Combination Of Propofol Research Articles

Behavioural Aversion and Cortisol Level Assessment When Adult Zebrafish Are Exposed to Different Anaesthetics.

Simple SummaryThe increased popularity of zebrafish as a research model calls for appropriate refinement of procedures, such as finding the best anaesthetic protocol to use in adult zebrafish in a laboratory setting. The scarce literature available regarding aversion described the most used anaesthetic (MS222) as aversive to adult zebrafish; therefore, the study of alternatives is urgent. Thus, we studied the impact of three anaesthetic alternatives (a combination of propofol with lidocaine, clove oil, and etomidate), and the standard anaesthetic (MS222) on zebrafish aversion and on cortisol levels. Contrary to what was expected, MS222 did not result in clear signs of aversion, while only etomidate generated a similar profile to the aversive substance (hydrochloric acid). Our results suggested that all the anaesthetic protocols except for etomidate were valid candidates for use in a laboratory setting, although none were innocuous.The use of zebrafish (Danio rerio) as an animal model is growing and occurs in a wide range of scientific areas. Therefore, researchers need better and more appropriate anaesthetics for stressful and/or painful procedures to prevent unpleasant experiences. Thus, we aimed to study if adult zebrafish displayed aversion-associated behaviours (conditioned place aversion) and alterations in cortisol levels when exposed to equipotent concentrations of MS222, propofol/lidocaine, clove oil, or etomidate. Adult AB zebrafish (mixed-sex, N = 177) were randomly assigned to MS222 (150 mg/L), Propofol/Lidocaine (5 mg/L propofol + 150 mg/L lidocaine), Clove Oil (45 mg/L), or Etomidate (2 mg/L) groups. The conditioned place aversion test was used to assess behavioural aversion. Only etomidate resulted in a similar aversion to the positive control group (HCl; pH = 3). Cortisol levels were measured 5 and 15 min after loss of equilibrium. Etomidate induced low levels of cortisol by impairing its synthesis, whereas all the other groups had similar cortisol levels. Based on our data, etomidate was ruled out as an alternative to MS222, as it showed an aversive profile. The remaining protocols were not innocuous, displaying a weak aversive profile when compared to the positive control. In conclusion, a combination of propofol with lidocaine, clove oil, and MS222 were valid candidates for use as anaesthetic protocols.

The median effective doses of propofol combined with two different doses of nalbuphine for adult patients during painless gastroscopy

Objective: Propofol is the most widely administered intravenous anesthetic to induce deep sedation for gastroscopy procedures. Coadministration of nalbuphine can provide analgesia and sedation to patients experiencing visceral pain, thereby decreasing the amount of propofol needed and reducing the risk of propofol-induced adverse events. We carried out this study to determine the median effective dose (ED50) of propofol in combination with different dosages of nalbuphine and the optimal dosage of nalbuphine during painless gastroscopy. Methods: We recruited sixty-five patients aged 18–60 years who underwent elective painless gastroscopy. A total of sixty-one patients were allocated randomly to the N1 group (nalbuphine 0.1 mg/kg) or N2 group (nalbuphine 0.15 mg/kg). Three minutes after administration of nalbuphine, patients received a preset dose of propofol at 2.0 mg/kg with a dose gradient of 0.2 mg/kg according to Dixon’s “up-and-down” method. The primary outcome was the ED50 of propofol in combination with nalbuphine. Hemodynamic parameters, recovery time, pain score, and adverse events were recorded as secondary outcomes. Results: The ED50 of propofol in the N2 group was significantly lower than that observed in the N1 group (p < 0.01). Using probit analysis, the ED50 and ED95 of propofol were 1.632 mg/kg and 2.759 mg/kg in the N1 group and 1.111 mg/kg and 2.243 mg/kg in the N2 group, respectively. The incidence of hypotension in the N2 group was lower than that in the N1 group (p < 0.05), and the recovery time was shorter than that of the N1 group (p < 0.05). Conclusion: In adult patients, 0.15 mg/kg nalbuphine led to a significant reduction in the ED50 and ED95 of propofol during gastroscopy. This dose of nalbuphine also reduced the incidence of hypotension and shortened the recovery time. Therefore, nalbuphine (0.15 mg/kg) combined with propofol is a safe option for enhancing recovery after painless gastroscopy in adult patients. Clinical Trial Registration: [https://www.chictr.org.cn/edit.aspx?pid=126699&htm=4], identifier [ChiCTR2100053204].

