PREVENTION OF HYPOTENSION CAUSED BY INDUCTION OF ANAESTHESIA WITH PROPOFOL, A COMPARISON OF PRELOADING WITH 3.5% POLYMERS OF DEGRADED GELATIN SOLUTION, CRYSTALLOID (RINGER LACTATE) & INTRAVENOUS EPHEDRINE

Abstract

AIMS:In this study, we compared the effect of preloading with crystalloid, colloid and intravenous ephedrine against the hypotensive effects of propofol induction in ASA I-II patients scheduled for elective surgical procedures. MATERIAL AND METHODS: 120 patients aged 20yrs to 50yrs were randomly allocated to one of the four groups of 30patients each. Group-1 (control) did not receive any study medication, group-2 received degraded gelatin 10ml/kg over a period of 15min, group-3 received ringer lactate 20ml/kg over a period of 15 min and group-4 received intravenous ephedrine 0.2mg/kg prior to induction of anesthesia. Midazolam 1mg was given 1hour before induction of anesthesia. Anesthesia was induced with propofol 2.5mg/kg over 20 to 30 seconds. Heart rate and blood pressure were recorded before induction and then every minute for 5 minutes after induction of anesthesia. After the study period patients were intubated and anesthesia was continued as required. Hypotension was defined as a drop in systolic arterial pressure more than or equal to 20% of baseline. RESULTS: A significant decrease in systolic arterial pressure occurred in patients of group preloaded with ringer lactate as well as the control group. Less decrease in systolic arterial pressure was seen in the patients preloaded with degraded gelatine and ephedrine group. The incidence of hypotension was also lower in ephedrine group when compared with degraded gelatin group. CONCLUSION: We conclude that crystalloid preloading is not efficacious in preventing hypotension while as degraded gelatine and ephedrine markedly attenuates, but does not fully abolish the decrease in blood pressure caused by induction.

Small dose of ephedrine for prevention of hypotension following propofol and fentanyl administration during induction of general anesthesia

“…19 Malla et al conclude that crystalloid preloading is not efficacious in preventing hypotension compared to gelatine and ephedrine which were markedly attenuated, but does not fully abolish the decrease in blood pressure caused by induction. 20 Dhungana et al found that preloading with colloid (Haemaccel, 10 mL/kg intravenously over 10-15 minutes) or prior injection of sympathomimetic ephedrine (0.2 mg/kg iv), prior to induction of anesthesia with propofol (2.5 mg/kg iv) though are not fully efficacious in preventing hypotension caused by propofol induction, both decrease the incidence in a significant number of patients with heart rate less than baseline value in the colloid group. 21…”