Propofol Induction Research Articles

Comparison of hemodynamic response of small dose ketamine versus midazolam as co- induction agent to propofol: a randomized double blind interventional study

The Anaesthesiology Department at Sawai Man Singh Medical College carried out this study. For this, 60 ASA grade I and II patients undergoing planned general surgery were randomly assigned into two groups of 30 each, with Group KP (n=30) receiving injections of ketamine at 0.3 mg/kg and Group MP receiving injections of midozolam at 0.03 mg/kg and Propofol I.V. The main goal of the study was to find the best induction by analysing changes in hemodynamic indicators from baseline to various time points after induction. On the basis of the necessary induction dose and hemodynamic characteristics, the groups were contrasted. The strategy used was to present the categorical data as percentages and compare them between groups using the Chi square test. The mean and standard deviation of the quantitative data were displayed, and students' t-tests were used to compare them. According to the study described above, group MP saw a greater fluctuation in heart rate than did group KP, whose heart rate remained more constant during the anaesthetic time. Group MP's blood pressure dropped more quickly after induction compared to group KP. The ketamine group's blood pressure remained the most stable out of all the groups. Apnea, pain upon injection, and uncontrollable movements were absent in the KP group. Of all the groups, the ketamine-propofol group required the least induction dose. As a result, we came to the conclusion that pretreatment with ketamine at a dose of 0.3 mg/kg results in better hemodynamic stability and requires less propofol for induction than midazolam does. The ketamine-propofol group is therefore the best of the two groups, making it the optimum induction agent

Comparison of hemodynamic response of small dose ketamine versus midazolam as co- induction agent to propofol: a randomized double blind interventional study

The Anaesthesiology Department at Sawai Man Singh Medical College carried out this study. For this, 60 ASA grade I and II patients undergoing planned general surgery were randomly assigned into two groups of 30 each, with Group KP (n=30) receiving injections of ketamine at 0.3 mg/kg and Group MP receiving injections of midozolam at 0.03 mg/kg and Propofol I.V. The main goal of the study was to find the best induction by analysing changes in hemodynamic indicators from baseline to various time points after induction. On the basis of the necessary induction dose and hemodynamic characteristics, the groups were contrasted. The strategy used was to present the categorical data as percentages and compare them between groups using the Chi square test. The mean and standard deviation of the quantitative data were displayed, and students' t-tests were used to compare them. According to the study described above, group MP saw a greater fluctuation in heart rate than did group KP, whose heart rate remained more constant during the anaesthetic time. Group MP's blood pressure dropped more quickly after induction compared to group KP. The ketamine group's blood pressure remained the most stable out of all the groups. Apnea, pain upon injection, and uncontrollable movements were absent in the KP group. Of all the groups, the ketamine-propofol group required the least induction dose. As a result, we came to the conclusion that pretreatment with ketamine at a dose of 0.3 mg/kg results in better hemodynamic stability and requires less propofol for induction than midazolam does. The ketamine-propofol group is therefore the best of the two groups, making it the optimum induction agent

Downregulation of connexin 43-based gap junctions underlies propofol-induced excessive relaxation in hypertensive vascular smooth muscle cells

