Intravenous Induction Agents Research Articles

Effects of General Anesthesia on Noninvasively Measured Central and Peripheral Blood Pressure: A Prospective, Observational-based Cross-over Study

Abstract Background: Blood pressure (BP) monitoring is the basic hemodynamic parameter necessary to monitor the hemodynamic changes occurring under general anesthesia (GA) to maintain adequate perfusion to major organs such as the heart, brain, and kidneys. Physicians heavily rely upon peripheral hemodynamic measurements despite availability of devices suitable for measurement of central blood pressure through non-invasive manner paving a gap in the literature concerning the effects of GA on central pressure. Aims and Objective: In this comparative cross-over study, authors have aimed to find out the degree of changes in central and peripheral BP after the introduction of GA among adult patients of different age groups scheduled for routine surgical procedures with an objective to maintain vital functions more precisely – considering the fact that vital organ perfusions (heart, brain etc.,) depend more on the required values of CBP than that of PBP. Material & Methods: Following approval from IEC, sixty adult patients with ASA physical status 1 or 2 undergoing routine surgical procedures under general anesthesia were enrolled in this prospective cross-over study where each patient was case as well control for measurement and comparison of his/her central and peripheral blood pressure. Patients, being divided into three groups as per age range - 20-40 years (Group A), 40-60 years (Group B), and 60-80 years (Group C) had their normal Riva Rocci BP cuff (Space Lab Inc. USA) placed in one arm for peripheral BP measurement and special Riva Rocci (Uscom Ltd., Australia).) BP cuff for on another arm for Central BP measurement. After patient’s arrival into operation theatre, baseline hemodynamic parameters were taken followed by sequential measurements of CBP and PBP with an interval of 2 minutes till 30-40 mins of operation. There were alternative measurements of these pressures with recording of data from either of the devices as mentioned for further comparison and analysis. Results: From baseline values, it was found that all the three groups were comparable in respect of age, height, weight, PBP and CBP. When measured pressure of all groups combined, that there was a fall in both Central and Peripheral SBP as well as DBP after giving intravenous induction agent (propofol) and rise in both central and peripheral SBP and DBP after laryngoscopy and intubation. Degree of systolic blood pressure change in both peripheral & central that is fall of BP in 3rd reading & rise of BP in 5th reading was greatest in group C, followed by group B, then group A [p - 0.005]. While comparing three subgroups, the baseline Augmentation Index (AI) was highest in group C and lowest in group A. Following the administration of general anesthesia (GA), the change in Augmentation Index (ΔAI), was most pronounced in the third reading corresponding to the time after the administration of the induction agent. Conclusion: Measurement of CBP through peripheral placement of cuff is a unique feasible method to detect real changes of circulation with actual pressure in vital organs. Thus, the study suggests that central blood pressure measurements can provide a more accurate reflection of hemodynamic changes during general anesthesia, especially in older individuals or those with different cardiovascular conditions allowing better vital management of body circulation.

Inadvertent administration of intravenous anaesthesia induction agents via the intracerebroventricular, neuraxial or peripheral nerve route - A narrative review.

Intravenous (IV) medication administration error remains a major concern during the perioperative period. This review examines inadvertent IV anaesthesia induction agent administration via high-risk routes. Using Medline and Google Scholar, the author searched published reports of inadvertent administration via neuraxial (intrathecal, epidural), peripheral nerve or plexus or intracerebroventricular (ICV) route. The author applied the Human Factors Analysis and Classification System (HFACS) framework to identify systemic and human factors. Among 14 patients involved, thiopentone was administered via the epidural route in six patients. Four errors involved the routes of ICV (propofol and etomidate one each) or lumbar intrathecal (propofol infusion and etomidate bolus). Intrathecal thiopentone was associated with cauda equina syndrome in one patient. HFACS identified suboptimal handling of external ventricular and lumbar drains and deficiencies in the transition of care. Organisational policy to improve the handling of neuraxial devices, use of technological tools and improvements in identified deficiencies in preconditions before drug preparation and administration may minimise future risks of inadvertent IV induction agent administration.

