Prevention of Hypotension During Propofol Induction: A Comparison of Preloading With Ringer Lactate and Intravenous Ephedrine

Abstract

ABSTRACT:The induction of general anaesthesia with propofol, however, has been associated with a decrease in systolic arterial blood pressure. Various measures to prevent hypotension include preloading with fluids (colloids and crystalloids) and use of vasopressors including ephedrine, dopamine, dobutamine, and metaraminol. The aim of the present study was to compare the three different regimes for the prevention of hypotension during induction of anaesthesia. MATERIALS AND METHODS: Ninety patients, classified as ASA physical status I or II, male/female, aged 20-50 years, body weight 45-85 kg, scheduled for various elective surgeries under general anaesthesia gave written informed consent to participate in this study. Patients were randomly allocated into one of three groups of 30 patients each to receive either normal saline Group C, ephedrine 70μg/kg, or Group E 10ml/kg Ringer Lactate Group RL prior to induction of anaesthesia with propofol (2mg/kg). Parameters analyzed were: heart rate and systemic arterial pressure noninvasively before induction, after propofol administration, immediate post intubation and then at 3min, 5min and at 10 post intubation. RESULTS: In all the groups there was an increase in the systemic arterial pressure post intubation; ephedrine> RL > control group. On comparing the groups at varied intervals the decrease was statistically significant in control group. (P<0.00).On comparing ephedrine group with RL decrease was statistically significant in the ephedrine group at 10mins. (P<0.01). CONCLUSION: We concluded, preoperative administration of ephedrine failed to prevent propofol-induced hypotension, but preoperative volume loading with 10ml/kg of ringer lactate successfully antagonised it, hence provide more haemodynamic stability.

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

“…18 Agarwal et al also concluded that preoperative administration of ephedrine failed to prevent propofol-induced hypotension, but preoperative volume loading with 10mL/kg of ringer lactate successfully antagonized it. 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.…”