A comparative study of efficacy of propofol auto-co-induction versus midazolam propofol co-induction using the priming principle

Kataria, Roopam; Singhal, Ajay; Prakash, Shiv; Singh, Ishwar

doi:10.4103/0019-5049.72647

Cited by 16 publications

(16 citation statements)

References 12 publications

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“…This variation may be attributed to the higher doses of oral clonidine being used for preoperative sedation 4-5 μg/kg in the previous studies,[ 4 8 9 10 11 12 ] while we used only 1.5 μg/kg i.v. [ 7 13 14 ] observed mean reduction in the propofol doses after midazolam pretreatment, more than our study, the reason, which may be attributed to this difference is relatively younger age group of the patients in our study. This study supports that induction doses of propofol required were less with midazolam premedication as compared to clonidine clinically, which could be due to the fact that both propofol and midazolam have been known to have a depressive effect on the CNS via GABA-A receptor-mediated inhibition, and share a common receptor or exert effect on the GABA-A receptor.…”

Section: Discussioncontrasting

confidence: 56%

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Efficacy of intravenous midazolam versus clonidine as premedicants on bispectral index guided propofol induction of anesthesia in laparoscopic cholecystectomy: A randomized control trial

2014

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Background:Midazolam and clonidine are preferred premedicants whose effects are not restricted to the preoperative period. In addition, these premedicants significantly modulate not only the intraoperative requirements of the anesthetic agents, but also the postoperative outcome. We aim to compare the efficacy of both the agents in view of premedication, induction characteristics, hemodynamic changes and postoperative complications utilizing bispectral index (BIS) using propofol anesthesia.Materials and Methods:The type of this study was randomized control trial conducted on patients undergoing laparoscopic cholecystectomy under general anesthesia with endotracheal intubation. Study included 105 patients of either sex aged 20-60 years. The patients were randomly allocated into three groups: Intravenous midazolam (Group 1), clonidine (Group 2), and normal saline (Group 3) (control). The initial value of BIS and Ramsay Sedation Score, dose of propofol required for induction were noted in each group and monitored for pulse rate, electrocardiograph, noninvasive blood pressure, and BIS.Results:The requirement of propofol ranged from 40 to 150 mg. Mean requirement was maximum in Group 3 (109.43 ± 20.14 mg) and it was minimum in Group 1 (78.57 ± 22.15 mg). A significant reduction in consumption of propofol with the use of midazolam (P < 0.001) and clonidine (P < 0.001) was observed. Both premedicants partially attenuates laryngoscoy and intubation response along with reduction in the incidence of postoperative complications.Conclusion:Both clonidine and midazolam contributed equally in lowering propofol consumption. Reduction in the induction dosage of propofol and hemodynamic variations were also observed to be similar with the use of midazolam or clonidine as premedicants. Both provide a beneficial effect in relation to recovery and less postoperative complications. However clonidine premedication was found to be more effective in preventing post operative shivering and can be recommended in routine practice.

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Section: Discussioncontrasting

confidence: 56%

“…Calculation of sample size was done on the basis of findings from a previous study[ 7 ] considering reduction in propofol dose as a main parameter. A difference between the groups of more than 20-25% will be considered as a practical significant.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of intravenous midazolam versus clonidine as premedicants on bispectral index guided propofol induction of anesthesia in laparoscopic cholecystectomy: A randomized control trial

2014

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“…SBP at OMAI, IAI values are not significant as p values are 0.428 and 0.2 respectively. In the study by Roopam Kataria et al 5 mean SBP observed to be maintained at induction in control group and slight fall observed in other two groups i.e propofol auto co induction and Midazolam co induction group.…”

Section: Bar Graph 6: Mbp Values At Varied Intervals Groupsmentioning

confidence: 86%

Hemodynamic Study During Induction of General Anaesthesia With Propofol Using Priming Principle

Pratap¹,

Shareena²,

Mahmood³

et al. 2015

jemds

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Propofol is a popular intravenous induction agent, hypotension is known complication of propofol, hence priming technique is adopted to reduce the induction dose and hence reduce the incidence of hypotension. Current study is undertaken to evaluate the haemodynamic changes with bolus dose and priming dose of propofol. METHODS: the study population is divided into two groups -PRIMING GROUP: After calculating the total dose of Propofol induction agent (2mg/kg) 20% was injected as bolus and remaining drug is administered till the loss of eye lash reflux and verbal response at the rate of 30mg/10sec. NON PRIMING GROUP: intravenous injection of propofol bolus (2mg/kg) iv in 30 seconds was given. RESULT: A mean induction dose of Propofol required in priming group is 88.26mg and in non-priming group it is 106.28mg. Reduction in dose requirement in priming group is by 16.74%.Haemodynamic stability was better in non-priming group. Complications like apnoea, involuntary movements, were seen in both the groups. CONCLUSION: Induction dose of Propofol is reduced in priming group and there is greater fall of blood pressure compared to non-priming group, both groups had fewer side effects like apnoea and involuntary movements.