BackgroundPostinduction hypotension caused by propofol remains a non-negligible problem for anesthesiologists, and is especially severe in chronic hypertensive patients with long-term vasoconstriction and decreased vascular elasticity. The functional change in gap junctions composed of Cx43 (Cx43-GJs) is reported as the biological basis of synchronized contraction or relaxation of blood vessels. Thus, we investigated the role of Cx43-GJs in propofol-induced dramatic blood pressure fluctuations in chronic hypertensive patients, and their internal mechanisms.MethodsHuman umbilical artery smooth muscle cells (HUASMCs) were pretreated with long-term angiotensin II (Ang II), with or without propofol, to simulate the contraction and relaxation of normal and hypertensive VSMCs during anesthesia induction. The levels of F-actin polymerization and MLC2 phosphorylation were used as indicators to observe the contraction and relaxation of HUASMCs. Different specific activators, inhibitors and siRNAs were used to explore the role of Cx43-GJs and Ca2+ as well as the RhoA/ LIMK2/cofilin and RhoA/MLCK signaling pathways in the contraction and relaxation of normal and hypertensive HUASMCs.ResultsBoth F-actin polymerization and MLC2 phosphorylation were significantly enhanced in Ang II-pretreated HUASMCs, along with higher expression of Cx43 protein and stronger function of Cx43-GJs than in normal HUASMCs. However, with propofol administration, similar to Gap26 and Cx43-siRNA, the function of Cx43-GJs in Ang II-pretreated HUASMCs was inhibited compared with that in normal HUASMCs, accompanied by a larger decrease in intracellular Ca2+ and the RhoA/LIMK2/cofilin and RhoA/MLCK signaling pathways. Eventually F-actin polymerization and MLC2 phosphorylation were more dramatically decreased. However, these effects could be reversed by RA with enhanced Cx43-GJ function.ConclusionLong-term exposure to Ang II significantly enhanced the expression of the Cx43 protein and function of Cx43-GJs in HUASMCs, resulting in the accumulation of intracellular Ca2+ and the activation of its downstream RhoA/LIMK2/cofilin and RhoA/MLCK signaling pathways, which maintained HUASMCs in a state of excessive-contraction. With inhibition of Cx43-GJs by propofol in Ang II-pretreated HUASMCs, intracellular Ca2+ and its downstream signaling pathways were dramatically inhibited, which ultimately excessively relaxed HUASMCs. This is the reason why the blood pressure fluctuation of patients with chronic hypertension was more severe after receiving propofol induction.9gEgDUsF4_-ddhb1iAhQGKVideo

Propofol Infusion Versus Isoflurane/Nitroglycerine Combination for Controlled Hypotensive Anesthesia in Neurosurgery

Background: The use of hypotensive anesthesia is one of several techniques that have been used to lessen the intraoperative loss of blood and improve visibility in the operative field. A procedure that requires a clear area and little intraoperative bleeding, which can affect the surgeons' abilities, is Neurosurgery. Objective: The current study aimed to assess how both anesthetics affected tissue perfusion, blood loss, operating field visibility, and extubation time. Settings and Design: A prospective quasi-experiment was used in the design of this clinical trial Practical Implication: The practical implication for choosing between propofol infusion and the isoflurane/nitroglycerine combination for controlled hypotensive anesthesia in neurosurgery includes considering several factors. Firstly, the patient's individual characteristics and medical history should be taken into account to determine the most suitable anesthesia approach. Secondly, the surgical procedure and the desired level of hypotension required should be evaluated. Thirdly, the availability and expertise of the anesthesia team in managing either method should be considered. Finally, potential side effects and complications associated with each technique should be weighed. Ultimately, a well-informed decision must be made based on these considerations to ensure the safety and efficacy of controlled hypotensive anesthesia in neurosurgery. Patients and Methods: Sixty individuals with ASA I or II were separated into two groups; Group P received both induction and maintenance doses of propofol, while Group I received isoflurane for maintenance with nitroglycerine. Blood loss, heart rate, mean arterial pressure, and the degree of surgical field clarity were all monitored every ten minutes. Results: As opposed to the isoflurane group, the propofol group substantial reduction in blood loss (p=0.01), improved clarity of the surgical field (p=0.002), and reduced time to extubation (p=0.001). Conclusion: Even with the addition of the hypertension medication nitroglycerine to isoflurane, propofol for craniotomy improved surgical conditions and gave a quicker recovery than isoflurane. Keywords: Nitroglycerin, Isoflurane, Propofol, Hypotensive Anesthesia, and Neurosurgery

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.

Activation of GABAergic neurons in the zona incerta accelerates anesthesia induction with sevoflurane and propofol without affecting anesthesia maintenance or awakening in mice

