hemodynamic stability were compared. In addition, the evaluation of propofol injection pain after the use of coinduction agent was made.&#x0D; Material and Method: The study included 60 patients aged 2-10 years, of ASA I-III class, who underwent ambulatory surgery. For anesthesia induction, the KF group (n:30) were administered intravenous (iv) 1 mcg/kg fentanyl + 0.5 mg/kg ketamine followed by 3 mg/kg propofol, and the R group (n:30) were administered iv 0.5 mcg/kg remifentanil followed by 3 mg propofol. The I-gel insertion conditions were evaluated by scoring the six variables of mouth opening, ease of insertion, swallowing, coughing, movement, and laryngospasm. Pain during propofol injection was graded using a four-point scale. &#x0D; Results: No statistically significant difference was determined between the groups in terms of I-gel insertion conditions total score values (p&gt;0.05). The pain of the propofol injection was determined at a significantly higher level in Group R (p

Efficacy and safety of ciprofol versus propofol for the induction of anesthesia in adult patients: a multicenter phase 2a clinical trial

BackgroundCiprofol is a novel 2, 6-disubstituted phenolic derivative anesthetic that binds to the gamma-aminobutyric acid-A receptor.AimTo determine the equally potent dose of ciprofol compared with propofol as an induction agent for general anesthesia in patients undergoing selective surgery, and to assess its safety.MethodA total of 109 patients undergoing selective non-emergency, non-cardiothoracic or non-neurosurgical surgery requiring tracheal intubation for general anesthesia were enrolled. Ten patients per group were assigned to ciprofol-0.3, 0.4 and 0.5 mg/kg, and propofol-2.0 or 2.5 mg/kg groups, respectively to receive an intravenous bolus dose. An additional 20 patients were enrolled in the ciprofol-0.3, 0.5 or propofol-2.0 mg/kg groups. The primary outcome was the success rate of induction defined as a Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) ≤ 1 after the initial bolus dose. The secondary outcomes included the time to reach MOAA/S ≤ 1, the time to loss of the eyelash reflex, the incidences and severity of adverse events (AEs).ResultsThe success rates were 100% for all 5 groups. The mean time to MOAA/S ≤ 1 and the time to loss of the eyelash reflex were not different among the 5 groups, regardless of whether a top-up dose was needed. There were no significant differences in the incidences and severity of AEs in the dose ranges investigated of ciprofol vs. propofol.ConclusionThe efficacy and safety of a single bolus dose of ciprofol-0.5 mg/kg for the general anesthesia induction in selective surgery patients was comparable to that of propofol-2.0 mg/kg.Trial registrationClinicaltrials.gov, NCT03698617, retrospectively registered.

COMPARATIVE STUDY OF ETOMIDATE AND PROPOFOL FOR INDUCTION OF GENERAL ANESTHESIA IN ELDERLY PATIENTS

Introduction: An ideal induction agent for general anesthesia should have hemodynamic stability, minimal respiratory side effect and rapid recovery. Presently etomidate and propofol are popular rapid acting inducing agents. Material and methods: After obtaining informed written consent from patients this prospective, randomized, double blind study was conducted in 100 patients of ASA grade 3 and 4 posted for elective surgeries under general anaesthesia. They were divided into two groups of 50 in each group based on random number as group A and group B. The patients in Group A given Inj. Propofol and the patients in Group B received Inj. Etomidate. Parameters such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and spo2 were monitored continuously and recorded. Incidence and degree of pain of myoclonic movements were recorded. Demographic variables such as age Result: , gender, weight and ASA grade were comparable no significant difference existed between both the groups.Baseline mean heart rate, mean systolic blood pressure and mean diastolic blood pressure were comparable in both the Groups. (P&gt;0.05)Significant (P&lt;0.05) fall in mean systolic blood pressure, mean diastolic pressure and mean arterial pressure was observed immediately after induction, at 2, 5, 10 minutes up to 30 minutes in group A (propofol) compare to group B (etomidate). After then no significant difference seen in mean systolic pressure, mean diastolic pressure and mean arterial pressure. Etomidate was found ideal for its hemodynamic stability when compared to Propofol Conclusion: along with less incidence of pain on injection, the only drawback being high incidence of myoclonus elderly patient

Effects of tiletamine-zolazepam versus propofol on peri-induction intraocular pressure (IOP) in dogs: a prospective, randomized, blinded crossover study

Introduction: Anesthesia induction agents have the potential to cause severe ocular side effects, resulting in lasting damage to the eye. The purpose of this study is to determine the effects of tiletamine-zolazepam on IOP compared to propofol when used as an induction agent in normal healthy dogs.