A retrospective analysis of anesthetic techniques and their related perioperative complications in children undergoing cochlear implant surgeries – our preliminary experience at a tertiary care referral centre

: Cochlear implants serve as a favorable option for treatment of hearing loss in children. However, there is limited data regarding the type of anesthetic techniques used and its associated complications in such patients. Hence, the primary objective of this study was evaluation of postoperative nausea vomiting (PONV) with three different general anesthesia techniques in pediatric cochlear implant surgeries. The secondary objectives included assessment of intraoperative and postoperative complications: A retrospective analysis of all children less than 13 years, who underwent cochlear implant surgery at our hospital between December 2019 to February 2022 was performed. Appropriate data were noted. Nine patients each were classified into three groups (Group A, B and C) on the basis of anesthetic techniques used in our institution. Group A received inhalational agent for induction and maintenance, with no Non-Depolarizing Muscle Relaxant (NDMR), Group B patients received Total Intravenous Anesthesia with NDMR and Group C received intravenous induction and inhalational agent for maintenance with NDMR. Twenty-seven patients were included. There were no major intraoperative complications. PONV was noticed in two patients of Group A and one patient of Group C. One patient belonging to Group A developed laryngospasm and desaturation. Delayed Awakening was seen in one patient each of Group A, B and C. Overall, four complications were noted in patients of Group A, one in Group B and two in Group C. All complications were mild and were managed successfully.This preliminary study suggests that peri-operative anesthetic complications with all three anesthestic techniques were comparable and safe.

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

Effect of etomidate and propofol on airway mechanics during induction - A prospective randomized trial.

Intravenous induction agents like propofol and etomidate change the airway mechanics and thus influence mask ventilation. These changes have an impact on the administration of muscle relaxant in a difficult mask ventilation scenario. The difference in dynamics of airway after administration of two different intravenous agents has been assessed in this study. After formal registry in clinical trials, patients undergoing general anesthesia were recruited and randomized into group P and E. Patients were induced with either of the intravenous agents, and mask ventilation was performed with a ventilator. After 60 s, rocuronium was administered and ventilation continued. Measurements of tidal volume, peak airway pressure, and compliance were taken from the anesthesia ventilator at different time points - induction, relaxant, and intubation. There was no statistically significant difference between the two groups with respect to demographics, airway parameters, and airway mechanics, as measured by tidal volume, peak airway pressure, and lung compliance. There was an improvement in the tidal volume and compliance following induction with propofol, with a P value of 0.007 and 0.032, respectively, obtained in within-group comparison. Propofol and etomidate were comparable in airway mechanics, but compliance and tidal volumes improved with propofol, which facilitated face mask ventilation.

A prospective study of various anesthetic techniques in patients with acyanotic congenital heart diseases undergoing device closure.

Transcatheter device closure of congenital heart defects (CHD) has recently gained popularity. As limited literature exists regarding the ideal anesthetic technique for these procedures, we studied the perioperative anesthetic management and its effects on hemodynamics and complication rate in patients undergoing device closure. In this prospective observational study, all patients of 1 month to 50 years of age with acyanotic congenital heart diseases undergoing device closure were included. The anesthesia technique, i.e., general anesthesia with endotracheal tube (GETA)/supraglottic airway device (SGD) or conscious sedation with face mask (S-FM), and intravenous induction agent used was noted. Intraoperatively vital parameters, use of transesophageal echocardiography (TEE), and perioperative complications if any, were noted. Descriptive statistical analysis was done using a statistical package for the social sciences (SPSS) version 15. GETA was used in the atrial septal defect (ASD) (62.8%), patent ductus arteriosus (PDA) (66.7%), ventricular septal defect (VSD) (65%) patients, SGD in ASD (6.3%), PDA (16.7%), and VSD (13.3%) patients. S-FM in ASD (31.3%), PDA (16.7%) and VSD (21.7%) patients. Etomidate was used as an induction agent in 30.61% of the patients and propofol in 69.39% of the patients. The mean arterial pressure (MAP) in the etomidate and propofol groups was statistically insignificant while decreased heart rate was noted in both groups. Complications like SGD dislodgement, supraventricular tachycardia, and device dislodgements were seen. In PDA device closure patients, GETA should be preferred. Patients for VSD device closure should receive general anesthesia as complications are common. In ASD device closure, patients without TEE use can be done under general anesthesia with SGD.

