Propofol Requirements Research Articles

Comparison of Dexmedetomidine and Nalbuphine on Intubating Conditions and Hemodynamic Responses During Awake Fiberoptic Intubation: A Randomized Study

Background: The pre-requisites to a successful awake fiberoptic intubation (AFOI) include adequate psychological and pharmacological preparation of the patient. This study aims to compare two pharmacological agents, dexmedetomidine and nalbuphine, in addition to nebulization and airway topicalization, for intubating conditions during AFOI.
 Methods: Sixty consenting patients belonging to ASA I/II, MPC I/II, age-group of 18-60 years weighing between 40-70 kgs requiring general anaesthesia with endotracheal intubation were randomly allocated to one of the two groups. Patients received dexmedetomidine 1µg/kg i.v. (group D) or nalbuphine 0.2 mg/kg i.v. (group N) over 10 min before intubation. Fiberoptic intubation was attempted. Intubating conditions were assessed in terms of sedation score, cough score and post-intubation score. Hemodynamic responses, lignocaine and propofol requirement were also recorded. Repeated measure ANOVA, Tukey’s test, unpaired t test, Chi‑square test or Fisher’s exact test were used for data analysis. A P < 0.05 was considered significant.
 Results: Sedation score (P = 1.000), cough score (P = 0.165) and post‑intubation score (P = 0.157) were comparable among the two groups. Hemodynamic responses, propofol and lignocaine requirements were also comparable.
 Conclusion: Both intravenous dexmedetomidine and nalbuphine provide good intubating condition with minimal adverse effects on haemodynamic profile during awake fibreoptic intubation.

Effect of magnesium sulphate on propofol requirement in abdominal surgeries under general anesthesia

Background & Objective: Magnesium sulphate (MgSO4) has the potential to be used as a part of balanced anesthesia due to its inherent pharmacological actions. Its judicial use can enhance patient safety. We evaluated the effect of MgSO4 on the total dose of propofol used under bispectral index (BIS) targeted general anesthesia for abdominal surgeries.
 Methodology: This prospective randomized controlled trial was conducted on 60 adult patients of either sex, scheduled for elective surgery under general anesthesia. Patients were allocated to two study groups of 30 patients each. In Group I, MgSO4 was administered as 30 mg/kg intravenously (IV) in 100 ml normal saline (NS) over 15 min followed by 10 mg/kg/h infusion intraoperatively. In Group II 100 ml NS was administered over 15 min followed by NS infusion intraoperatively. Anesthesia was induced with propofol, fentanyl, and atracurium in both groups. Intraoperative propofol infusion was started to keep BIS values within 45-55. Data was compared for total dose of propofol used, Ramsay sedation score, recovery characteristics and hemodynamic parameters. Data so collected was statistically analyzed.
 Results: The mean quantity of propofol required for induction was less in Group I as compared to Group II, being 1.70 ± 0.19 mg/kg and 2.39 ± 0.58 mg/kg respectively (P < 0.001). Group I achieved BIS 60 (59.20 ± 7.63 seconds) faster than Group II (78.36 ± 13.03 sec) (P < 0.001). The requirement of propofol for maintenance was less in Group I (4.48 ± 0.95 mg/kg/h) as compared to Group II (6.63 ± 1.65 mg/kg/h) (P < 0.001). During recovery, the MgSO4 group needed more time to reach BIS 70 as compared to control group with their mean values being 8.86 ± 1.48 min and 6.88 ± 1.54 min respectively. Response to verbal commands and orientation was also significantly delayed in MgSO4 group as compared to control group (P < 0.001).
 Conclusion: Magnesium sulphate co-administration with propofol decreases the dosage of propofol to maintain a constant BIS value at 45–55. Sedation and delayed recovery are the notable drawbacks of using magnesium sulphate.
 Abbreviations: NMDA - N-methyl-D-aspartate; BIS - Bi‑spectral index; HR - Heart rate; MAP - mean arterial pressure
 Preregistration: Clinical Trial Registry-India (CTRI/2020/11/029315)
 Key words: Magnesium Sulphate; Propofol; BIS Target; Balanced Anesthesia
 Citation: Kaur H, Singh A, Prasad V, Singh A, Gupta KK, Sharma P. Effect of magnesium sulphate on propofol requirement in abdominal surgeries under general anesthesia. Anaesth. pain intensive care 2023;27(5):471−477. DOI: 10.35975/apic.v27i5.2118
 Received: January 14, 2023; Reviewed: July 17, 2023; Accepted: July 20, 2023