Laryngeal assessment in dogs: a clinical review

This article reviews the literature describing the anaesthetic and ancillary drugs used during the assessment of laryngeal function in dogs, and summarises the evidence for their use in clinical practice. A review of the literature was conducted using PubMed and Google Scholar, with the search terms ‘laryngeal assessment dogs’, ‘laryngeal collapse’, ‘laryngeal paralysis’, ‘premedication laryngeal assessment’, ‘induction agent laryngeal assessment’ and ‘dogs’. Further studies and reports were obtained from the reference lists of the retrieved papers. Related anaesthesia textbooks were also reviewed. Drugs used to induce anaesthesia affect laryngeal function by diminishing the laryngeal reflex. Based on the current literature, premedication using acepromazine and an opioid allows for the assessment of laryngeal examination without impairing laryngeal motion. Dexmedetomidine in combination with an opioid may offer an alternative, but there are no studies comparing these sedative drugs directly. Examination times were shorter with propofol compared to alfaxalone, while ketamine was not recommended as an anaesthetic induction agent for this purpose. The use of doxapram hydrochloride may be helpful, particularly when airway assessment remains equivocal. At low doses, doxapram causes minimal increases in arterial blood pressure and heart rate.

The use of ketamine as an induction agent for anesthesia in pulmonary thromboendarterectomy surgery: A case series.

Pulmonary thromboendarterectomy (PTE) surgery is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (CTEPH). The induction of anesthesia in patients with severe pulmonary hypertension (PHT) can be challenging, with a risk of cardiovascular collapse. The administration of ketamine in patients with PHT is controversial, with some recommendations contraindicating its use. However, ketamine has been used safely in children with severe PHT. We present a retrospective case series of adult patients with severe PHT presenting for PTE surgery, using intravenous ketamine as a co-induction anesthetic agent.

Effect of priming in preventing myoclonic movements after intravenous induction with etomidate in adult patients undergoing cardiac surgery: a randomised controlled interventional study

Etomidate is a hypnotic drug used as an intravenous anaesthetic induction agent. Etomidate causes myoclonic movements in 50-80% patients after induction which makes it less desirable for induction. Aim: Present study was to determine the effect of priming in preventing myoclonic movements after intravenous injection with etomidate in adult patients undergoing cardiac surgery. Materials and Methods: 108 patients ASA grade III scheduled for elective cardiac surgery were allocated randomly in two groups- Group A (n=54): Patients received induction dose of 0.3mg/kg I.V. etomidate, Group B (n=54): Patients received a priming dose of 0.03mg/kg etomidate I.V. followed after 1 minute by induction dose of 0.3 mg/kg I.V. etomidate over 20 seconds. 3 minutes after the start of induction with etomidate, patients in both groups were given injection fentanyl 4mcg/kg followed by injection Rocuronium (1mg/kg bodyweight) to facilitate tracheal intubation. The occurrence and intensity of myoclonus were observed for 3 min from the start of injection of the induction dose and graded clinically by a blinded observer as: 0=no myoclonus, 1=mild myoclonus, 2=moderate myoclonus and 3=severe myoclonus. Result: The average dose of etomidate used during induction and demographic variables were similar in both the groups. The incidence of myoclonus in priming Group (27/54 [50%] was significantly lower than in control Group (45/54 [83.33%].Myoclonus of moderate or severe grade occurred in significantly more patients in control Group (68.3%) than in priming Group (36.5%).Conclusion: Pre-treatment with etomidate (0.03 mg/kg), given 60 seconds before induction of anaesthesia is more effective in reducing the incidence of etomidate-induced myoclonus without related side-effects.

Comparison between propofol and desflurane anaesthetic agent for short elective surgery

Background: Desflurane is known to have a rapid onset and offset of action, thereby making it possible for the anesthetist to control the depth of anesthesia rapidly. Intravenous propofol with rapid induction and recovery is currently a popular induction agent for surgical anesthesia. Objective: To compare desflurane and propofol as single agent anesthesia in short elective surgeries. Materials and methods: It was a hospital based prospective comparative study, 80 patients scheduled for elective short surgery were taken. After routine pre-anesthetic work up, patients were induced with either Group D: O2:N2O (50:50) + Desflurane 3-4% or; Group P: O2:N20 (50:50) + Propofol 3-5 mg/kg. Baseline parameters, relevant intra-op details, ease of procedure, hemodynamic changes, recovery, and complication rate were compared between both groups. Statistical analysis was done using SPSS ver. 22. Results: Parameters like jaw opening, attempts for LMA and ease of insertion was comparable in both the groups (p&gt; 0.05). Time to loss of consciousness and time to LMA insertion was significantly shorter with Propofol (p&lt;0.05). Mean pulse rate and MAP was significantly higher in Desflurane group (p&lt; 0.05). Modified Aldrete score was significantly higher in Desflurane group while Complication rate was comparable.