To explore the regulatory effects of GABAergic neurons in the zona incerta (ZI) on sevoflurane and propofol anesthesia. Forty-eight male C57BL/6J mice divided into 8 groups (n=6) were used in this study. In the study of sevoflurane anesthesia, chemogenetic experiment was performed in 2 groups of mice with injection of either adeno-associated virus carrying hM3Dq (hM3Dq group) or a virus carrying only mCherry (mCherry group). The optogenetic experiment was performed in another two groups of mice injected with an adeno-associated virus carrying ChR2 (ChR2 group) or GFP only (GFP group). The same experiments were also performed in mice for studying propofol anesthesia. Chemogenetics or optogenetics were used to induce the activation of GABAergic neurons in the ZI, and their regulatory effects on anesthesia induction and arousal with sevoflurane and propofol were observed; EEG monitoring was used to observe the changes in sevoflurane anesthesia maintenance after activation of the GABAergic neurons. In sevoflurane anesthesia, the induction time of anesthesia was significantly shorter in hM3Dq group than in mCherry group (P < 0.05), and also shorter in ChR2 group than in GFP group (P < 0.01), but no significant difference was found in the awakening time between the two groups in either chemogenetic or optogenetic tests. Similar results were observed in chemogenetic and optogenetic experiments with propofol (P < 0.05 or 0.01). Photogenetic activation of the GABAergic neurons in the ZI did not cause significant changes in EEG spectrum during sevoflurane anesthesia maintenance. Activation of the GABAergic neurons in the ZI promotes anesthesia induction of sevoflurane and propofol but does not affect anesthesia maintenance or awakening.

Comparison between patient state index, bispectral index, and clinical parameters for propofol induction in Indian patients: A prospective study.

Patient state index (PSI) and bispectral index (BIS) are depth of anesthesia monitors utilized for the dosage of propofol usage for induction. We compare PSI, BIS, and Observer's Assessment of Alertness/Sedation Scale (OAA/S) for propofol dose usage for induction. Seventy-four ASA I and II patients, aged 18-65 years scheduled for laparoscopic cholecystectomy were included and divided into groups to titrate the drug dosage of propofol needed for induction of anesthesia, monitored by PSI (Group A), BIS (Group B), or clinical OAA/S (Group C). The drug dosage needed for induction was based on a PSI value of 25 ± 2, BIS value of 48 ± 2, and OAA/S value of ≤2 as the endpoint of induction in respective groups. Intraoperative hemodynamic variables and any complications were compared. The mean doses of propofol needed for induction were 2.23 mg/kg (Group A), 2.05 mg/kg (Group B), and 2.11 mg/kg (Group C). A significantly decreased dose was needed to achieve the desired end in Group B compared to Group A (P = 0.01). The hemodynamic variables such as heart rate, systolic blood pressure, and diastolic blood pressure among the three groups were comparable. The clinical method of titrating the dose of propofol for induction and anesthetic depth by the loss of verbal response is comparable to both BIS and PSI monitoring.

EFFECT OF MELATONIN ON DOSE RESPONSE OF PROPOFOL FOR INDUCTION OF GENERALANAESTHESIA USING BISPECTRAL INDEX MONITOR

Background and Aims: Anaesthesia is a balance between anaesthetic drug requirement and state of arousal of patient. Premedication has been found to decrease the requirement of intravenous anaesthetic agents like propofol for induction of anaesthesia. This study was designed to study the effect of oral melatonin on dose response of propofol used for induction of general anaesthesia, using Bispectral Index(BIS). Material and Methods: The study included 54 patients who were admitted for elective surgeries under general anaesthesia. Patients were randomized into two groups to receive tablet melatonin 6 mg or placebo 100 minutes prior to induction. At 100 minutes all the patients were induced with intravenous propofol at the rate of 4ml (40 mg/min) with Bispectral Index monitoring. Induction was stopped when BIS score reached 45. The total dose of propofol required to achieve BIS score of 45 was recorded. Heart rate and blood pressure were compared between two groups. Results: The parameters obtained was analysed using chi-square test, shapirowik test, unpaired sample t test and pearson correlation. The total propofol dose to achieve BIS score of 45 and heart rate (HR) and mean arterial pressure (MAP) were comparable. The total dose of propofol to achieve BIS of 45 was less in melatonin group with a statistical signicance (P&lt;0.05). There was a minimal change in hemodynamic parameters in the two groups without statistical signicance (P&gt;0.05). Conclusion: Melatonin premedication decreases the dose requirement of propofol required for induction without affecting haemodynamic stability

Comparison of the hemodynamic effects of opioid-based versus lidocaine-based induction of anesthesia with propofol in older adults: a randomized controlled trial