Comparison of two sedation protocols, with and without analgesia, in pigs: Assessment of sedation end points and propofol requirements

ObjectiveTo compare the effects of intramuscular premedication with a novel nonanalgesic [alfaxalone–midazolam–acepromazine (AMA)] and an analgesic [ketamine–midazolam–detomidine (KMD)] protocol on sedation end points and propofol requirements for induction of anesthesia in swine. Study designProspective experimental study. AnimalsA total of 27 Yorkshire cross gilts weighing approximately 30 kg. MethodsTwo sedation protocols, AMA and KMD, were compared. Time from intramuscular injection to ataxia, recumbency and nonresponsiveness to tactile stimulation was recorded. The propofol dose requirement for induction of general anesthesia and tracheal intubation, and any adverse events (paddling, twitching), were recorded. Data were tested for normality using a Shapiro–Wilk test. Propofol requirements were compared using a Student’s t test. Times from injection to sedation end points were compared using a Mood’s test, and significance was confirmed using a Kaplan–Meier curve with Wilcoxon test survival analysis. ResultsSedation end points were reached significantly faster with KMD than with AMA. Nonresponsiveness occurred in 5 (0–16) and 9.5 (5–36) minutes for KMD and AMA, respectively (p = 0.011). No significant difference (p = 0.437) was found between propofol doses used in either group (KMD; 64.38 ± 5.98 mg, AMA; 72.00 ± 7.57 mg). More adverse events were noted with AMA (11/16 pigs) than with KMD (1/11 pigs). Conclusions and clinical relevanceIn pigs, AMA can be used as a reliable sedation protocol. Frequency of adverse events and time to reach sedation end points between AMA and KMD differed, but the dose of propofol needed to induce general anesthesia was not significantly different.

Evaluation of thyromental distance versus tongue width versus weight-based method for size determination of laryngeal mask airway in adults

Background: Supraglottic airway devices (SGD) are indispensable for airway management. The successful placement of the laryngeal mask airway (LMA) supreme largely depends on the right size selection. Aims and Objectives: The study was undertaken to compare three LMA supreme insertion methods in short elective surgeries under general anesthesia. Materials and Methods: Atotal of 90 American Society of Anesthesiologists I and II patients (either gender, 18–55 years, Mallampati grade I and II) undergoing short surgeries were randomized into three equal groups (n=30 in each). Insertion of LMA was done after an adequate depth of anesthesia for jaw relaxation (Young’s criteria). The efficacy of controlled ventilation through LMA by each method, success rate, ease of insertion, insertion time, additional induction dose (propofol) required during insertion, hemodynamic stability (baseline vitals and 10 min after insertion), and adverse events after LMA removal were evaluated between groups. Results: Better ventilation (tidal volume at 10 cmH2O) was observed in the thyromental group (448±35) than in tongue width (440±46) and weight-based (409±33) groups. Minimum additional propofol requirement during insertion was in thyromental distance group. Thyromental distance group had the most easy LMA insertions (70%) with minimum insertion time (10±4) and minimum additional propofol requirement during insertion (P<0.05) than other groups. Overall hemodynamic stability and incidence of adverse events were comparable. Conclusion: Thyromental distance may be an alternative attractive choice for size determination of LMA supreme in female adults with normal airway anatomy in comparison to tongue width and conventional body weight-based methods.