Transabdominal self-expandable metal stent placement as a rescue therapy for drainage of walled-off necrosis.

Video 1CT scan of a walled-off necrosis in the right pararenal space extended to the iliac area.

Comparison of nalbuphine and propofol verses pentazocine and promethazine in tympanoplasty surgeries under monitored anesthesia care

Background: A middle ear surgery (tympanoplasty), is done under various modes of anaesthesia such as local anaesthesia (LA), general anaesthesia (GA) or sedation with local anaesthesia (MAC). It is usually performed under MAC providing advantages of rapid onset, allowing hearing test intraoperatively and early mobilization of the patient. Aims and Objectives: The aim of this study was to compare effectiveness of nalbuphine and propofol with pentazocine and promethazine combination for intraoperative sedation under monitored anesthesia care for tympanoplasty under local anesthesia (LA). Materials and Methods: A total 60 patients undergoing tympanoplasty under LA divided in to two groups randomly to receive either IV nalbuphine (50 mcg/kg) and propofol 750 mcgs/kg in 10 min followed by a maintenance infusion at the rate of 25 mcg/kg/min. Group N or pentazocine 0.6 mg/Kg and Inj. Promethazine 0.5 mg/kg IV diluted in 10 ml normal saline over 10 min followed by 25 mcg/kg/min infusion of normal saline (Group P). Sedation was titrated to Ramsay Sedation Score (RSS) of 3. Vital parameters such as HR, BP, SpO2, RSS, visual analog scale score (VAS), requirement of rescue analgesics, mean bleeding score, and surgeon satisfaction score (Likert Scale) were recorded and analyzed. Results: RSS was higher and VAS score was lower in Group N at 30, 60, 90, and 120 min (P&lt;0.05) that mean bleeding score was lower in Group N as compare to Group P which was statistically significant. Conclusion: Nalbuphine and propofol combination are superior to pentazocine and promethazine combination in terms of producing better analgesia, sedation with batter surgical field.

Efficacy and safety of the combination of propofol and S(+)-ketamine for procedural sedation in pediatric patients undergoing totally implantable venous access port implantation: A prospective randomized controlled study.

BackgroundTotally implantable venous access port (TIVAP) implantation is usually performed under general anesthesia with endotracheal intubation in children. Procedural sedation without endotracheal intubation has been applied to minor pediatric surgeries like central venous catheter insertion. To explore a more efficient and less invasive anesthesia mode to implant TIVAPs for children, we aimed to evaluate the efficacy and safety of procedural sedation using propofol and S(+)-ketamine compared with general anesthesia.MethodsSixty-six patients aged 6 months to 10 years undergoing TIVAP implantation were randomly allocated to two groups. Patients under procedural sedation [S(+)-ketamine-propofol (sketofol) group] were given target-controlled infusion of propofol 4 μg/ml using the Paedfusor model and S(+)-ketamine 0.5 mg/kg as induction, and had target-controlled infusion of propofol 3–4 μg/ml as maintenance. Patients in sketofol group received medium-flow oxygen inhalation through facemasks during surgery. Patients under general anesthesia (control group) were given propofol 2 mg/kg, cisatracurium 0.2 mg/kg, fentanyl 3 μg/kg as induction, and sevoflurane 0.8 minimum alveolar concentration as maintenance after endotracheal intubation. Primary outcome was the postoperative emergence agitation evaluated 5 min after awakening.ResultsPostoperative emergence agitation evaluated 5 min after awakening was lower in sketofol group versus control group [1.0 (0.5, 1.0) vs. 3.0 (2.0, 4.0); median difference (95% CI): 2.0 (1.0, 2.0); P < 0.001]. Time to awakening was significantly lower in sketofol group versus control group [15.0 (5.0, 23.0) vs. 26.0 (20.5, 37.5); median difference (95% CI): 11.0 (7.0, 19.0); P < 0.001], as well as time to discharge from post anesthesia care unit [35.0 (24.0, 45.0) vs. 45.0 (37.5, 59.5); median difference (95% CI): 10.0 (10.0, 23.0); P < 0.001]. Postoperative complications or adverse events were not reported in sketofol group.ConclusionsCompared to general anesthesia with endotracheal intubation, procedural sedation using propofol and S(+)-ketamine improves the postoperative emergence agitation right after the recovery of consciousness, and has advantage in shortening anesthetic recovery time for pediatric patients undergoing TIVAP implantation.