BackgroundThe present study aims to compare the hemodynamic profile of lidocaine and fentanyl during propofol induction of general anesthesia. MethodsThis randomized controlled trial included patients aged above 60 years undergoing elective non-cardiac surgery. The included patients received either 1 mg/kg lidocaine (n = 50) or 1 mcg/kg fentanyl (n = 50) based on total body weight with propofol induction of anesthesia. Patient’s hemodynamics were recorded every minute for the first 5 min then every 2 min until 15 min after induction of anesthesia. Hypotension (mean arterial pressure [MAP] <65 mmHg or >30% reduction from baseline) was treated by intravenous 4 mcg bolus of norepinephrine. Outcomes included norepinephrine requirements (primary), the incidence of postinduction hypotension, MAP, heart rate, intubation condition, and postoperative delirium via the cognitive assessment method. ResultsForty-seven patients in the lidocaine group and 46 patients in the fentanyl group were analyzed. None in the lidocaine group experienced hypotension, while 28/46 (61%) of patients in the fentanyl group developed at least one episode of hypotension requiring a median (25th and 75th quartiles) norepinephrine dose of 4 (0,5) mcg, p-value <0.001 for both outcomes. The average MAP was lower in the fentanyl group than in the lidocaine group at all time points after anesthesia induction. The average heart rate was comparable between the two groups nearly at all time points after anesthesia induction. The overall intubation condition was comparable between the two groups. None of the included patients developed postoperative delirium. ConclusionLidocaine-based regimen for induction of anesthesia reduced the risk of postinduction hypotension in older patients compared to the fentanyl-based regimen.

Propofol infusion for sedated upper gastrointestinal endoscopic ultrasound: a comparison of propofol alone versus propofol-fentanyl or propofol-midazolam

Background: Gastrointestinal (GI) endoscopic untrasound is the major technique for diagnosis of GI disease and treatment. Various sedation and analgesia regimens such as midazolam, fentanyl, and propofol can be used during GI endoscopy. The purpose of the study was to compare propofol alone and propofol combine with midazolam or fentanyl in moderate sedation for GI endoscopy. Objectives: To observe the efficiency comparison between propofol alone and propofol/fentanyl or propofol/midazolam on sedation during upper gastrointestinal endoscopic ultrasound. Methods: In a prospective, randomized clinical study, 90 patients were assigned to group 1 (n = 30; 1 mg/kg IV propofol) group 2 (n = 30; 1 mg IV midazolam intravenous followed 1 mg/kg IV propofol) or group 3 (n = 30; 50 μg fentanyl followed 1 mg/kg IV propofol). Each patient was administered 1 mg/kg propofol for induction. All of the patients were administered an additional dose of IV propofol infusion (5 mg/kg/h). This study was performed in Hue University of Medicine and Pharmacy Hospital, between January 2020 - 2021. Total propofol consumption, time to achieve, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded. Postprocedural records included recovery time, postoperative adverse events (nausea, vomiting, dizziness, recall, and pain) and satisfaction. Results: The average propofol consumption was 283.8 ± 113 mg in Group 1 and 230 ± 76.3 mg in Group 2 and 231.8 ± 76.3 mg in Group 3 (p &lt; 0.05). The incidence of moving motor or verbal) was lower in Group 3 (p &lt; 0.05). The physician satisfaction was higher significantly in Group 3 (p &lt; 0.05). Total propofol consumption was higher in group 1 significantly. Time to onset of sedation was significantly higher in group 1 The physician satisfaction was higher significantly in Group 3. Overall, the other results were similar in 3 groups. Conclusion: Both propofol/fentanyl and propofol/midazolam combinations provided appropriate hypnosis and analgesia during upper gastrointestinal endoscopy. However, propofol consumption was significantly lower and greater endoscopist satisfaction in group using the propofol/ fentanyl combination. Key words: sedation, upper gastrointestinal endoscopy, propofol, fentanyl, midazolam

Remimazolam Compared to Propofol During Hysteroscopy: A Safety and Efficacy Analysis.