Comparison of clinical effectiveness of propofol auto co-induction and midazolam propofol co-induction using the priming principle among patients undergoing surgeries

Introduction and Aim: Anaesthesia is a balance between adequate usage of anaesthetic drugs and the state of arousal of the patient. Inadequate dose of anaesthesia leads to increased incidence of awareness, while administration of generous drugs leads to complications such as hemodynamic instability and delayed recovery. The objective of the present study was to investigate the clinical effectiveness of propofol auto co-induction (PP) and midazolam propofol co-induction (PM) using the priming principle among patients undergoing surgeries. Materials and Methods: A prospective, randomized and comparative study, recruited 80 patients who were admitted for elective surgeries was carried out after the approval from institutional ethics committee approval and the trial was registered with the clinical trial registry-India (CTRI). Patients were randomly divided into 2 groups: PP group, where patients received 0.4mg/kg of propofol and PM group, where patients received 0.05mg/kg of midazolam. This was followed by propofol induction (2 mg/kg)-10mg every 15 seconds until a BIS value of 45 was attained in both groups. The collected data was assessed for the normality using the Shapiro-Wilk test. A p-value greater than 0.05 (>0.05) was considered to check the normality. The Student’s t-test and Mann-Whitney U test was used to analyse parametric data and non-parametric data before and after the intervention, respectively. Results: The results depicted a significantly reduced requirement of propofol (induction dose) in the PM group. Conclusion: Pre-dosing with Midazolam significantly decreases the induction dose (propofol) requirement without affecting hemodynamic stability.

A Comparative Study between Nebulized Ketamine, Nebulized Dexmedetomidine and Topical Lidocaine as Premedications for Flexible Fiberoptic Bronchoscopy in Pediatrics

Abstract Background Flexible fiberoptic bronchoscopy remains an invaluable tool in the evaluation and management of infant and pediatric respiratory disease. Anesthetic strategies in pediatric fiberoptic bronchoscopy should aim at minimizing respiratory complications as oxygen desaturation, hypoxemia, cough, bronchospasm and airway trauma. Objective To compare between the efficacy and safety of nebulized ketamine, nebulized dexmedetomidine and topical lidocaine as premedication for flexible fiberoptic bronchoscopy in pediatrics regarding the incidence of moderate to severe cough. Patients and Methods This prospective randomized clinical study was conducted in Ain shams University, Pediatric endoscopy unit on 186 children aged 2 to 8 years and classified according to the American Society of Anesthesiologists (ASA) physical status I or II and scheduled for flexible fiberoptic bronchoscopy (either diagnostic or therapeutic). The included patients were divided into 3 equal groups. Group D (Dexmedetomidine group) received nebulized dexmedetomidine 30 minutes before procedure (2 mic/kg), Group K (Ketamine group) received nebulized ketamine 30 minutes before procedure (2 mg/kg), and Group L (lidocaine group) received topical lidocaine 2% (3 mg/kg). Results Mean heart rate was insignificantly different at baseline among the three groups. Heart rate before induction, 15 minutes after induction and in PACU was significantly lower in group D compared with group K and group L (P < 0.001) and significantly higher in group K compared with group L (P < 0.001). Mean arterial blood pressure at baseline, before induction, 15 minutes after induction, and in PACU were insignificantly different among the three groups. Mean propofol requirements in group L were significantly higher compared with group D, and group K (p < 0.001) but insignificantly different between group D and group K. Conclusion Incidence of moderate to severe cough was less with nebulized dexmedtomidine and nebulized ketamine compared with topical lidocaine. There were no significant differences between nebulized dexmedtomidine and nebulized ketamine with regards to the incidence of moderate to severe cough. There was an insignificant difference between dexmedetomidine and ketamine in the incidence of moderate to severe cough, but it was significantly different between dexmedetomidine and lidocaine, and group ketamine and group lidocaine.

Efficacy of intravenous dexmedetomidine-lignocaine infusion compared to morphine for intraoperative haemodynamic stability in modified radical mastectomy: A randomised controlled trial.