Effectiveness of low-dose ketamine versus lignocaine pre-treatment to prevent propofol injection pain and hemodynamic instability in adult elective surgical patients at Tikur Anbessa specialized hospital, 2022: A prospective observational cohort study

BackgroundPropofol is the most commonly used general anesthesia induction agent. It has injection pain and hemodynamic changes as a major drawback. These side effects are clinically undesirable because they can cause agitation and hinder the smooth induction of anesthesia. Determining the best method to reduce this effect is paramount important. This study aimed to compare the effectiveness of low dose ketamine versus lignocaine pre-treatment to prevent propofol injection pain and hemodynamic changes among study participants. MethodsAn institutional prospective cohort study was conducted on 82 (n1 = n2 = 41) adult elective surgical patients who took general anesthesia induction by propofol at our hospital from 01-Jan-2022 to30 Mar-2022. A systematic random sampling technique was used to select study participants. The pain was scored using a verbal rating scale and mean arterial pressure, heart rate and oxygen saturation was recorded during induction using a questionnaire. An independent samples t-test or chi-square test were used as appropriate. A P-value of < 0.05 was considered as statistically significant. ResultsTwo groups of 41 (LDK = low dose ketamine = Ld = Lignocaine = 41) patients were studied and the incidence of pain after pre-treatment with Low-dose ketamine (4.9%) group was significantly lower than lignocaine (22%) group (p = 0.023). The mean pain score after pre-treatment with low-dose ketamine group was significantly lower than the lignocaine group (p = 0.024). However, there was no statistically significant difference in heart rate, mean arterial pressure, and oxygen saturation (SpO2) between the groups. Conclusion and recommendationPre-treatment with a low dose of ketamine significantly reduces the incidence of propofol injection pain. We recommend its routine use before propofol injection ,and a multi-center more controlled study.

Propofol Augments Paclitaxel-Induced Cervical Cancer Cell Ferroptosis In Vitro.

Introduction: Cervical cancer is common in women. The present standardized therapies including surgery, chemotherapy, and radiotherapy are still not enough for treatment. Propofol is the most commonly used intravenous anesthetic agent for induction and maintenance of anesthesia and has been shown to exert anti-malignancy effects on cancer cells, inducing oxidative stress and apoptosis. However, the biological effects of propofol have not yet been systematically assessed. In this study, we examined the ferroptosis-related changes caused by propofol and the chemotherapeutic agent paclitaxel besides apoptosis in vitro. Methods: Cervical cancer cell lines (C-33A and HeLa) were treated with propofol alone (1, 2, 5, 10, and 20 μg/ml) or in combination with paclitaxel (0.5, 1, and 5 μg/ml). The viability was assessed using cell counting kit-8 (CCK8), apoptosis was detected by flow cytometry, morphological changes of mitochondria were examined using transmission electron microscope (TEM), cellular reactive oxygen species (ROS), and intracellular ferrous ions were determined by fluorescence microscope or confocal microscopy. The expression and cellular localization of apoptosis and ferroptosis-related molecules were detected by Western blot and multiplex immunohistochemistry (mIHC), respectively. Calcusyn software was used to determine whether propofol has a synergistic effect with paclitaxel. Results: Propofol and paclitaxel inhibited C-33A and HeLa cell viability. There were also synergistic effects when propofol and paclitaxel were used in combination at certain concentrations. In addition, propofol promoted paclitaxel-induced cervical cancer cell death via apoptosis. ROS level and Fe2+ concentrations were also influenced by different drug treatments. Furthermore, propofol, propofol injectable emulsion, and paclitaxel induced ferroptosis-related morphological changes of mitochondria in C-33A and HeLa cells. Ferroptosis-related signaling pathways including SLC7A11/GPX4, ubiquinol/CoQ10/FSP1, and YAP/ACSL4/TFRC were found to be changed under drug treatments. Conclusion: Propofol showed synergistic anticancer effects with paclitaxel in cervical cancer cells. Propofol and paclitaxel may induce ferroptosis of cervical cancer cells besides apoptosis.

English

BACKGROUND Propofol is an appropriate intravenous anaesthetic induction agent for rapid induction and suppression of airway reflexes and is widely used for laryngeal mask airway insertion. Sevoflurane is a halogenated, non-pungent and non-explosive liquid anaesthetic agent with low blood gas solubility administered by inhalation for use in induction and maintenance of general anaesthesia. We wanted to compare the characteristics of sevoflurane and propofol for the induction of anaesthesia and laryngeal mask airway (LMA) insertion. METHODS We conducted a randomized control study among 70 patients (n=35 in each group) undergoing elective surgery. Patients were anaesthetised with either vital capacity breaths of 8% sevoflurane with 50% N2O and O2 or IV propofol, with loss of eyelash reflex considered as the end point of induction. RESULTS Both the drugs produced almost similar rapid loss of consciousness (propofol-45.29 ± 11.98 sec, sevoflurane-51.03±14.68 sec). The LMA was inserted more rapidly in propofol group (20.43±9.460 sec) than in the sevoflurane group (34.37 ± 17.338 sec), p=0.018. The score for jaw opening was better in the propofol group (2.94 ± 0.236) than in the sevoflurane group (2.66 ± 0.482), p=0.000. The ease of LMA insertion score was better in the propofol group (2.91 ± 0.284) than in the sevoflurane group (2.66 ± 0.482), p=0.008. Both groups had stable haemodynamic parameters. CONCLUSIONS Propofol was more favourable than sevoflurane for laryngeal mask airway insertion due to better jaw relaxation and less insertion time. However, sevoflurane is an alternative to propofol as an induction agent for laryngeal mask airway insertion. KEY WORDS Propofol, Sevoflurane, Laryngeal Mask Airway.