Propofol is the main drug used to induce sedation for endoscopic procedures, and few drugs had shaken its dominant clinical use for a decade until the development of remimazolam. Remimazolam has been demonstrated to perform well in post-marketing studies on sedation for colonoscopy or other procedures requiring short periods of sedation. This study aimed to establish whether remimazolam was effective and safe for inducing sedation for hysteroscopy. One hundred patients who were scheduled to undergo hysteroscopy were randomly assigned to receive induction with remimazolam or propofol. A dose of 0.25mg/kg remimazolam was administered. Propofol was started at 2-2.5mg/kg. Before remimazolam or propofol induction, 1μg/kg fentanyl was infused. Hemodynamic parameters, vital signs, and bispectral index (BIS) values were measured and adverse events recorded to evaluate safety. We comprehensively evaluated the efficacy and safety of the two drugs by the success rate of induction, fluctuation of vital signs, depth of anesthesia, adverse reactions, recovery time, and other indicators. Information on 83 patients was successfully recorded and carefully documented. The success rate of sedation in the remimazolam group (groupR) was 93%, which was lower than for the propofol group (groupP) (100%), but there was no statistically significant difference between the two groups. The incidence of adverse reactions in groupR (7.5%) was significantly lower than that in groupP (67.4%), and the results were statistically significant (P < 0.01). The fluctuation of vital signs in groupP was more severe after induction, especially in patients with cardiovascular diseases. Remimazolam avoids the injection pain produced by propofol sedation, has a better pre-sedation experience, had the advantage of stable hemodynamics after injection compared to propofol, and a lower respiratory depression rate in the study patients.

An exploratory study of distractions during the induction phase of pediatric procedural sedation with propofol.

Distractions are a leading cause of disturbance to workflow during medical care. Distractions affecting the anesthetic team in the operating room are frequent and have a negative impact on patient care one-fifth of the time. The objective of this study was to evaluate the frequency, source, target, and impact of distractions during the induction phase of pediatric procedural sedation outside the operating room. Distractions were analyzed during propofol induction for oncology procedures from 45 video recordings. Distraction was defined as any event that disturbs or has potential to disturb the sedation team from performing their primary tasks. The type of distraction was cataloged into communication, coordination, extraneous events, equipment, layout, and usability. A five-point Likert scale was used to quantify the impact on the sedation team or its members. All patients had a diagnosis of acute lymphocytic leukemia and had a mean age of 8.4 years. Five hundred and sixty-seven distractions occurred and averaged 12.6 events (±5.6) per induction (mean induction time 3 min 12 s). Extraneous events were most common, accounting for 55% (312/567) of all distractions. Most distractions had an impact on the sedation team's workflow, resulting in multitasking (46%, n = 262), and in either brief or complete disruption from a primary task (17%). Sedation nurses were impacted most often, 62% of the time. Coordination and usability issues resulted in the greatest negative impact, mean ± SD, 3.7 ± 1.0 and 3.5 ± 0.9, respectively. There was no significant association between distractions and adverse events or induction length. Distractions are common during procedural sedation, with extraneous events being most frequent. Coordination issues within the team and usability problems had the greatest negative impact on sedation team workflow. Nurses were the most frequent target. Distractions impacted sedation team workflow but had no association with patient outcomes.

Comparison of cerebral metabolic rate of oxygen, blood flow, and bispectral index under general anesthesia.

The optical measurement of cerebral oxygen metabolism was evaluated. Compare optically derived cerebral signals to the electroencephalographic bispectral index (BIS) sensors to monitor propofol-induced anesthesia during surgery. Relative cerebral metabolic rate of oxygen ( ) and blood flow (rCBF) were measured by time-resolved and diffuse correlation spectroscopies. Changes were tested against the relative BIS (rBIS) ones. The synchronism in the changes was also assessed by the R-Pearson correlation. In 23 measurements, optically derived signals showed significant changes in agreement with rBIS: during propofol induction, rBIS decreased by 67% [interquartile ranges (IQR) 62% to 71%], by 33% (IQR 18% to 46%), and rCBF by 28% (IQR 10% to 37%). During recovery, a significant increase was observed for rBIS (48%, IQR 38% to 55%), (29%, IQR 17% to 39%), and rCBF (30%, IQR 10% to 44%). The significance and direction of the changes subject-by-subject were tested: the coupling between the rBIS, , and rCBF was witnessed in the majority of the cases (14/18 and 12/18 for rCBF and 19/21 and 13/18 for in the initial and final part, respectively). These changes were also correlated in time ( to , ). Optics can reliably monitor in such conditions.

