The effect of propofol when injected at different speeds for induction of general anesthesia: an observational study
Keywords:Propofol, Intravenous anesthetics, Hemodynamics, Induction time
Background: The hypotensive effect of propofol is attributable to a decrease in sympathetic activity, direct vasodilatation and myocardial depression. The aim of the study was to assess the effect of propofol when injected at different speeds for induction of general anesthesia on the following parameters: blood pressure, time of induction of anesthesia, dose of propofol used.
Methods: The present study was conducted in post Graduate Department of Anesthesia and Surgery, Govt. Medical College, Srinagar for a period of two years and included 90 patients from July 2014 to June 16, the study was prospective one.
Results: In our study patients divided into three groups with 30 patients in each group. The mean age in group P400, P600, P800 was statistically insignificant p>0.843.The mean weight in group P400, P600, P800 was statistically insignificant p>0.885.The mean height in group P400, P600, P800 was statistically insignificant p>0.748. The mean induction time in P400 and in P600 was statistically significant. The mean systolic blood pressure, pre and post induction in P400, in P600 and in group P800 was statistically significant. The mean diastolic blood pressure, in pre and post induction in P400, P600, P800 was statistically insignificant with a p>0.05. The mean arterial pressure in pre and post induction in P400, P600, P800 was statistically significant (p<0.05). The mean heart rate in pre and post induction was statistically insignificant. The mean oxygen saturation (%) pre and post induction was statistically insignificant.
Conclusions: We concluded that induction dose required for loss of consciousness increased with a faster rate of infusion while time for induction was shorter in P800 compared to P400 and P600, and the decrease in mean blood pressure was less after induction in P400. Propofol injection should be slow enough to prevent any hemodynamic deterioration in anesthesia induction.
Sebel PS, Lowdon JD. Propofol, a new intravenous anaesthetic. Anesthesiol. 1989;71:260-77.
Kazama T, Ikeda K, Morita K, Ikeda T, Kikura M, Sato S. Relation between initial blood distribution volume and propofol induction dose requirement. Anesthesiol. 2001;94:205-10.
Adachi YU, Watanabe K, Higuchi H, Satoh S. The determinants of propofol induction of anaesthesia dose. Anesth Analg. 2001;92:656-61.
Kazama T, Ikeda K, Morita K, Kikura M, Ikeda T, Kurita T, et al. Investigation of effective anesthesia induction doses using a wide range of infusion rates with undiluted and diluted propofol. Anesthesiol. 2000;92:1017–28.
Kazama T, Ikeda K, Morita K, Kikura M, Ikeda T, Kurita T, et al. A physiological model of induction of anaesthesia with propofol in sheep. 2. Model analysis and implications for dose requirement. Br J Anaesth. 1997;79:505–13.
Larijani G, Gratz I, Afshar M, Jacobi AG. Clinical pharmacology of propofol:an intravenous anesthetic agent. DICP. 1989;23:743-9.
New awakening in anaesthesia-at a price. Lancet. 1987;8548:1469-70.
Propofol. Med Lett Drugs Ther. 1990;32:22.
Kanto J, Gepts E. Pharmacokinetic implications for the clinical use of propofol. Clin Pharmacokinet. 1989;17:308-26.
Wagner B, Berman S, Devitt P, O'Hara DA. Retrospective analysis of postoperative nausea and vomiting to determine antiemetic activity of droperidol added to propofol:a possible drug interaction. Pharmacotherapy. 1994;14:586-91.
Rolly G, Versichelen L, Huyghe L, Mungroop H. Effect of speed of injection on induction of Anesthesia using propofol. Bri J Anesth. 1985;57(8):743-6.
Liu SH, Wei W, Ding GN, Ke JD, Hong FX, Tian M. Relationship between depth of anesthesia and effect- site concentration of propofol during induction with the target- controlled infusion technique in elderly patients. Chin Med J (Engl). 2009;122(8):935-40.
Gillies GW, Lees NW. The effects of speed of injection on induction with propofol. A comparison with etomidate. Anaesthesia. 1989;44:386-88.
Rolly G, Versichelen L, Huyghe L, Mungroop H. Effects of speed of injection on induction of anaesthesia using propofol. Br J Anaesth. 1985;57:743-6.
Robinson B, Ebert T, O'Brien T, Colinco MD, Muzi M. Mechanisms whereby propofol mediates peripheral vasodilation in humans. Anesthesiol. 1997;86:64-72.
Langley M, Heel R. Propofol. A review of its pharmacodynamic and pharmacokinetic properties and use as an intravenous anaesthetic. Drugs. 1988;35:334-72.
Caleys MA, Gepts E, Camu F. Hemodynamic changes during anesthesia induced and maintained with propofol. Br J Anaesth. 1988;60:3- 9.
Tramer MR, Moore RA, McQuay HJ. Propofol and bradycardia:causation, frequency and severity. Br J Anaesth. 1997;78:642-51.
Ebert TJ, Muzi M, Berens R, Goff D, Kampine JP. Sympathetic response to induction of anesthesia in humans with propofol or etomidate. Anesthesiol. 1992;76:725-33.
Uzun S, Özkaya BA, Yilbaş OS, Ayhan B, Şahin A, Aypar U. Effects of different propofol injection speeds on blood pressure, dose, and time of induction. Turk J Med Sci. 2011;41(3):397-401.
Peacock JE, Lewis RP, Reilly CS, Nimmo WS. Effect of different rates of infusion of propofol for induction of anaesthesia in elderly patients. Br J Anaesth. 1990;65:346-52.
Stokes DN, Hutton P. Rate dependent induction phenomena with propofol: Implications for the relative potency of intravenous anesthetics. Anesth Analg. 1991;72:578-83.