Blockade of endothelial Mas receptor restores the vasomotor response to phenylephrine in human resistance arterioles pretreated with captopril and exposed to propofol

BackgroundHypotension that is resistant to phenylephrine is a complication that occurs in anesthetized patients treated with angiotensin converting enzyme (ACE) inhibitors. We tested the hypothesis that Ang 1–7 and the endothelial Mas receptor contribute to vasodilation produced by propofol in the presence of captopril.MethodsThe internal diameters of human adipose resistance arterioles were measured before and after administration of phenylephrine (10–9 to 10–5 M) in the presence and absence of propofol (10–6 M; added 10 min before the phenylephrine) or the Mas receptor antagonist A779 (10–5 M; added 30 min before phenylephrine) in separate experimental groups. Additional groups of arterioles were incubated for 16 to 20 h with captopril (10–2 M) or Ang 1–7 (10–9 M) before experimentation with phenylephrine, propofol, and A779.ResultsPropofol blunted phenylephrine-induced vasoconstriction in normal vessels. Captopril pretreatment alone did not affect vasoconstriction, but the addition of propofol markedly attenuated the vasomotor response to phenylephrine. A779 alone did not affect vasoconstriction in normal vessels, but it restored vasoreactivity in arterioles pretreated with captopril and exposed to propofol. Ang 1–7 reduced the vasoconstriction in response to phenylephrine. Addition of propofol to Ang 1–7-pretreated vessels further depressed phenylephrine-induced vasoconstriction to an equivalent degree as the combination of captopril and propofol, but A779 partially reversed this effect.ConclusionsMas receptor activation by Ang 1–7 contributes to phenylephrine-resistant vasodilation in resistance arterioles pretreated with captopril and exposed to propofol. These data suggest an alternative mechanism by which refractory hypotension may occur in anesthetized patients treated with ACE inhibitors.

Anesthesia and Analgesia Management Profile for Airway Surgeries at Dr. Soetomo General Academic Hospital Surabaya

Introduction: Ear, Nose, and Throat (ENT) surgeries are commonly performed and very often require the surgeon and anesthesiologist to share the same workspace. Over the years, ENT surgery techniques have evolved from conventional methods to computer-assisted intraoperative navigation. In contrast to the past, a minimally invasive approach to paranasal sinus and petrous bone surgery is now preferred. Bleeding, postoperative nausea, and vomiting are complications often encountered in ENT surgery. In addition, pain management during surgery and patient comfort after a surgical procedure is a challenge for anesthesiologists. Therefore, the choice of anesthetic drugs is important. Objective: This study aims to determine the action profile, anesthetic management, and pain management in ENT surgery at Dr. Soetomo General Academic Hospital Surabaya. Materials and Methods: This is a retrospective descriptive study. A total of 177 patients underwent airway surgery. Data were obtained from the Medical Records of the Integrated Surgery Center of Dr. Soetomo General Academic Hospital recorded from January to December 2021. Results and Discussion: Most of the patients were in the age group of 45 - 65 years (40.1%) and a majority were men (65.5%). Most patients who were ≥ 20 years old had a normal nutritional status (54.2%). The most frequent diagnosis was laryngeal cancer (23%), with micro laryngeal surgery being the most frequently performed (35.8%). Most surgeries also needed less than 60 minutes followed by 60 to 119 minutes (27.1%). The most frequently used induction agents were a combination of propofol, fentanyl, and rocuronium (39.5%), with isoflurane as the most frequent inhalation agent (91.3%). Metamizole (70.1%) was the most postoperative analgesic. Conclusion: In general, intravenous agents were used for anesthesia induction. A combination of different induction agents brings synergistic benefits.