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 of Propofol Alone with Admixture of Propofol and Thiopentone Sodium for Laryngeal Mask Airway Insertion in Paediatric Elective Surgery

Background: Laryngeal Mask Airway (LMA) is mostly used for the application of general anesthesia. Intravenous Propofol is still preferable for induction of anesthesia due to its favorable recovery profile and low incidence of side effects. Thiopentone sodium is also one of the most commonly used intravenous induction agent. Combination of Propofol and thiopentone sodium may be more is beneficial rather than propofol alone. So we conducted this study to find more effective method. Objective: To compare the outcome of combination of Thiopentone sodium with Propofol versus Propofol alone for the Laryngeal mask airway insertion in pediatric patients. Methodology: This “Randomized controlled trial” was done at the Department of Anesthesia, Jinnah Hospital, Lahore for 6 months i.e. from July 2021 to Dec 2021. 80 children were selected for surgery through Non-Probability, Consecutive Sampling. Randomization of patients into group A & B was done. Informed consent was obtained from parents. Intravenous induction agents were prepared, for Propofol group (A), propofol was mixed with lignocaine and for the combination group (B), Thiopentone was combined with propofol. A correct sized LMA was inserted. Excellent LMA insertion was assessed. Data was analyzed in SPSS. Excellent LMA insertion in both groups was analyzed using Chi Square test with p <0.05 as statistically significant. Results: The mean age of patients in our study was 8.29±3.16 years. In Propofol group, there were 28 males and 12 were females while in combination group, 22 patients were male and 18 patients were females. In Propofol group, 15 cases had LMA score 1, 17 had LMA score 2 and 8 had LMA score 3. In combination group, 25 cases had LMA score 1 and 15 had LMA score 2 but no one had LMA score 3. The difference was significant (p<0.05). In Propofol group, 15 cases had excellent outcome while in 25 cases, excellent outcome could not be achieved. In combination group, 25 cases had excellent outcome while in 15 cases, excellent outcome could not be achieved. The difference was significant (p<0.05). Conclusion: So it has been proved that combination of Propofol with thiopentone sodium is more effective for effective insertion of LMA in children instead of using porpofol alone. Keywords: General Anesthesia, Laryngeal Mask Airway, Children, Propofol, Thiopentone Sodium

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.

“The Induction Dose with Ketamine and Midazolam Co-Induction to Propofola”

Background: Propofol is a commonly used intravenous (IV) induction agent. The induction dose of propofol is 1.5 to 2.5 mg/kg in healthy adults producing unconsciousness, depending upon concomitant medications (i.e. opoid analgesics), the patient’s age and physical status, and the extent of surgical stimulation. Objective: To assess the induction dose with ketamine and midazolam co-induction to propofola. Methods: This was a prospective, randomized, double-blind and interventional study conducted at Department of Anesthesiology, Sher-e-bangla Medical College Hospital, Barishal, Bangladesh from January to June 2019. Sixty adult patients undergoing elective surgery to be performed under general anesthesia were randomized to receive 0.3 mg/kg of Ketamine or 0.03 mg/ kg of Midazolam intravenously as co-induction agent. A minute after administration of co-induction agent, anesthesia was induced with Propofol 40 mg bolus then 10 mg every 10 seconds until the loss of verbal response. The hemodynamic response at 0, 1, 2, 5 minutes respectively and the induction dose of Propofol were noted. Results: The mean arterial pressure heart rates were significantly lower at 1, 2 and 5 minutes in midazolam group. However, mean arterial pressure and heart were within the physiological range in both the groups. Propofol dose requirement for induction between the two groups was similar (p>0.05) but co-induction significantly decreased the induction dose of Propofol as compared to standard recommended dose for induction. Conclusion: Our study showed that hemodynamic variables were maintained within the physiological range with midazolam and ketamine co-induction. However, lesser degree of decrease in mean arterial pressure was seen with ketamine but the heart rate was higher. A similar reduction of induction dose of propofol was achieved with both the drugs.

