The Influence of Fentanyl and Tracheal Intubation on the Hemodynamic Effects of Anesthesia Induction with Propofol/N2O in Humans

Aken, Hugo Van; Meinshausen, E.; Prien, T.; Brussel, Thomas Van; Heinecke, Achim; Lawin, P.

doi:10.1097/00000542-198801000-00031

Cited by 100 publications

(5 citation statements)

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“…In the present study, SI was maintained throughout the study period, except after induction (T2) in the midazolampropofol group, whereas a decrease of the SI was observed at T2, T4 and T5 in the propofol group. Aken et al [21] reported that propofol infusion at 2.5 mg.kg )1 , with or without vecuronium at 100 lg.kg…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic changes and heart rate variability during midazolam‐propofol co‐induction*

Win¹,

Kohase

Yoshikawa

et al. 2007

Anaesthesia

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SummaryIn a prospective, blind, randomised study, we examined the effects of midazolam-propofol co-induction on haemodynamic (blood pressure, heart rate and stroke volume) and heart rate variability. The latter was measured by spectral analysis using the maximum-entropy method to calculate the following: the low frequency component (LF), which reflects both the cardiac sympathetic and parasympathetic activity, the high frequency component (HF) and entropy, which reflects the cardiac parasympathetic activity, the total power (TP), calculated by the addition of LF and HF, and the LF ⁄ HF ratio, which reflects the balance between the cardiac sympathetic and parasympathetic nervous activity. Forty patients were randomly allocated to the propofol group and the midazolam-propofol group, and the parameters described above were calculated at baseline (T1), post induction (T2), after tracheal intubation (T3), and 3 min (T4) and 5 min after intubation (T5). Propofol was administered at 2.5 mg.kg )1 in the propofol group and midazolam at 0.1 mg.kg )1 followed by propofol at 1.5 mg.kg )1 in the midazolam-propofol group for anaesthesia induction. Then, propofol was administered at 4-6 mg.kg )1 propofol for maintenance in both groups. The midazolam-propofol group showed compensated haemodynamic changes, which were related to significant increases in the LF ⁄ HF ratio at T2, T4 and T5 (p = 0.011, 0.038 and 0.034). These results suggest that the midazolam-propofol combination yielded compensated modulatory effects on the cardiovascular system, including preserved baroreflex activity. Combined induction (co-induction) refers to the administration of a small dose of a sedative or anaesthetic agent prior to the induction of anaesthesia, with the aim of achieving more specific 'target' responses, while minimising side-effects. Co-induction with midazolam and propofol has been mainly studied in relation to the drugs' synergistic hypnotic actions of the drugs and haemodynamic changes [1-4] during induction of anaesthesia, but there are no reports to date of the haemodynamic changes occurring during tracheal intubation. Propofol decreases the arterial blood pressure, associated with a decrease of the cardiac output ⁄ index, stroke volume index, and systemic vascular resistance [5]; on the other hand, the cardiac output ⁄ index and ventricular filling pressures are maintained after the administration of midazolam [5,6]. The autonomic nervous system exerts important neural control on the heart for maintaining cardiovascular stability. Previous studies have evaluated the effects of propofol [7][8][9][10] and midazolam [11][12][13] on the cardiac autonomic nervous system by means of heart rate variability (HRV) analysis, a non-invasive technique [14][15][16]. There are, however, no reports on simultaneous analysis of the changes of the stroke volume and HRV during midazolam-propofol co-induction. The aim of this study was to investigate the haemodynamic changes and heart rate variability during midazolam co-induction with propofol as comp...

