A Clinical Comparative Study of Propofol, Thiopentone Sodium and Midazolam as Anaesthetic Inducing Agents

The ideal intravenous anesthetic agent should be available in a stable, non-irritant solution, the solvent of which causes no adverse effects in normal usage, rapid acting i.e. unconsciousness should supervene in one arm-brain circulation time, short acting so that recovery is not prolonged and should be devoid of cardiovascular side effects especially myocardial depression, respiratory side effects particularly medullary depression, cerebral excitatory side effects, cerebral cortical side effects, should not liberate histamine or cause local tissue damage. Here in this study an attempt was made to evaluate clinically the practical utility of propofol and midazolam as alternatives to thiopentone for induction of anesthesia. MethodsSixty adult patients of ASA I undergoing elective surgery were divided into three equal groups of twenty patients as follows- Group 1 (Thiopentone), Group 2 (Propofol) and Group 3 (Midazolam). Group 1 received 5 mg / Kg of thiopentone, group 2 received 2 mg / Kg of propofol. In group 1 & 2 given doses were found to be adequate for induction. In group 3, 0.1 mg / Kg of midazolam could induce 16 out of 20 patients. Remaining patients in group 3 required higher dose of midazolam. In this study, induction time, quality of induction, haemodynamic changes, recovery, and post-operative side effects were compared. ResultsThe result of this study showed that the induction time was shortest in case of thiopentone (31.65 secs +/-1.56 sec) and prolonged in Midazolam (150 secs +/-7.9 sec) and intermediate in propofol group (56.25 +/- 3.18 sec). Quality of induction is best with midazolam without any abnormal movements, coughing or bucking during laryngoscopy. Midazolam maintained the best cardiovascular stability. Propofol prevented any rise in B.P. after induction when compared to baseline induction. Recovery was best with propofol with orientation to time and space at 5 mins. Post-operative side effects were negligible in all the three groups. ConclusionsMidazolam may be the drug of choice in cases where cardiovascular stability is of prime importance. Propofol maybe the drug of choice where early ambulation is absolutely necessary and also in cases of susceptible patients with reactive airways.

Hemodynamic Response and Dose Requirement during Induction and Intubation with Propofol and Pentothal Sodium in Patients Undergoing Elective Coronary Artery Bypass Surgery

Introduction: The aim of the study was to observehaemodynamic changes during induction of patientsundergoing CABG with Propofol and Pentothal. It was alsointended to see if fixed dose combination of premedicationwith midazolam and fentanyl helps to reduce dose requirementof induction agents.Material Methods: 60 ASA grade II patients posted forelective Coronary Artery Bypass Surgery (CABG) weredivided into two groups. Group I (propofol group) and groupII (pentothal Group). All patients received premedication asInj.Midazolam 0.03 mg/kg and Inj.Fentanyl 4 µg/kg. Withcomputer generated randomization patient was allotted toeither propofol or Pentothal group. End point of inductiontaken as loss of eye-lash reflex or apnoea whichever appearsfirst. Hemodynamic parameters were recorded from baselinetill 7 minutes post intubation.Results: In both the groups SBP, DPB, MAP, HR and RPPwere found to be comparable. Both the drugs showed stablehemodynamic at various levels of observations. The meandose required for induction was found to be 1.7 mg/kg withpropofol and 1.07 mg/kg with Pentothal.Conclusion: Both propofol and Pentothal are equally ableto provide required stability even when standard doses ofbenzodiazepines and opioids are used in much lower dosesthan mentioned in literature

A randomized trial of anesthetic induction agents in patients with coronary artery disease and left ventricular dysfunction.