An Analytical Comparison Between Ketamine Alone and a Combination of Ketamine and Propofol (Ketofol) for Procedural Sedation and Analgesia From an Emergency Perspective: A Systematic Review and Meta-Analysis.

Procedural sedation and analgesia (PSA) is a treatment approach involving treating patients with agents with dissociative, sedative, or analgesic properties to suppress their consciousness to variable levels. Ketamine and propofol have been used historically for PSA. Because they each have their demerits, it was postulated that combining both drugs (ketofol) would result in a mixture with additive properties and lessen or eliminate the demerits attributed to each drug. The primary objective of this systematic review and meta-analysis is to compare ketamine alone and a combination of ketamine and propofol (ketofol) for procedural sedation and analgesia from an emergency perspective.A systematic search was conducted on published studies from the databases of Scopus, ScienceDirect, PubMed, Google Scholar, APA PsycInfo, and the Cochrane Central Register of Controlled Trial (CENTRAL) until July 2022. The articles that were published on the online databases were authored between January 2007 and 2018. The selected papers were scanned and examined to check whether they met the eligibility criteria for the study.The search produced six articles that were included in the systematic review and meta-analysis. All six articles that passed the eligibility criteria were viable for the analysis. All the trials focused on the effectiveness of ketofol versus ketamine for PSA from an emergency perspective.Ketofol was found to be safe and more effective in comparison to ketamine for PTA.

Sedative and analgesic effects of propofol–ketamine versus propofol–fentanyl for emergency department procedures

Background:To manage and reduce painful procedures in the emergency wards, procedural sedation as well as analgesia can be used. Propofol combinations are the most common short‐acting intravenous sedative drugs in the field of emergency medicine.Objectives:This research aimed to compare the effectiveness, safety, and complications of intravenous infusion of ketofol with fentofol in painful emergency procedures.Methods:This study was a randomized, double‐blind clinical trial. Sampling was simple and used random assignment; 196 participants were randomly assigned to two groups of 98 patients each. In each group, injection was done with fentanyl–propofol or ketamine–propofol. For data gathering, pre‐procedure, and procedure, modified Aldrete's scoring checklist was used. In order to determine the levels of sedation, we used the Ramsay Sedation Scale. Data analysis was performed via SPSS Version 20 using statistical tests such as mean ± standard division, t‐test, chi‐square test, and analysis of variance.Results:Among the participants in this study, shoulder procedure was performed more than other procedures (56.6%). The mean of recovery time was significantly different in the two groups (ketofol: 5.65 ± 0.35 vs fentofol: 9.33 ± 0.78); the recovery time in group B (fentofol) was longer than that in group A (ketofol) (p = 0.001). Drug complications were statistically significant in the two groups, and complications by ketofol were less than those by fentofol (p = 0.001). “Hypotension and bradycardia” were observed with fentofol and “tachycardia” was observed with ketofol. The performance of these two drugs was not the same when subject to various procedures.Conclusion:Results of this study revealed that ketofol provided better analgesia and sedation, faster recovery time, lesser complications and adverse events, and reduced bradycardia and hypotension.