EFFECT OF NEBULISED DEXMEDETOMIDINE IN BLUNTING HAEMODYNAMIC RESPONSE TO INTUBATION- A RANDOMIZED DOUBLE BLIND CONTROLLED STUDY

BACKGROUND: Dexmedetomidine, an alpha-2 agonist, has been used for attenuation of he- modynamic response to laryngoscopy but not through the nebulized route. We evaluated the effects of preoperative dexmedetomidine nebulization on the hemodynamic response to laryngoscopy and intubation. To evaluate the AIM: effects of nebulised dexmedetomidine as a premedication in Blunting the haemodynamic response to laryngoscopy and tracheal intubation. After MATERIALS AND METHODS: written informed consent and ethics committee approval, 50 patientsBelonging to ASA status I or II were randomly allocated to two groups.Patients not Giving consent,predicted airway difculty and uncontrolled hypertension were Excluded. All the patients were monitored by ASA standard monitors.They were Randomized into two groups- C and D Group C received 5 ml of normal saline and Group D received 5 ml of dexmedetomidine at a dose of 1 μg/kg as nebulisation 10 mins prior to induction.Then the patients were premedicated and induced with Propofol and intubated after giving a non depolarizing muscle relaxant. Vital monitoring like HR,SBP,DBP,MAP,SPO2,was noted at baseline, post nebulization ,post intubation at 1,5,10 minutes. Demographic details and surgery cha RESULTS: racteristics were comparable between the Groups.Heart rate between the two groups were comparable.The MAP,SBP and DBP values after intubation were lower in group D, which was statistically Signicant(P&lt;0.05).The mean dose of propofol for induction was also lower in Group D. To conclude,nebulised CONCLUSION: dexmedetomidine effectively blunts the pressor response To laryngoscopy and intubation with no serious adverse effects

Age-Stratified Propofol Dosage for Pediatric Procedural Sedation and Analgesia.

Procedural sedation and analgesia (PSA) for diagnostic and minimally invasive therapeutic procedures has become common practice in children of all ages. Based on our clinical experience, we suspected an inverse relation between age and dosage. However, a schedule for age-stratified propofol induction and maintenance dosage for PSA was not available and could be helpful to many anesthesiologists as a reference. We performed a retrospective cohort study of children who received procedural sedation at the Wilhelmina Children's Hospital (WKZ), a tertiary pediatric hospital part of the University Medical Center Utrecht (UMCU), between June 2007 and December 2020. We studied whether the induction (mg·kg -1 ) and maintenance (mg·kg -1 ·h -1 ) dosage is age-dependent using linear regression models. A total of 6438 pediatric procedures were retrieved from Anesthesia Information Management Systems (AIMS). A total of 5567 records were available for induction dose analysis and 5420 records for analysis of the maintenance dose. After adjustment for sex, American Society of Anesthesiologists (ASA) physical status classification, opioid administration, and diagnostic or interventional, we obtained a coefficient of -0.11 (95% confidence interval [CI], -0.12 to -0.11) for age (years) from a multivariable linear regression model for propofol induction dosage (mg·kg -1 ) and a coefficient of -0.36 (95% CI, -0.39 to -0.34) for age (years) for propofol maintenance dosage. We found a noteworthy inverse age-effect on propofol dosage for both induction and maintenance of pediatric procedural sedation. Furthermore, our study revealed that remarkably higher propofol sedation doses were needed for infants and toddlers than previously expected and reported.

Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: outcomes of a dedicated anesthesia and surgery protocol.