The deleterious effects of anesthetic agents in patients suffering from coronary artery disease are well known. The risk increases when a patient has compromised ventricular function. There is a paucity of literature regarding the choice of the suitable agent to avoid deleterious effects in such patients. The use of etomidate and propofol has been considered superior to other intravenous anesthetic agents in these groups of patients. The aim of the present study is to compare the hemodynamic effects of anesthesia induction with etomidate, thiopentone, propofol, and midazolam in patients with coronary artery disease and left ventricular dysfunction. This randomized clinical trail was conducted at the All Indian Institute of Medical Sciences, New Delhi, India. Sixty patients with coronary artery disease and left ventricular dysfunction (ejection fraction < 45%) scheduled for elective coronary artery bypass surgery participated in this study. After stabilization baseline hemodynamic data stroke volume variation and systemic vascular resistance index were recorded for all patients (Flo Trac TM sensor with Vigileo cardiac output monitor used for hemodynamic monitoring). The patients were randomly alloted to one of the four groups and the intravenous induction agent was administered for over 60 - 90 seconds (Group E - Etomidate 0.2 mg/Kg; Group M - Midazolam 0.15 mg/Kg; Group T - Thiopentone 5 mg/Kg; Group P - Propofol 1.5 mg/Kg). Hemodynamic data were recorded at one minute intervals starting from induction till seven minutes after intubation, - the end point of the present study. There was a significant decrease in the heart rate in comparison to the baseline(-7 to -15%, P = 0.001), mean arterial pressure (-27 to -32%, P = 0.001), cardiac index (-36 to -38%, P = 0.001), and stroke volume index (-27 to -34%, P = 0.001) after induction in all four groups. The hemodynamic response was similar in all the four groups. There was no significant change in central venous pressure and stroke volume variation (SVV) during induction and intubation, while the effects on the systemic vascular resistance index (SVRI) were variable. The midazolam group was the most effective in preventing intubation stress (tachycardia,hypertension). The change from baseline values in heart rate (+ 4%, P = 0.12) and mean arterial pressure (-1%, P = 0.77) after intubation were not statistically significant in the midazolam group. The etomidate group was the least effective of all the four groups in minimizing stress response, with statistically significant increase from baseline in both heart rate (P = 0.001) and mean arterial pressure (P = 0.001) at 1 minute after intubation. All the four anesthetic agents were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction despite a 30 - 40% decrease in the cardiac index. Clinician experience along with knowledge of the potential interactions (e.g., premedication, concurrent opioid use) is needed to determine hemodynamic stability during anesthetic induction in these patients with ventricular dysfunction.

The Comparison of Anesthetic Agents and Adjuvants between University Hospitals, General Hospitals and Hospitals / 대한마취과학회지

BACKGROUND: This study was performed to compare anesthetic agents and adjuvants for general anesthesia or regional anesthesia between university hospitals, resident-training general hospitals and hospitals without training program of residents. METHODS: We surveyed university hospitals, resident-training hospitals and hospitals without training program of residents and divided randomly each hospital groups to become twenty hospitals. We compared the use frequency of inhalation anesthetics, muscle relaxants, induction agents, reversing agents, local anesthetics, premedicants, cardiovascular drugs and plasma expanders. RESULTS: Enflurane was most commonly used inhalation anesthetic in all hospital groups. Isoflurane was less commonly used inhalation anesthetic in hospitals without training program of residents. Pancuronium was most commonly used muscle relaxant in university hospitals. Midazolam, ketamine, fentanyl, propofol were commonly used induction agents during induction in university hospitals and resident-training general hospitals. Differences of use frequency of local anesthetics among hospital groups were not significant, but epinephrine mixing with local anesthetics was more frequent in university hospitals and resident-training general hospitals. Midazolam as a premedicant and norepinephrine, phenylephrine, amrinone, esmolol, pentastarch were less used in hospitals without training program of residents. CONCLUSIONS: These results suggest that university hospitals and resident-training general hospitals didn't show difference in anesthestics or adjuvants but hospitals without training program of residents used less commonly isoflurane, atracurium, midazolam, ketamine, propofol, fentanyl, cardiovascular drugs and pentastarch.