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.

Therapeutic Efficacy of dexmedetomidine on the pressor response due to endotracheal intubation and on the induction dose of propofol for surgeries under general anesthesia

Introduction: Pressor response to laryngoscopy and endotracheal intubation has been associated with sympathetic and parasympathetic responses which can be attenuated by alpha 2 receptor agonists. Aims: The present study aimed to compare and evaluate the effectiveness of dexmedetomidine in attenuating hemodynamic response to endotracheal intubation and also on the induction dose of propofol. Materials and Methods: It was a prospective, randomized, double-blinded, parallel group, placebo-controlled study in tertiary care hospital. A total of 50 patients aged 18–60 years, American Society of Anaesthesiology 1 and 2, scheduled for elective surgeries under general anesthesia (GA). Each patient in Group 1 received a loading dose of dexmedetomidine at 0.001 mg/kg over 10 min before induction of anesthesia and Group 2 received 20 ml normal saline over 10 min. Hemodynamic parameters prior to laryngoscopy and up to 10 min after intubation were measured. The requirement of induction dose of propofol was also calculated. Results: Dexmedetomidine showed significant efficacy in suppressing pressor response during endotracheal intubation. Furthermore, lesser dose of propofol was required for induction of GA. Conclusion: Dexmedetomidine can be used as an adjuvant in GA to prevent pressor response during intubation and decrease the requirement of intravenous induction agent propofol.

A Comparative Study of Different Doses of Lignocaine on Prevention of Etomidate Induced Myoclonus during Induction of Anesthesia

Abstract Background and Aims Etomidate, an intravenous (IV) induction agent known for its stable myocardial action, can produce myoclonus which can be detrimental for the cardiac patients. Though lignocaine has proven its efficacy in attenuating the etomidate-induced myoclonus, the ideal dose of lignocaine is not known. The aim of our trial was to analyze two different doses of lignocaine on the occurrence and intensity of etomidate induced myoclonus. Materials and Methods A total of 120 patients were randomly assigned into three groups of 40 each. Patients in group A were injected lignocaine 0.5 mg/kg intravenously, group-B patients were injected lignocaine 1 mg/kg intravenously, and group-C patients were injected saline placebo. After 2 minutes, anesthesia was induced with 0.3 mg/kg of etomidate over 30 seconds. The patients were assessed for myoclonus using clinical severity scoring system during first 2 minutes of induction. Our primary outcome was the incidence of myoclonus. The severity of myoclonus and adverse effects were the secondary outcomes. Results No remarkable variation was found regarding demographic profile among three groups. Incidence of myoclonus in groups A and B was 35% and in group C was 98%, the difference being statistically significant. Both doses of lignocaine reduced the severity of myoclonus up to same extent. Conclusion Pretreatment with IV lignocaine 0.5mg/kg and 1 mg/kg IV remarkably decreased the occurrence and severity of myoclonus induced by etomidate up to same extent.