METHODS OF LABOR ANALGESIA BY DETERMING THE LEVEL OF CHILDBIRTH SATISFACTION

Introduction. Paroxysmal sympathetic hyperactivity (PSH) can occur as a result of brain injury, hypoxic brain damage, acute cerebrovascular accident (ACVA). The clinical picture of PSH is caused by excessive sympathetic activity and includes transient paroxysms of tachycardia, hypertension, hyperventilation, hyperthermia, and diaphoresis. PSH is a neurological emergency, which in the vast majority of cases is a diagnosis of exclusion. Lack of adequate detection and treatment of the disease leads to a high mortality rate. The diagnosis is exclusively clinical, so other pathologies must be excluded. Currently, the most widely accepted diagnostic criteria for PSH are the criteria proposed by Baguley et al. Case description. Patient D., 29 years old, was hospitalized with a diagnosis of middle cerebral artery stroke. The patient had attacks which were characterized by tachycardia, hypertension, tachypnea with asynchrony with the ventilator, diaphoresis and hypertension every day with a frequency of 2-3 times per day and were ending approximately 30-40 minutes after the onset. The diagnosis of PSH was established according to the score on the scale proposed by Baguley et al., 25 points (17 or more points – a probable diagnosis of PSH). Conclusions. It is believed that the cause of PSH is a violation of the inhibition function of the cortex on the brain structures located below, as a result of which paroxysms of sympathetic activation occur, manifested by tachycardia, hypertension, hyperventilation, diaphoresis, and hyperthermia. In this clinical case, resolution of paroxysms was observed faster with the combination of morphine and propofol. An important aspect of therapy is adequate rehydration therapy to compensate for fluid losses due to hyperthermia and diaphoresis, as well as the administration of beta-blockers on an ongoing basis

INFLUENCE OF SEDATION STRATEGY ON THE PATIENT’S HEMODYNAMIC STATUS IN THE EARLY POSTOPERATIVE PERIOD AFTER CARDIAC SURGERIES WITH CARDIAC PULMONARY BYPASS. COMPARISON OF PROPOFOL-BASED, DEXMEDETOMIDINE-BASED SEDATION OR THEIR COMBINATION

Introduction: Patient sedation in the intensive care unit after cardiac surgeries with cardiac pulmonary bypass (CPB) has an element of negative impact on the hemodynamic status of the patient. Vasoplegia caused by the use of of artificial blood circulation in combination with the use of hypnotics can lead to a large number of complications and increase the duration of the patient’s stay in the conditions of the intensive care unit. Purpose: to compare the effect on the hemodynamic status of patients after cardiac surgery with the use of artificial blood circulation 3 drugs for sedation: propofol, dexmedetomidine and their combination. Materials and methods: A randomized controlled parallel study was conducted. The study included 356 patients over 18 years of age who underwent cardiac surgical treatment with CBP. Statistical data processing was carried out on the basis of Prism 9.0 software. Results and discussion: The frequency of hemodynamic disturbances that required vasopressors in the early postoperative period was 35.79% (n= 34) in the propofol group (n= 95) ,12.35% (n = 10) in the group of the combination of propofol and dexmedetomidine (n= 81), 31.25% (n=5) dexmedetomidine sedation group (n= 16). (p=0.0011) Conclusions: Vasopressors infusion has been less common in the propofol and dexmedetomidine combination group (p = 0.0011).

Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation

Laryngospasm is a rare but potentially life-threatening complication of sedation. The objective of this study was to perform a predictor analysis of biologically plausible predictors and the interventions and outcomes associated with laryngospasm. Secondary analysis of prospectively collected data from consecutively sedated patients, less than or equal to 22 years of age, at multiple locations at 64 member institutions of the Pediatric Sedation Research Consortium. The primary outcome was laryngospasm. The independent variables in the multivariable model included American Society of Anesthesiologists category, age, sex, concurrent upper respiratory infection, medication regimen, hospital sedation location, whether the procedure was painful, and whether the procedure involved the airway. The analysis included adjusted odds ratios (aORs) and predicted probabilities. We analyzed 276,832 sedations with 913 reported events of laryngospasm (overall unadjusted prevalence 3.3:1,000). A younger age, a higher American Society of Anesthesiologists category, a concurrent upper respiratory infection (aOR 3.94, 2.57 to 6.03; predicted probability 12.2/1,000, 6.3/1,000 to 18.0/1,000), and airway procedures (aOR 3.73, 2.33 to 5.98; predicted probability 9.6/1,000, 5.2/1,000 to 13.9/1,000) were associated with increased risk. Compared with propofol alone, propofol combination regimens had increased risk (propofol+ketamine: aOR 2.52, 1.41 to 4.50; predicted probability 7.6/1,000, 3.1/1,000 to 12/1,000; and propofol+dexmedetomidine: aOR 2.10, 1.25 to 3.52; predicted probability 6.3/1,000, 3.7,/1,000 to 8.9/1,000). Among patients with laryngospasm, the resulting outcomes included desaturation less than 70% for more than 30 seconds (19.7%), procedure not completed (10.6%), emergency airway intervention (10.0%), endotracheal intubation (5.3%), unplanned admission/increase in level of care (2.3%), aspiration (1.1%), and cardiac arrest (0.2%). We found increased associations of laryngospasm in pediatric procedural sedation with multiple biologic factors, procedure types, and medication regimens. However, effect estimates showed that the laryngospasm prevalence remained low, and this should be taken into consideration in sedation decisionmaking.

Anaesthetic Management in Duchenne Muscular Dystrophy Patient with TIVA Using Combination of Propofol and Dexmedetomidine Complimented with USG Guided ESPB Block- A Case Report

Muscular dystrophies are a group of genetic diseases which cause progressive degeneration of skeletal muscle along with weakness. They are characterized by an impaired synthesis or regeneration of contractile protein. Patients with muscular dystrophies possess high preoperative risk with significant anaesthetic implications (hyperkalaemia, rhabdomyolysis, cardiovascular instability, sudden death, etc.). We herein describe the anaesthetic management of a 31yr old male who was a known case of Duchenne muscular dystrophy posted for right percutaneous nephrolithotomy (PCNL). The patient was induced and maintained with TIVA and using nitrous oxide as the only inhalational agent supplemented with USG guided Erector spinae plane block (ESPB) for post-operative analgesia. A thorough preoperative evaluation and multidisciplinary approach is essential for perioperative management of such cases.

Peri‐anaesthetic management of three dogs undergoing renal transplantation surgery

AbstractThis report describes the perioperative anaesthetic management of three dogs undergoing renal transplant surgery at the University of Pennsylvania using a familial donor kidney. All three cases were pre‐medicated with morphine for preoperative sedation and analgesia. Two cases were induced with a combination of fentanyl, midazolam and propofol. One case was induced with etomidate and midazolam. Anaesthesia was maintained with isoflurane in oxygen and an opioid constant‐rate infusion in all three cases, with one case also receiving a ketamine constant‐rate infusion throughout the anaesthetic procedure. Intraoperative complications that were corrected included hypotension (N = 2), hypokalaemia (N = 2), hyperkalaemia (N = 2), metabolic and respiratory acidosis (N = 2), low colloid‐oncotic pressure (N = 2), tachycardia (N = 1), bradycardia (N = 1) and anaemia secondary to intraoperative haemorrhage (N = 1). All dogs survived to be discharged from the hospital. The total survival times were 623, 350 and 46 days, which are longer than the previously reported median survival time of 24 days from discharge.

The perioperative effect of anesthetic drugs on the immune response in total intravenous anesthesia in patients undergoing minimally invasive gynecological surgery.