In recent times, non-opioid analgesic-based anaesthesia has been gaining popularity as it can achieve the goals of hypnosis, amnesia, and haemodynamic stability while avoiding opioid side effects. Our study compares the efficacy of opioid-free anaesthesia and opioid-based general anaesthesia regarding intraoperative haemodynamic stability, anaesthetic requirements, awareness, and recovery profile. After receiving ethical approval and registering the trial, we conducted this randomised, single-blinded study on American Society of Anesthesiologists (ASA) physical status I and II patients who were aged 18-65 and were scheduled for modified radical mastectomy under general anaesthesia. Patients were randomised into two groups of 60 each. Group DL received IV dexmedetomidine 1 μg/kg loading over 10 min, 10 min before induction and 0.5 μg/kg/h infusion after that along with IV lignocaine 1.5 mg/kg at bolus followed by 1.5 mg/kg/h infusion. Group MN received IV morphine 0.15 mg/kg. Standard monitoring and general anaesthesia protocol were followed. Intraoperative haemodynamics, anaesthetic requirement, extubation time, and recovery profile were monitored. Data were analysed using Stata version 14 software, and statistical tests (Chi-squared test for qualitative variables, unpaired t-test and Mann-Whitney U test for quantitative variables) were performed. Both groups had comparable haemodynamic stability (P > 0.05). Group DL had a significantly lower propofol requirement for induction and maintenance (P < 0.001). Ramsay sedation score (P = 0.002) and extubation time (P = 0.029) were significantly higher in Group MN. The recovery profile was favourable in Group DL, with there being lower postoperative complications. Dexmedetomidine and lignocaine IV infusion demonstrated stable intraoperative haemodynamic stability, lower anaesthetic requirement, and better recovery profile than morphine without significant complications.

Effects of intravenous administration of magnesium sulfate in propofol-based sedation for ERCP in elderly patients: a randomized, double-blind, placebo-controlled study

BackgroundPropofol-based sedations are widely used in elderly patients for endoscopic retrograde cholangiopancreatography (ERCP) procedure, but respiratory depression and cardiovascular adverse events commonly occur. Magnesium administered intravenously can alleviate pain and decrease propofol requirements during surgery. We hypothesized that intravenous magnesium was used as adjuvant to propofol might be beneficial in elderly patients undergoing ERCP procedures.MethodsEighty patients aged from 65 to 79 years who were scheduled for ERCP were enrolled. All patients were intravenously administered 0.1 µg/kg sufentanil as premedication. The patients were randomized to receive either intravenous magnesium sulfate 40 mg/kg (group M, n = 40) or the same volume of normal saline (group N, n = 40) over 15 min before the start of sedation. Intraoperative sedation was provided by propofol. Total propofol requirement during ERCP was the primary outcome.ResultsThe total propofol consumption were reduced by 21.4% in the group M compared with the group N (151.2 ± 53.3 mg vs. 192.3 ± 72.1 mg, P = 0.001). The incidences of respiratory depression episodes and involuntary movement were less in the group M than those in the group N (0/40 vs. 6/40, P = 0.011; 4/40 vs. 11/40, P = 0.045; respectively). In the group M, the patients experienced less pain than those in the group N at 30 min after the procedure (1 [0–1] vs. 2 [1–2], P < 0.001). Correspondingly, the patients’ satisfaction was clearly higher in the group M (P = 0.005). There was a tendency towards lower intraoperative heart rate and mean arterial pressure in group M.ConclusionsA single bolus of 40 mg/kg of intravenous magnesium can significantly reduce propofol consumption during ERCP, with higher sedation success and lower adverse events.Trial RegistrationID UMIN000044737. Registered 02/07/2021.

Effect of Classical Music on Depth of Sedation and Induction Propofol Requirements in Dogs.

The main objective of this prospective, randomized, blind, cross-over experimental study was to evaluate the effect of classical music on the depth of sedation and propofol requirements for the induction of anaesthesia in dogs. Twenty dogs were involved, and each was subjected to three different treatments with a 3-month gap: Chopin music, Mozart music, and no music, via loudspeakers. The dogs were premedicated with acepromazine and butorphanol by intramuscular injection, and anaesthesia was induced using propofol intravenously. To compare the depth of sedation and propofol requirements for the induction of anaesthesia among the different treatments, we utilized non-parametric tests (Kruskal-Wallis test) for the depth of sedation due to a slight deviation from the normal distribution and parametric (ANOVA) for propofol requirements. When exposed to music (Chopin or Mozart), dogs exhibited deeper sedation and required less propofol for their intubation compared to the no-music treatment (p < 0.05). Exposure to classical music had a positive impact on the level of sedation, and more profound central nervous system depression seemed to contribute to approximately 20% lower propofol dose requirements for tracheal intubation. Therefore, classical music during the preoperative period appeared to exert a beneficial effect, at least when applying the specific pre-anaesthetic medications used in the present study.

Multidisciplinary Approach to Sedation and Early Mobility of Intubated Critically Ill Neurologic Patients Improves Mobility at Discharge.