Comparison the Effect of Etomidate vs. Thiopentone on Left Ventricular Strain and Strain Rate at the Time of Anesthesia Induction in Patients Undergoing Elective Coronary Artery Bypass Surgery: A Randomized Double Blind Controlled Trial

AbstractMyocardial strain imaging with speckle tracking echocardiography (STE) is getting popularity because it does not depends on insonation angle and has shown good correlation with intraoperative and postoperative ventricular function in patients with coronary artery disease. The impact of thiopentone and etomidate induction on myocardial function was studied and compared on sixty patients undergoing elective coronary artery bypass grafting. Three loops for each views (apical 4 chamber, apical 2 chamber, and apical long axis ) were acquired at base line (T0) and 1 minute (T1) after induction for offline analysis. In Group T, significant increase in HR from the base line values (67.8 ± 13.8 vs 79.2 ± 15.6, p = 0.001) occurred post induction, where as in Group E it remain near to the base line (71.7 ± 8.3 vs 70.1± 8.9, p = 0.345). A reduction in mean arterial pressure (MAP) was noted in both the groups after the injection of the allocated drug. There was no significant difference in the index of contractility (ICON) (T0 vs T1: 48.7 ± 10.6 vs 47.0 ± 11.7, p = 0.120) in Group E where as in Group T there was a reduction in the ICON value (T0 vs T1: 45.0 ± 10.7 vs 41.0 ± 8.4, p = 0.005). A similar picture was also noted in systemic vascular resistance index. A significant decrease in cardiac index (CI) was seen in Group E (T0 vs T1: 2.7 ± 0.4 vs 2.5 ± 0.4, p = 0.027), however it remain near to the base line in Group T. There occurred no changes in stroke index (SI) in Group E (T0 vs T1: 38.7 ± 6 vs 37.0± 5.3, p = 0.134), where as a significant decrease was noted after injection of thiopental (T0 vs T1: 38.0 ± 6.2 vs 36.1± 4.9, p = 0.049). A significant decline in cardiac performance index (CPI) was also recorded in Group E (T0 vs T1: 0.57 ± 0.15 vs 0.52 ± 0.12, p = 0.032), and not in Group T. There was decrease in left ventricular ejection fraction (LVEF) after the injection of both the drugs (Group E, T0 vs T1: 57 ± 3.7 vs 54± 3.7, p= 0.001; and Group T, T0 vs T1: 57 ± 3.7 vs 54± 3.7, p = 0.001). In Group E, global longitudinal peak systolic strain (GLPSS) showed no change after the injection of the drug (T0 vs T1: −13.2 ± 2.2 vs −13.1± 2.3, p = 0.631). However, a significant decrease in GLPSS (T0 vs T1: −13.5 ± 1.5 vs – 10 ± 1.8, p = 0.001) after injection of thiopental. Longitudinal peak systolic strain rate (LPSSR) was significantly decreased in all echocardiographic views after the injection of respective drugs. However, the decrease in LPSSR was significantly less in Group E in comparison to Group T.To conclude, STE provides accurate and reliable real time quantitative regional and global LV assessment. Use of thiopentone for anesthesia induction is associated with more profound impairment of LV function in comparison to etomidate as assessed by a decreased longitudinal peak systolic strain rate and global longitudinal peak systolic strain. Further studies are warranted to understand the exact clinical impact, which may influence the choice of intravenous induction agent based upon preoperative patient characteristics.

COMPARATIVE STUDY OF SEVOFLURANE AND PROPOFOL FOR EASE OF I-GEL INSERTION IN ADULT PATIENTS UNDERGOING GENERALANESTHESIA FOR SHORT PROCEDURES.