Background: The specific mechanism of action of each anesthetic drug on the immune system is still incompletely known. It is important to know how the various anesthetics used in minimally invasive surgery (MIS) act on the inflammatory response because the choice of the anesthetic agent can influence the patient’s immune system. Aim: Evaluation of the effect of anesthetic drugs used for total intravenous anesthesia (Propofol and Midazolam) on the inflammatory response after minimally invasive gynecological surgery. Patients, Materials and Methods: The inflammatory response in 20 female patients who underwent minimally invasive gynecological surgery under which intravenous anesthesia was performed. Depending on the combination of anesthetics used, we subdivided the study group into two groups, Group 1 consisting of the patients (n=10) who were given for total intravenous anesthesia, the combination with Midazolam+Fentanyl, and Group 2 (n=10) the patients who received the combination of Propofol+Fentanyl, respectively. Surgical interventional procedures included day surgery: diagnostic and operative hysteroscopy, endometrial ablation, surgical treatment of vulvar disorders. Serological profiling of patients was performed by dosing the serum concentration of nucleotide-binding domain (NOD) and leucine-rich repeat protein 3 (NLRP3) inflammasomes, interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), IL-10 before and two hours after the surgical procedure. Results: In our study, we found that in both groups of patients (Midazolam+Fentanyl – Group 1, Propofol+Fentanyl – Group 2), NLRP3 and cytokines concentrations in the serum were higher after MIS than those before MIS. Conclusions: It appears that both Midazolam and Fentanyl and Propofol and Fentanyl have an immunomodulatory action due to the anti-inflammatory effect of both anesthetics. Therefore, anesthesiologists must choose an anesthetic method that uses individualized anesthetic agents, depending on the patient’s immune status and disease.

Effect of combination of intravenous general anesthesia with propofol and fentanyl on surgery for aortic dissection repair in patients, and its influence on respiratory and circulatory functions

Purpose: To investigate the effect of application of propofol in combination with fentanyl intravenous anesthesia in interventional surgery for aortic dissection repair, and its influence on respiratory and circulatory functions in patients.Methods: 100 patients undergoing interventional surgery for aortic dissection repair in Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang. China from ovember 2018 to May 2020 were assigned equally to control group (CG) and study group (SG). CG received general anesthesia with propofol, while those in SG received combined intravenous general anesthesia with propofol and fentanyl. Time of anesthesia onset, postoperative awakening time, extubation time, respiratory function indicators and circulatory function indicators before operation (T0), and at intraoperative 1 h (T1), intraoperative 2 h (T2) and postoperative 2 h (T3); as well as postoperative VAS pain scores, and Ramsay sedation scores were determined and compared.Results: Compared with CG, SG had shorter anesthesia onset, shorter postoperative awakening and extubation times, and lower postoperative VAS pain and Ramsay sedation scores (p &lt; 0.05). At T1, T2 and T3, indicators of respiratory and circulatory functions were better in SG than in CG (p &gt; 0.05).Conclusion: Combined intravenous general anesthesia using propofol and fentanyl was more effective in interventional surgery for repair of aortic dissection, and it enhanced respiratory and circulatory functions in the patients.

Ketamine and Electroconvulsive Therapy: Better Together?

IntroductionMajor depressive disorder (MDD) is a highly prevalent clinical condition with a leading cause of disability worldwide. The currently available therapeutic agents have important limitations regarding side effects, partial or non-responsiveness. Patients are considered to have treatment-resistant depression (TRD) if there is no effect or minimal effectiveness after receiving adequate dose-duration use of antidepressants from two different categories. For this patients, electroconvulsive therapy (ECT) can be a treatment option and new therapies appear to tackle TRD like ketamine, a dissociative anesthetic and analgesic.ObjectivesThe authors elaborate a narrative literature review to understand if ketamine might enhance the antidepressant efficacy of ECT.MethodsPubMed database searched using the terms “Electroconvulsive therapy”, “ketamine” and “treatment-resistant depression”.ResultsECT is currently recommended as an end-line therapy for TRD. Memory impairment after ECT could be a consequence of indiscriminate activation or saturation of glutamate receptors during the treatment, disrupting hippocampal plasticity involved in memory. Ketamine inhibits N-methyl-d-aspartate (NMDA) receptors, while stimulating glutamate release and was proposed as an ECT adjuvant, might reduce cognitive adverse effects, time until response/ remission and inclusively improve response rates to ECT. However, response and remission rates of ketamine in ECT showed no significant difference from the comparator groups and was associated with higher rates of psychiatric and cardiovascular adverse events.ConclusionsThe results did not support the use the combination of ketamine and propofol as anesthetic agents for ECT in patients with MDD. However, further studies are needed to investigate the beneficial clinical and cognitive effects of ketamine alone in ECT settings.DisclosureNo significant relationships.