Over-sedation may confound neurologic assessment in critically ill neurologic patients and prolong duration of mechanical ventilation (MV). Decreased sedative use may facilitate early functional independence when combined with early mobility. The objective of this study was to evaluate the impact of a stepwise, multidisciplinary analgesia-first sedation pathway and early mobility protocol on medication use and mobility in the neuroscience intensive care unit (ICU). We performed a single-center prospective cohort study with adult patients admitted to a neuroscience ICU between March and June 2016-2018 who required MV for greater than 48 hours. Patients were included from three separate phases of the study: Phase I - historical controls (2016); Phase II - analgesia-first pathway (2017); Phase III - early mobility protocol (2018). Primary outcomes included propofol requirements during MV, total rehabilitation therapy provided, and functional mobility during ICU admission. 156 patients were included in the analysis. Decreasing propofol exposure was observed during Phase I, II, and III (median 2243.7 mg/day vs 2065.6 mg/day vs 1360.8 mg/day, respectively; P = .04 between Phase I and III). Early mobility was provided in 59.7%, 40%, and 81.6% of patients while admitted to the ICU in Phase I, II, and III, respectively (P < .01). An increased proportion of patients in Phase III were walking or ambulating at ICU discharge (26.7%; 8/30) compared to Phase I (7.9%, 3/38, P = .05). An interdisciplinary approach with an analgesia-first sedation pathway with early mobility protocol was associated with less sedative use, increased rehabilitation therapy, and improved functional mobility status at ICU discharge.

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

Dose Response Curves of Plasma Concentration 50 of Propofol Target-Controlled Infusion for Supraglottic Airway Devices: A Randomized Controlled Trial

Objective: We aimed to determine the plasma concentration 50 (CP50) of propofol target controlled infusion (TCI) for successful insertion of four types of supraglottic airway devices (SGD). Material and Methods: This prospective parallel randomized controlled, double blinded, superiority trial was conducted in June 2012 following approval by the Ethics Committee of the Faculty of Medicine, Prince of Songkla University, Thailand. Effect-site concentrations (Ce) of propofol TCI were determined by the modified Dixon’s up-and-down method. After equilibration was established between the plasma and effect-site concentrations, a SupremeTM, ProSealTM(control groups), I-gelTM or Laryngeal Tube Suction IITM devices were inserted. The CP50 was determined by dose response logistic curves presented as means and 95% confidence intervals (CI). The General Estimating Equation was used to determine factors associated with hemodynamic changes. Results: The Ces of TCI propofol requirements in the SupremeTM, ProSealTM, I-gelTM and Laryngeal Tube Suction IITM groups were 5.8, 4.8, 5.6, and 5.8 μg/ml, respectively (effect size [95% CI]: 0.22 [0.06, 0.51], p-value 0.036). The CP50 [95% CIs] in the SupremeTM, ProSealTM, I-gelTM and Laryngeal Tube Suction IITM groups were 5.8 [-0.01, 11.6], 4.9 [3.3, 6.5], 5.7 [5.0, 6.3] and 5.5 [4.7, 6.4] μg/ml, respectively. Heart rates and systolic blood pressure were significantly higher in the Laryngeal Tube Suction IITM group than in the ProSealTM (p-value&lt;0.01) and I-gelTMgroups (p-value&lt;0.01 Conclusion: The ProSealTM and I-gelTM are preferred over the SupremeTM and Laryngeal Tube Suction IITM devices due to the lower CP50 and hemodynamic changes.

Fentanilo para la coinducción de la anestesia con propofol en perros premedicados con morfina