Patients requiring percutaneous endoscopic gastrostomy (PEG) for amyotrophic lateral sclerosis (ALS) related dysphagia represent a clinical challenge. Diminished pulmonary function and aspiration risks can lead to anesthesia-related complications, and gastric displacement from hemidiaphragm elevation may preclude safe gastric access. This study reports the efficacy and outcomes of a dedicated anesthesia/surgery management protocol for ALS patients undergoing PEG. In 2013, a PEG placement protocol for ALS patients was developed emphasizing efficient pre-operative evaluation, rapidly metabolized anesthetic agents, and minimization of opioid use. Outcomes were analyzed retrospectively. Preoperative weight loss, pulmonary function tests, total analgesia, procedural time, and 90-day morbidity and mortality were recorded. From 2013-2019, 67 ALS patients (mean age 65.3years, 52.2% female) received a PEG under the protocol. Mean percentage weight loss 6months before PEG was 9.3 ± 5.1% with 38.8% of patients meeting criteria for severe malnutrition. Mean anesthesia time (propofol induction to anesthesia emergence) was 34.5 ± 10.8min and mean operative time (endoscope insertion to dressing placement) was 16.4 ± 8.2min. Regional anesthesia with liposomal bupivacaine was performed in 76.1%. All attempts at PEG placement were successful. With a mean follow-up of 6.1 ± 6.8months, all PEGs were functional and there were no surgical site complications. Thirty-day readmission rate was 7.0% and 90-day mortality was 22.4% (46.7% occurring within 30days). Mean time from surgery to death was 8.8 ± 7.8months. Protocols for optimizing PEG may help overcome challenges present in the ALS patient population. Despite patient comorbidities, protocol implementation and dedicated team members resulted in a high procedural success rate and low complication rate. Further study is warranted to optimize the timing of PEG placement in relation to ALS disease progression and determine the utility of regional anesthesia during PEG placement.

Comparison of Half-Effective Concentration of Propofol in Patients with Parkinson's Disease and Non-Parkinson's Disease.

This study aimed to compare the half-effective concentration (EC50) of propofol required for the bispectral index (BIS) 50 in patients with Parkinson's disease (PD) and non-PD (NPD) during induction by the Dixon's improved sequential method. This prospective study recruited 20 patients with PD undergoing deep brain stimulation and 20 patients with NPD accompanied by meningioma or glioma undergoing intracranial surgery from March 2018 to March 2019. The patients were induced by propofolviatarget-controlledinfusion. The targeteffect-siteconcentrationof propofol was determined by the Dixon's improved sequential method. The results of the pilot experiment showed that the targeteffect-site concentration for the first patient with PD and NPD was 3.5 µg/mL and 2.8 µg/mL, respectively. BIS values were recorded after achievingaconstanteffect-siteconcentrationof propofol. The increment or decrement of the targeteffect-site concentration of the next patient was 0.1 µg/mL. Demographic data, general physical condition, and hemodynamic values were similar between the PD and the NPD groups. The targeteffect-siteconcentrationof propofol induction doses was significantly higher in the PD group than in the NPD group. The EC50 of propofol required for BIS 50 was 3.213 µg/mL [95% confidence interval (CI), 3.085-3.287 µg/mL] in the PD group and 2.77 µg/mL (95% CI, 2.568-2.977 µg/mL) in the NPD group. The EC50 of propofol required for BIS 50 was higher in patients with PD than in patients with NPD.

Clinical observation of different dosages of dexmedetomidine combined with a target-controlled infusion of propofol in hysteroscopic submucosal myomectomy.

This study aimed to explore the clinical effects of different dosages of dexmedetomidine (Dex) combined with a target-controlled infusion of propofol in hysteroscopic submucosal myomectomy. Ninety patients who underwent hysteroscopic submucosal myomectomy between September 2021 and March 2022 were enrolled and randomly divided into three groups, with 30 patients in each group. Patients in Groups A, B, and C received injections of 0.25, 0.5, or 0.75 µg/kg of Dex, respectively, by intravenous pump over 10 min. After this time, a maintenance dosage of 0.5 µg/kg/h was administered by intravenous infusion until the end of the surgery. Anesthesia was induced using 1.5 mg/kg of propofol and 0.3 µg/kg of sufentanil that were introduced through a laryngeal mask. The plasma concentration of propofol was maintained at 3 µg/ml by target-controlled infusion until the end of the surgery. The mean arterial pressure (MAP), heart rate (HR), and electroencephalographic bispectral index (BIS) were observed when the patient entered the operating room (T0), after catheter indwelling for anesthesia (T1), at the time of cervical dilation (T2), at the time of hysteroscopic surgery (T3), and at the end of the surgery (T4) in all three groups. The total dosage of propofol for induction and maintenance, anesthesia awakening time, orientation recovery time, Visual Analog Scale (VAS) score of the post-awakening uterine contraction pain, and adverse reactions were recorded. The intraoperative reductions of MAP and HR in patients were significant in Group C when compared with those in Groups A and B (P < 0.05), and BIS was significantly lower in Group C at T2 and T3 when compared with the baseline measurement at T0 (P < 0.05). The dosage of propofol was significantly higher for Group A than for Groups B and C (P < 0.05). The anesthesia awakening time and orientation recovery time were significantly longer for patients in Group C when compared with patients in Groups A and B (P < 0.05). Within 5-30 min after awakening, the VAS scores in Groups B and C were significantly lower than those for Group A (P < 0.05). The incidence of adverse reactions in Group B was significantly less than that for Groups A and C (P < 0.05). The continuous pumping of 0.5 µg/kg of Dex combined with a target-controlled infusion of propofol in hysteroscopic submucosal myomectomy resulted in positive anesthetic and analgesia effects and fewer adverse reactions. It therefore has high clinical significance.