A COMPARISON OF PROPOFOL, ETOMIDATE AND KETOFOL AS INDUCTION AGENT: A RANDOMIZED CLINICAL STUDY

Introduction: Laryngoscopy and tracheal intubation is integral part of general anaesthesia but is frequently associated with haemodynamic disturbances. Propofol, ketamine and etomidate have their own limitations when they used alone for induction. Thus, this study was designed to compare haemodynamic changes during induction and intubation with propofol, etomidate and ketofol. Materials And Methods: After taking Clinical Trial Registry of India (CTRI/2018/04/013409) registration, this prospective, randomized, comparative, double blind Study was conducted on 120 patients aged 18-60 yrs, ASA grade I or II, posted for elective surgery under general anaesthesia. The patients were randomly allocated into three groups. Group P- Inj Propofol (2.0 mg/kg), Group E -Inj Etomidate (0.3 mg/kg) and Group KP- Inj Propofol (1.5 mg/kg) plus Inj ketamine (0.5mg/kg) intravenously. Heart rate, systolic blood pressure , diastolic blood pressure and mean arterial blood pressure were recorded before induction, immediately after induction, 0,1,3,5 and 10 min after intubation. Results: The data related analysed using Student t test, Pearson Chi-square test and ANOVA wherever applicable, P&lt;0.05 was considered statistically signicant. A statistically signicant difference was noted between the groups regarding vital parameters at different time interval [p&lt;0.05]. Conclusion: The combination of ketamine plus propofol has better haemodynamic stability without side effects than etomidate and propofol alone as an induction agent. Hence, combination (ketofol) may be better choice than either propofol or etomidate alone as induction agent with stable haemodynamics.

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 &amp; 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 &lt;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&lt;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&lt;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

Prospective randomized double-blind study to evaluate propofol and combination of propofol and sevoflurane as maintenance agents in reducing postoperative nausea and vomiting in female patients undergoing laparoscopic surgery.

Prevention and management of postoperative nausea and vomiting (PONV) is a fundamental part of anesthesia. Using sevoflurane and propofol in combination for maintenance of anesthesia has been found to reduce PONV compared to sevoflurane alone. However, there are limited studies comparing propofol with a combination of propofol and sevoflurane for the incidence of PONV after laparoscopic surgery. The prospective, randomized, double-blind study was planned to compare propofol and combination of propofol and sevoflurane as maintenance agents for the incidence of PONV. Seventy female patients of 18–60 years, of American Society of Anesthesiologists I or II, undergoing laparoscopic surgery were included. Propofol group (n = 35) included induction with propofol and maintenance with propofol infusion, and propofol + sevoflurane group (n = 35) included induction with propofol and maintenance with a combination of propofol infusion and sevoflurane inhalation. The objectives were to find the incidence of PONV and requirement of rescue antiemetic. In the propofol group, 11 patients (33%) experienced PONV and in the propofol + sevoflurane group, PONV was experienced by 12 patients (38.7%) [0.65]. In the propofol group, 11 patients required ondansetron and out of these 11 patients, 2 patients required metoclopramide. In the propofol + sevoflurane group, Ondansetron was required by 12 patients and 3 patients out of these 12 patients required metoclopramide. In the present study, the incidence of PONV was found to be similar in both groups. So, it can be suggested to add sevoflurane in smaller doses to infusion of propofol for maintenance of anesthesia.