The aim of the present study was to evaluate the effectiveness of fentanyl to reduce the induction dose of propofol and the quality of induction in dogs premedicated with morphine. The sedative effect promoted by morphine and its action on some physiological variables were also investigated. Twenty-two healthy dogs had their baseline values (BL) of the physiological variables and the degree of sedation recorded. Then, received morphine (0.3 mg/kg) intramuscularly. Ten minutes after morphine administration (T10), all variables were reassessed. Dogs were randomly assigned to receive intravenously: fentanyl (2.5 µg/kg) or saline (3.0 mL), followed by propofol (2 mg/kg/minute), groups FP and SP, respectively. The dose of propofol required for intubation and the quality of anesthetic induction were recorded. Morphine administration resulted in vomiting and no sedation. Heart rate significantly decreased at T10 in FP and in SP groups, compared to BL. The total dose of propofol used for anesthetic induction was 6.4 ± 1.7 and 5.8 ± 1.6 [mean ± standard deviation] mg/kg in FP and SP, respectively, with no differences between groups (P &gt; 0.05). The quality of anesthetic induction score was excellent in all groups. During anesthetic induction, some dogs had apnea and muscle stiffness. Fentanyl was not effective in reducing the propofol requirement in the anesthetic induction of dogs premedicated with morphine. Anesthetic induction was excellent in both groups, and may be accompanied by apnea and muscle stiffness. Morphine resulted in no sedation, minimal changes in physiological parameters and vomiting.

Effects of Earmuffs and Eye Masks on Propofol Sedation during Spinal Anesthesia for Orthopedic Surgery: A Randomized Controlled Trial.

Intravenous sedative drugs are commonly administered during regional anesthesia. However, reducing the excessive use of sedatives while providing adequate sedation is important from the clinical perspective, since the use of sedatives can cause considerable complications. We hypothesized that the application of earmuffs and eye masks would help reduce the sedative dose required to maintain proper sedation by blocking external stimuli. Patients who underwent orthopedic surgery under spinal anesthesia were randomly allocated to the control (no intervention) or intervention group (wearing earmuffs and eye masks). Intravenous sedation was administered using target-controlled infusion of propofol. The target concentration was controlled to maintain a Modified Observer's Assessment of Alertness and Sedation score of 3 or 4. The primary outcome was the intraoperative propofol requirement. We also investigated the incidence of apnea, and patient satisfaction. Propofol requirement was significantly lower in the intervention group than that in the control group (2.3 (2.0-2.7) vs. 3.1 (2.7-3.4) mg·kg-1·h-1; p < 0.001). Intraoperative apnea occurred less frequently (p = 0.038) and patient satisfaction was higher (p = 0.002) in the intervention group compared to the control group. This study demonstrated that the use of earmuffs and eye masks during sedation was associated with lower propofol requirement and improved sedation quality.

A randomized comparative study of preoperative fentanyl and dexmedetomidine nebulization on the hemodynamic response to endotracheal intubation

Background: Intense sympathetic activity is linked to laryngoscopy and endotracheal intubation, which could lead to intraoperative problems. We undertook this study to compare the effects of preoperative nebulized Fentanyl and Dexmedetomidine on hemodynamic response to laryngoscopy and endotracheal intubation, taking advantage of their high bioavailability and better absorption through nasal mucosa. Aim and Objectives: The objectives of the study were (i) to compare the effect of preoperative nebulization on the hemodynamic response to laryngoscopy and intubation; and (ii) to assess intraoperative requirement of anesthetic agents. Materials and Methods: This prospective, randomized, and comparative study was conducted among 100 American Society of Anesthesiologists (ASA) I, II patients (of either gender) undergoing elective surgeries and requiring tracheal intubation, were randomized in two groups. Group A was given Fentanyl Nebulization (2 μg/kg in 4 ml of 0.9% saline) and Group B was given Dexmedetomidine nebulization (1 μg/kg in 4 ml of 0.9% saline) 10 min before anesthesia induction. Hemodynamic parameters were noted before and immediately after induction, 1 min, 5 min and 10 min after intubation. The main goal was to assess how Fentanyl and dexmedetomidine nebulization affect the laryngoscopy and intubation-induced stress response. The secondary outcome was to assess the intraoperative requirement of anesthetic agents, observe adverse effects of study drug and sedation score. Results: Dexmedetomidine nebulization was found to be more effective in blunting rise in heart rate post laryngoscopy compared to Fentanyl Nebulization (P &lt; 0.0001) as well as in MAP after 10 min of intubation (P &lt; 0.0001). Requirement of propofol was seen to be significantly reduced in Group B compared to Group A (P &lt; 0.05). Sedation scores were significantly higher in Group B (P &lt; 0.05). No evidence of side effects was observed in any group. Conclusion: Nebulisation of dexmedetomidine was found to be more effective in attenuation of stress response of laryngoscopy and intubation compared to nebulisation of fentanyl, with stable intraoperative hemodynamic and no significant side effects.