Background: I-gel is a second generation supraglottic airway device designed to provide and maintain a seal around the laryngeal inlet for spontaneous ventilation and allow controlled ventilation at modest levels of positive pressure thereby endotracheal intubation can be avoided. Propofol has been the drug of choice due to its better safety prole, relaxation and suppression of airway reexes among intravenous induction agents. Sevourane with its pleasant odor, non-irritating to the airways and due to its bronchodilator property are best among the volatile agents. We aim to compare induction characteristics and ease of I gel insertion with sevourane and intravenous propofol. Methods:The study was conducted in 60 eligible adult patients undergoing general anesthesia for short surgical procedures in Pushpagiri Medical College and Research Centre.Group Preceived Propofol and Group S received Sevourane 8%. Consecutive subjects who satisfy inclusion criteria were randomly assigned into one of the two groups of 30 until sample sizes were achieved. I gel insertion attempted after adequate jaw relaxation. Ease of I-gel insertion assessed by a three-point scoring system. Data was analysed by SPSS software .The independent variables assessed in this study includes the drugs given and the comparison was done using unpaired t test. Results: Sevourane group took more time for induction than Propofol group .It was found that insertion time for sevourane was higher than the propofol group. The ease of I Gel insertion based on three point scale showed that in Sevourane group overall insertion conditions was excellent in 36.7% ;satisfactory in 63.3% as compared to group Propofol group which was 83.3%; 16.7% respectively. The results were statistically signicant (p<0.01). Conclusion:It can be concluded that sevourane can be considered as a safer alternative to propofol for I Gel insertion

Comparison of efficacy of ketamine and dexmedetomidine for prevention of pain due to propofol injection

Background: Propofol is a popular intravenous anesthetic induction agent which produces a smooth, rapid induction with rapid clearance and recovery but Pain on injection with Propofol is a common problem and can be very distressing to the patient. Ketamine is a phencyclidine derivative routinely used as an inducing agent and Dexmedetomidine Hydrochloride, an imidazole compound is the alpha 2 agonist. The present study was undertaken to compare the efficacy of Ketamine (0.5 mg/kg) and Dexmedetomidine (0.5 mcg/kg) in preventing the incidence and reducing the severity of pain on Propofol injection.Method: 150 patients, ASA I&II, 18-60 year old undergoing elective surgical procedure under general anaesthesia (GA) were randomly assigned into 3 equal groups. Group C, Group K and Group D. In Group C 10 ml Normal Saline, In Group K Ketamine 0.5 mg/kg diluted to 10 ml with normal saline and in Group D Dexmedetomidine 0.5 mcg/kg diluted to 10 ml with normal saline was infused over 10 minutes before injecting Propofol. All study medications were prepared in a 10ML syringe that was covered with black tape by an anaesthesiologist who was not involved in the study. HR,BP,SPO2and Pain Scores were noted at baseline, after premedication, while injecting study drugs at 3, 5 and 10 minutes and while injecting Propofol at the beginning, after half Propofol was injected, after complete Propofol was injected and at 1,3 and 5 minutes after completing the Propofol. Incidence and severity of pain and involuntary movements, verbal communication by the patient was watched constantly. Injection pain was graded using a 4-point scale. The pain score was evaluated as ‘0’ when there was no discomfort in the injection area (no pain), ‘1’ when the patient simply answered

Comparison between Propofol and Thiopentone for Laryngeal Mask Airway Insertion in Day Care Surgery

Background: Insertion of Laryngeal Mask Airway (LMA) requires an adequate depth of anesthesia. Optimal insertion conditions and hemodynamic stability during LMA insertion are mainly influenced by the choice of the intravenous induction agent. Propofol was recommended as a standard induction agent for LMA insertion. Objective: To assess the effectiveness of thiopentone compared to propofol on LMA insertion. Material and Methods: A prospective study conducted at tertiary care hospital in department of Anaesthesia from March 2019 to April 2020 in 80 patients randomized into propofol group (Group A) and thiopentone group (Group B). Result: There was easy insertion of LMA in all the patients of group A whereas in group B satisfactory conditions were seen in 8 patients for insertion of LMA. This result was found statistically significant (<0.001) though no insertion failure was noticed in either groups. Conclusion: This study demonstrated that for smooth insertion of LMA Thiopentone sodium is a cost effective and safe alternative for Propofol.