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“…[ 2 3 ] “Auto-coinduction” is a technique where we administer a precalculated dose of the induction agent before administering the full dose of the same agent. [ 4 5 6 ] In our study, we proposed to study the efficacy of propofol auto-coinduction technique as compared to the conventional propofol induction technique in patients who are not pretreated with midazolam. We aim to study the total induction dose requirement of propofol, the incidence of hemodynamic side effects and pain on injection, and the incidence of fentanyl-induced cough (FIC) between the auto-coinduction technique and the conventional induction technique.…”

Section: Introductionmentioning

confidence: 99%

A study comparing propofol auto-coinduction and standard propofol induction in patients undergoing general anesthesia without midazolam pretreatment: A prospective randomized control trial

Prathapadas

Gomathiamma

Arulvelan³

et al. 2018

Anesth Essays Res

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Background:Propofol has emerged as an induction agent of choice over the past two decades due to its quick, smooth induction and rapid recovery. The main concern for an anesthesiologist is the hemodynamic instability caused by the standard induction dose of propofol (2–3 mg/kg).Aim:We aim to study the efficacy of propofol auto-coinduction technique in comparison to the standard propofol induction technique in terms of the total induction dose requirement of propofol, the incidence of hemodynamic side effects and pain on injection, and the incidence of fentanyl-induced cough (FIC) in the absence of a synergistic agent like midazolam.Materials and Methods:This was a prospective, observer-blinded, randomized controlled trial. The study was initiated after obtaining the institutional ethics committee approval and is registered in the Clinical Trials Registry India. Eighty American Society of Anesthesiology Physical Status I and II patients, of either sex, aged between 18 and 55 years, and scheduled for elective surgeries under general anesthesia were randomized into two equal groups. Patients allocated to Group I (auto-coinduction) received 20% of the calculated dose of injection propofol 2 mg/kg (i.e., 0.4 mg/kg) as the priming dose followed by injection fentanyl 1 μg/kg after 1 min and the remaining propofol was administered in titrated doses till loss of verbal response after 2 min. In Group II (control), patients received injection fentanyl 1 μg/kg followed by single bolus dose of injection propofol up to 2 mg/kg till loss of verbal response. Midazolam was not used for premedication or induction. Intubation was carried out only after ensuring achievement of optimum depth of anesthesia using bispectral index scale. The total dose of propofol administrated for induction, occurrence of pain on injection, severity of cough after fentanyl administration, hemodynamic parameters, and apneic episodes were recorded.Statistical Analysis:All data were expressed as mean ± 2 standard deviation. For statistical analysis, SPSS software version 16 (SPSS Inc., 2007, Chicago, IL, USA) was used.Results:The mean dose of injection propofol required for induction was significantly lower in Group I (67.0 ± 17.9 mg) when compared with Group II (111.3 ± 17.6 mg) (P < 0.01). The mean heart rate was significantly higher (P < 0.01) and the mean blood pressure was significantly lower in Group II (P < 0.01) when compared to Group I at 1 min postinduction, immediately after intubation, and 5 min after induction. The incidence of complications such as hypotension, pain on injection, and FIC was higher in Group II (50%) as compared to Group I (18%).Conclusion:In our study, we found that the induction dose requirement of propofol was significantly lower in the auto-coinduction group when compared to the conventional induction group. The auto-coinduction technique offered a stable hemodynamic profile, reduced pain on injection, and less incidence of FIC as compared to the conventional propofol induction technique.

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A comparative study of efficacy of propofol auto-co-induction versus midazolam propofol co-induction using the priming principle

Cited by 16 publications

References 12 publications

Efficacy of intravenous midazolam versus clonidine as premedicants on bispectral index guided propofol induction of anesthesia in laparoscopic cholecystectomy: A randomized control trial

Efficacy of intravenous midazolam versus clonidine as premedicants on bispectral index guided propofol induction of anesthesia in laparoscopic cholecystectomy: A randomized control trial

Hemodynamic Study During Induction of General Anaesthesia With Propofol Using Priming Principle

A study comparing propofol auto-coinduction and standard propofol induction in patients undergoing general anesthesia without midazolam pretreatment: A prospective randomized control trial

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