Effects of oral melatonin premedication on hemodynamic responses to intubation, anesthetic requirements and postoperative sedation: A randomized trial.

Sedative effects of melatonin may have an additive effect on general anesthesia (GA). We compared hemodynamic response to intubation following oral premedication with melatonin versus placebo. Induction dose of propofol, isoflurane and fentanyl consumption were also compared. This prospective, double-blinded study was conducted in fifty patients randomized into two equal groups. Group M received oral melatonin 6 mg and group P a placebo two hours before surgery. All patients were induced with intravenous propofol of 1.5-2.5mg/kg till loss of response to verbal commands, three minutes after vecuronium, laryngoscopy was done and trachea was intubated. Heart rate (HR) and mean arterial pressures (MAP) were recorded before premedication, before induction, immediately after induction and then at 1,3,5 and 10 minutes after intubation. Mean HR was comparable in both groups throughout the study period. Group M had significantly lower MAP before induction and immediately after induction (P < 0.05). At all other time points MAP remained comparable in both groups. Mean isoflurane consumption was significantly lower in group M compared to group P (14.8 ± 4.2 vs 19.7 ± 3.2 mL). Propofol requirement for induction was also significantly lower in group M (102.4 ± 19.6 vs 122.4 ± 26.3mg). Intraoperative fentanyl consumption was comparable. Oral premedication with melatonin 6mg administered two hours before surgery significantly reduced MAP before and after induction of GA with a significant reduction in dose of propofol requirement. Titrating induction dose of propofol till loss of response to verbal commands did not effectively attenuate responses to laryngoscopy and intubation following melatonin oral premedication.

ANESTHETIC PROPERTIES OF PROPOFOL AND KETOFOL (KETAMINE WITH PROPOFOL): A COMPARATIVE STUDY

Background: Surgical procedures require a safe anesthesia and safe anesthetic agents for this purpose use of small dose of sedative agent or any other anesthetic agent in order to reduce the dose requirement as well as adverse effects of the main inducing agent. Therefore, this study was carried out using ketamine with propofol (KETOFOL) to compare the hemodynamic stability (Heart rate and Mean arterial pressure) and induction doses. Methods: Fifty patients of age 18 to 60 years of ASA II and I scheduled for elective surgery to be performed under general anaesthesia were randomly selected and divided into two groups. Patient in Group-P received 50 mg propofol and Group-K received 50 mg (25mg ketamine with 25 mg propofol) intravenously bolus slowly and then 10 mg in every 10 seconds until the loss of eyelash reflex and verbal response. The hemodynamic response was noted at different given time. Chi square test and student’s t test were used for analysis. Results: The study showed that the hemodynamic (heart rate and mean arterial pressure) was maintained and decrease in dose requirement for propofol for induction in (ketamine with propofol Ketofol group whereas there was significant decrease in hemodynamic (heart rate and mean arterial pressure) in Propofol group. Conclusions: Our study concluded that fluctuations in heart rate and mean arterial pressure from baseline were more in propofol group compared to ketofol (ketamine with propofol) group. Therefore, Ketofol achieved better hemodynamic stability over propofol alone and also induction dose of propofol was reduced.

Effect of Oral Clonidine Premedication on Hemodynamic Stress Response to Laryngoscopy and Tracheal Intubation

Introduction: Different techniques have been tried to blunt undesirable hemodynamic effects like tachycardia, hypertension and dysarrhythmias during and after laryngoscopy and tracheal intubation.&#x0D; Objective: To find out the effect of oral clonidine premedication on hemodynamic stress response to laryngoscopy and tracheal intubation.&#x0D; Methodology: It was a prospective, randomized, double-blind comparative study conducted in patients undergoing laparoscopic cholecystectomy. Either oral clonidine 300 mcg (n=30) or placebo (n=30) was given one hour before the surgery. Depth of anesthesia was monitored and maintained at 40-60 level using bispectral index (BIS) monitor. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP) and oxygen saturation (SpO2) at baseline, one hour after premedication, on operation theatre (OT) table, just before and after one, two and five minutes after laryngoscopy and intubation were compared in Clonidine and placebo group using Paired t test and Chi-square test. SPSS was used for statistical analysis at P-value&lt;0.05&#x0D; Results: Hemodynamic variables like HR, SBP, DBP and MBP were significantly lower in the clonidine group compared to placebo just before and after the first five minutes of laryngoscopy and tracheal intubation (P&lt;0.05). Propofol requirement for induction of anesthesia was less in the clonidine group (95±31.8 mg vs 75.3±28.5 mg, p=0.014) compared to the placebo group. Adverse effects like hypotension and bradycardia were comparable in the groups. Time taken for extubation, time to follow verbal commands and time to orientation after surgery were similar in the both groups (P&gt;0.05).&#x0D; Conclusion: Oral clonidine premedication was effective in blunting undesirable hemodynamic stress response to laryngoscopy and tracheal intubation compared to the placebo.