Comparison of thiopentone with lidocaine spray vs propofol for laryngeal mask airway insertion at tikur anbessa specialized hospital. A prospective cohort study

BackgroundInsertion of laryngeal mask airway (LMA) requires an adequate depth of anesthesia. Optimal insertion conditions and hemodynamic stability during LMA insertion are mainly influenced by the choice of the intravenous induction agent. Propofol was recommended as a standard induction agent for LMA insertion. Due to unavailability and cost for treatment Propofol is not easily availed, thus this study aimed at assessing the effect of thiopentone with lidocaine spray compared to Propofol on hemodynamic change and LMA insertion on the patient undergoing elective surgery. MethodsEighty-four participants were followed in a prospective cohort study based on the induction type of either thiopentone-lidocaine group (TL) or Propofol (P). Hemodynamic variables, LMA insertion condition, apneic time, and cost of treatment during the perioperative time were recorded. Data were checked for normality using the Shapiro-Wilk test. Numeric data were analyzed unpaired student's t-test or Manny Whitney test. Categorical data were analyzed by the chi-square test. A p-value ≤ 0.05 was considered a statistically significant difference. ResultThe comparison of data showed that a significant reduction in mean arterial blood pressure (MAP) in the Propofol group during the first 10 min. The MAP at first minute after LMA insertion was 78.4 ± 5.5 in the Propofol group compared to 81.8 ± 5.6 in thiopentone-lidocaine group p < 0.001. the mean MAP at 5th and 10th minutes after LMA insertion is also significantly lower in the Propofol group compared to the thiopentone-lidocaine group, p < 0.05. There were no statistically significant differences regarding the heart rate change and insertion conditions between the two groups. Mean apneic time was 138 ± 45.8 s in the Propofol group and 85 ± 13.8 s in thiopentone-lidocaine group p < 0.001. Thiopentone-lidocaine group had a lower treatment cost compared to the Propofol group. ConclusionThiopentone with 10% topical Lignocaine is an alternative for the insertion of LMA to Propofol, with better hemodynamic stability and cost-effectiveness.

Pro: Propofol Is a Better Induction Agent than Etomidate

AbstractInduction refers to the start of anesthesia when the patient is rendered unconscious. The intravenous induction agents allow the patient to experience a pleasant loss of consciousness while also rapidly achieving surgical levels of anesthesia. An ideal induction agent must have a rapid onset and offset of action, and must be easy to administer and without significant side effects. Currently, the commonest used agents include sodium pentothal, propofol, ketamine, and etomidate. Unfortunately, none of these agents possess the characteristics of an ideal induction agent. In this article, we will discuss the merits of propofol as an ideal induction agent for cardiac surgery and how it scores over etomidate for the same purpose.

English

BACKGROUND The present study was done to compare the cardiovascular responses of etomidate and propofol as induction agents of general anaesthesia under Bispectral index (BIS) guidance and evaluate the effect of intravenous induction agent etomidate and propofol on the variation in heart rate and blood pressure during induction of general anaesthesia. METHODS This is a prospective randomized and double blinded comparative study done in Assam Medical College and Hospital on patients scheduled for elective surgeries under general anaesthesia from June 2019 to May 2020. 80 patients were randomly allocated to group E (etomidate group) and group P (propofol group) of 40 each. All patients were pre-medicated with fentanyl 2 microgram / kg intravenously. Group E received etomidate infusion at 0.05 mg / kg / min and group P received propofol infusion at 0.5 mg / kg / min until Bispectral index value dropped to 60. Patients were intubated with vecuronium 0.1 mg / kg and maintenance of anaesthesia was continued according to institutional protocol. At the end of anaesthetic period, extubation was done after acceptable recovery. Haemodynamic parameters were recorded in both the groups until 10 minutes of induction. RESULTS Statistically significant fall in heart rate was seen in group P than that of group E starting from 3 minutes of induction up to 10 minutes with P value &lt; 0.05 and statistically significant fall in systolic, diastolic, and mean arterial pressure (MAP) was seen in propofol group from that of etomidate group starting from 1 minute of induction up to 10 minutes was seen. CONCLUSIONS We conclude that etomidate is haemodynamically more stable than propofol during the time of induction of anaesthesia. KEY WORDS Etomidate, Propofol, Bispectral Index