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Section: Discussionmentioning

confidence: 99%

Haemodynamic changes and heart rate variability during midazolam‐propofol co‐induction*

Win¹,

Kohase

Yoshikawa

et al. 2007

Anaesthesia

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“…Decreases in the systolic pressure of 30-45% and decreases in the diastolic pressure of 20-30% have been reported during induction with propofol. [15][16][17] In our study, we saw minimal decreases in blood pressure, with the systolic decreasing 5.6%, the mean decreasing 7.4%, and the diastolic decreasing 9.0%.…”

Section: Discussionmentioning

confidence: 83%

Computer‐Assisted Continuous Infusion for the Delivery of Target‐Controlled Infusions of Propofol During Outpatient Surgery

Arndt,

Reiss,

Bathke

et al. 1995

Pharmacotherapy

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Propofol was administered intravenously using a first‐order, three‐compartment, computer‐controlled infusion pump (CCIP) based on the Ohmeda 9000 syringe pump. The CCIP system produced a target‐controlled infusion (TCI) based on the estimated blood concentration (EBC). Twenty‐five patients undergoing ambulatory surgery completed the study. The induction EBC was 4.72 ± 0.28 μg/ml, and was achieved rapidly with minimal hemodynamic changes. The emergence EBC was 1.55 ± 0.21 μg/ml, and the discharge EBC was 1.06 ± 0.22 μg/ml. The EBC, together with clinical signs, allowed for predictable inductance and emergence from anesthesia using propofol.

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“…Aken et al . [18] evaluated the haemodynamic effects of fentanyl 3 mcg/kg immediately preceding propofol administration and reported significant drop in arterial pressure, cardiac output, and heart rate in patients receiving fentanyl. Injection of propofol immediately after fentanyl can be postulated to be the primary reason for such findings, although effects of a higher dose of fentanyl and lormetazepam premedication may also have contributed.…”

Section: Discussionmentioning

confidence: 99%

Effect of varying time intervals between fentanyl and propofol administration on propofol requirement for induction of anaesthesia: Randomised controlled trial

et al. 2019

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Background and Aims:Administration of fentanyl before induction of anaesthesia with propofol should facilitate smooth induction, with a reduction in induction dose of propofol and its side effects. This study was designed to examine the effect of varying intervals between fentanyl and propofol administration on the dose of propofol required for induction of anaesthesia.Methods:After institutional ethical clearance, 129 American Society of Anesthesiologists physical status I--II patients, aged 18--65 years, undergoing elective surgery under general anaesthesia were randomised into three groups. Fentanyl 2 mcg/kg was administered immediately prior to, 3 and 5 min before induction with propofol in Groups 1, 2, and 3, respectively. Requirement of propofol induction dose and haemodynamic parameters was recorded. Statistical analysis was performed using software SPSS (SPSS Inc., Chicago, Illinois, USA).Results:Total dose of propofol required for induction was highest in Groups 1 and lowest Group 3 (Group 1 vs. 2 vs. 3: 86.28 ± 21.12 vs. 71.67 ± 21.68 vs. 59.98 ± 20.35 mg, P < 0.00001). Dose of propofol required per kg body weight was significantly higher in Group 1 (1.41 ± 0.34 mg/kg) compared to both Group 2 (1.14 ± 0.38 mg/kg) and Group 3 (0.97 ± 0.32 mg/kg) (P < 0.00001). Incidence of hypotension during induction was significantly lower in Group 3 (14%) and Group 2 (17.1%) than in Group 1 (35.6%; P = 0.03).Conclusion:Administering fentanyl 5 min prior to propofol causes marked reduction in the dose requirement of the latter along with a significantly decreased incidence of hypotension during induction.

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The Influence of Fentanyl and Tracheal Intubation on the Hemodynamic Effects of Anesthesia Induction with Propofol/N2O in Humans

Cited by 100 publications

References 0 publications

Haemodynamic changes and heart rate variability during midazolam‐propofol co‐induction*

Haemodynamic changes and heart rate variability during midazolam‐propofol co‐induction*

Computer‐Assisted Continuous Infusion for the Delivery of Target‐Controlled Infusions of Propofol During Outpatient Surgery

Effect of varying time intervals between fentanyl and propofol administration on propofol requirement for induction of anaesthesia: Randomised controlled trial

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