A Comparative Study between Propofol-fentanyl versus Propofol-suxamethonium for Ease of Endotracheal Intubation in Children.

Following propofol induction, suxamethonium tremendously improves intubating conditions in children and has been the gold standard agent for this purpose. However, suxamethonium could be absolutely contraindicated in some patients. Fentanyl, a short acting opioid, has been investigated as a suitable alternative with varying results. This study compares the ease of tracheal intubation between propofol-suxamethonium (1.5 mg/kg) and propofol-fentanyl (3 mcg/kg) during general anaesthesia among children. In this double-blind randomised controlled study, 84 ASA I or II patients booked for elective surgery under general anaesthesia requiring tracheal intubation were randomised into two groups (F and S). Induction was with propofol 3 mg/kg over 30 s followed by either fentanyl 3 mcg/kg or suxamethonium 1.5 mg/kg. Two minutes later, there was an attempt at intubation and intubating conditions were assessed using Steyn's modification of Helbo-Hansen's score (ease of laryngoscopy, jaw relaxation, coughing, vocal cord position, and limb movement). All patients in both groups had successful intubation at the first attempt. Patients in group S (suxamethonium) had significantly better overall intubating conditions compared to those in group F (fentanyl) (p=0.0001), 85.7% in group S compared to 21.4% in group F had excellent intubation condition. None of the patients in the two groups demonstrated fair or poor intubation condition. A combination of propofol-fentanyl can be used as an alternative to propofol-suxamethonium to ease intubation in paediatric patients.

Dexmedetomidine decreases the 50% effective dose (ED50) of intravenous propofol required to prevent tracheal intubation response in Beagles.

To determine the 50% effective dose (ED50) of intravenous propofol required for successfully preventing tracheal intubation response in Beagles co-induced with dexmedetomidine. 36 adult male Beagles. The dogs were randomly assigned to either group D1, group D2, or group C (received 1 µg/kg, 2 µg/kg dexmedetomidine intravenously, or the same amount of normal saline as dexmedetomidine, 10 mL). The first dog in each group received 6 mg/kg of propofol for induction. The pump speed of propofol was 600 mL/h. The dosage varied with increments or decrements of 0.5 mg/kg based on the Dixon up-and-down method. The duration of eye-opening after propofol administration was recorded. Changes in heart rate (HR) and respiratory rate (RR) were recorded at 5 timepoints: after entering the operation room and prior to propofol administration (T1), 1 and 3 min after propofol administration (T2 and T3), 3 and 5 min after intubation (T4 and T5). The required ED50 of propofol that prevented tracheal intubation response in D1, D2, and C groups were 6.4 mg/kg (95% CI, 6.1 to 6.7 mg/kg), 5.8 mg/kg (95% CI, 5.67 to 6 mg/kg), and 8.3 mg/kg (95% CI, 8 to 8.5 mg/kg), respectively. The recovery time of group D2 was significantly longer than that of groups D1 and C (P < .05). The differences in HR among the 3 groups were significant from T2 up to T5 timepoint (P < .05). The differences in RR among the 3 groups were significant at T2 and T3 timepoints (P < .05). Dexmedetomidine pre-injection reduces the amount of propofol required for endotracheal intubation response in Beagles, thereby reducing the respiratory inhibition induced by propofol.