Evaluation of Propofol-Sparing Effect of Intravenous Lignocaine in Patients Undergoing Daycare Upper Gastrointestinal Endoscopic Procedures.

Background Propofolis the most commonsedativefor endoscopies. Propofol alonemay require larger doses for adequate level of sedation. Lignocaine is known for its anesthetic-sparing effect. We tested whether the addition of intravenous lignocaine to propofol-based sedation reduces its dose. Methods Thisprospective, randomized study was performed on 90 patients of 18 to 60 years of age, of either sex of the American Society of Anesthesiologists (ASA) Grade-I & II, and was divided into two groups. Group L + P received IV bolus of 1.5 mg/kg 2% lignocaine over 10 minutes followed by 1.5 mg/ kg/ h infusion andgroup NS + P- received the equivalent volumes of normal saline in bolus and infusion. Patients were induced with fentanyl (2 µg/kg) and propofol (1 mg/kg).To maintain an adequate sedation level, a supplemental bolus of 0.5 mg /kg propofol was administered. Theoutcomes recorded werethe totaland supplemental amount of propofol administered, as well as recovery time. Results The mean supplemental propofolfor group L + P and group NS + P- 37.00 ± 29.93 and 58.67 ± 19.49 mg, respectivelyandmean total propofol consumption was 98.22 ± 34.00 mg and 131.11 ± 23.18 mg, respectively, (p < 0.001). Mean recovery time in group L + P was also shorter (5.22 ± 2.14 versus 9.96 ± 2.14). The incidence of adverse events like gag reflux, upper airway obstruction, pain on injection, and hypotension was significantly lower in group L + P (p < 0.05). Conclusion The addition of lignocaine to propofol-based sedation reduced the overall propofol requirement at the same time maintaining hemodynamic stability, spontaneous respiration, and early recovery.

High daily caffeine intake is associated with lower propofol requirements for anesthetic induction.

There is significant interindividual variation in the dose of propofol required for anesthetic induction. Factors dictating this are poorly described, but understanding them would be useful for anesthetic drug dosing. It has been shown in rats and recently in humans that caffeine administration accelerates recovery from anesthesia, but no study has assessed the effect on anesthetic induction. Forty American Society of Anesthesiologists (ASA)-I, 18-65-year-old patients, undergoing day case general anesthesia with propofol and fentanyl took part in this observational study. Total daily caffeine intake (mg) was estimated using the caffeine assessment tool and caffeine content values from the US Department of Agriculture National Nutrient Database. Pharmacokinetic-pharmacodynamic modeling was used to estimate the effect site concentration of propofol at loss of consciousness (Ce(p) LOC). Median (interquartile range [IQR]) daily caffeine intake was 106 (51-193) mg. Ce(p) LOC was lower in those with caffeine intake greater than or equal to the median of 106 mg (median (IQR) = 0.64 μg/ml (0.51-0.72) vs. 0.70 μg/ml (0.57-1.10), P = 0.04). The effect was robust when controlling for weight-adjusted fentanyl dose, age, smoking status, and alcohol intake (F (1,34) = 4.66, P = 0.04). High daily caffeine intake is associated with lower propofol requirements for day case anesthetic induction. We propose that high daily caffeine intake may cause lower arousal levels prior to surgery due to a relative caffeine deficit caused by being nil by mouth. As such, assessment of daily caffeine intake preoperatively may aid anesthetic drug dosing.