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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.
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Introduction: Midazolam, a water-soluble benzodiazepine, isnon-irritant on intravenous injection and has a shorter durationof action than diazepam. In this research, we evaluated theinduction time achieved with midazolam and compared withthiopentone. We also observed the hemodynamic effectsfollowing induction with midazolam and thiopentone. In thecurrent study, we also studied undesirable or unwanted effectsof the two drugs.Material and methods: The present study was conductedat Civil Hospital, Aizawl Mizoram in thedepartmentofAnaesthesiology and Critical Care. The study was conductedbetween November 2018 to October 2019. A clinical studywas carried out in hundred patients with a physical status ofASA I and ASA II patients, patients between 20-50 years ofage and weight 45-70 kg were selected and were divided intotwo groups each group consisting of fifty patients. Group A– Midazolam (0.2mg/kg) and Group B – Thiopentone (5mg/kg). A routine preanaesthetic check-up was carried out beforethe operation. The procedure of anaesthesia to be given wasexplained to the patients and written informed consent wastaken accordingly.Results: The mean age (in years) of the midazolam group was35.54 ± 8.5 and it was 34.06 ± 10.2 in the thiopentone group.We found a statistically significant difference of weight,spontaneous closure of eye, Loss of lid reflex between boththe groups. Patient Good acceptance was good in 16 (66.67%)participants in midazolam and 8 (33.33%) participants in thethiopentone group.Conclusion: We conclude that midazolam is a satisfactorysubstitute to thiopentone.
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Introduction: Study was conducted to determine the conditionsfor insertion of LMA following induction of anaesthesia with(Propofol, 2 mg/kg) and (Thiopentone, 5 mg/kg, preceded by10%Lignocaine spray to the posterior oropharyngeal wall) byobserving six different parameters (gagging, laryngospasm,body movements, coughing, ease of insertion, jaw relaxation)and assessing all six parameters together with Lund andStovner gradingsystem. The hemodynamic parameters wererecorded during induction of anaesthesia and following LMAinsertion.Material and Methods: Patients were allocated randomlyinto two groups, (40 patients per group), Group A- Propofoland Group B- Thiopentone, preceded with 10%Lignocainespray.Results: In Group A significant decrease in HR (p<0.05),systolic BP (p<0.01), diastolic BP (p<0.01) and mean BP(p<0.01) was observed as compared to Group B. The overallassessment for the ease of insertion of LMA was 100%inGroup A and 97.5%in Group B which was statistically notsignificant (p=0.314). No significant difference was observedin gagging (p=0.152), laryngospasm (p=0.314), bodymovements (p=0.221), coughing (p=0.221), jaw relaxation(p=0.314) and the ease of insertion (p=0.314).Discussion: 10% Lignocaine spray suppresses upper airwayreflexes in Thiopentone group and facilitates LMA insertionwithout any adverse response.Conclusion: Thiopentone preceded with 10%Lignocainespray to the posterior oropharynx (Group B) provides almostequal conditions for LMA insertion as compared to Propofol(Group A) with better hemodynamic stability
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Barbiturate coma therapy (BCT) is a treatment option that is used for refractory intracranial hypertension after all other options have been exhausted. Although BCT is a brain protection treatment, it also has several side effects such as hypotension, hepatic dysfunction, renal dysfunction, respiratory complications and electrolyte imbalances. One less concerning but potentially life-threatening complication of BCT is dyskalaemia. This complication could present as severe refractory hypokalaemia during the therapy with subsequent rebound hyperkalaemia after cessation of the therapy. Judicious potassium replacement during severe refractory hypokalaemia and gradual cessation of the therapy to prevent rebound hyperkalaemia are recommended strategies to deal with this complication, based on previous case series and reports. In this case report, we show that these strategies were applicable in improving severe hypokalaemia and preventing sudden, life-threatening rebound hyperkalaemia. However, even with use of these strategies, BCT patients could still present with mild, asymptomatic hyperkalaemia.
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Background: In Cesarean, two anesthesia techniques are commonly used i.e. general and regional techniques. Regional anesthesia is most preferable under some circumstances. Commonly used induction agents include thiopental, Ketamine and propofol, depending on availability and the maternal clinical condition. Aim: Propofol 2.5 mg/kg was compared with Thiopentone 5 mg/kg as on induction agent for elective Cesarean section. Materials and methods: A total 103 healthy patients were included in an open randomized study, among whom 51 patients received Thiopentone and 52 received Propofol. These patients were unpremedicated, after induction dose the maintenance was similar for both groups. Results: Both Propofol and Thiopentone group produced a rapid and smooth induction of anesthesia with a low incidence of side effects. Diastolic blood pressure was lower in Propofol group during the induction to delivery interval. Other hemodynamic changes were similar for both groups. Respiratory upsets occurred less frequently with Propofol (7.8%) than with Thiopentone (22.5%), but Propofol caused more pain (28.8%) on injection compared to Thiopentone. Recovery time was shorter after Propofol as evaluated by time to open eyes on commands. There was no significant neonatal depression as assessed by Apgar score. Conclusion: Propofol appears to be a suitable alternative to Thiopentone as induction agent for Obstetric anesthesia.
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Successfulness of day surgery depends upon the quality of anaesthesia and recovery from it. Because of poor psychomotor recovery and subjective feeling of tiredness and drowsiness limits thiopentone usefulness in day care surgery. A new era has been started in history of induction agents with the advent of propofol in 1970 Propofol has rapid psychomotor recovery and few post operative side effects. The present study was undertaken to compare the induction, recovery characteristics and haemodynamic stability of inducing agents, thiopentone and propofol along with Ketamine in day care surgery with following objectives. 1] Haemodynamic stability with the addition of ketamine. 2] Assessment of recovery in the groups of propofol and thiopentone. The conclusion of my study is the propofol is better than thiopentone. Cardio-vascular and respiratory stability due to addition of Ketamine as premedicant.
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Background: Succinylcholine induced fasciculations and myalgia may be a source of greater distress to the patient than the surgical pain. Aims & Objective: This study was designed to see if propofol offered any protection against succinylcholine induced fasciculations and myalgia compared with thiopentone sodium. Material and Methods: This prospective, randomized study was conducted in a teaching and tertiary care hospital. The study included 99 adult patients scheduled to undergo general anaesthesia for elective surgery. The patients were allocated randomly and equally into Group P1, P2 and T. Anaesthesia was induced in group P1 with propofol 2.5 mg/kg, group P2 with propofol 3.5 mg/kg and group T with thiopentone sodium 5 mg/kg. Tracheal intubation was facilitated by administration of intravenous succinylcholine 2 mg/kg. Incidence and severity of fasciculations were recorded. Anaesthesia was maintained with 50% Nitrous oxide in oxygen, Isoflurane and Vecuronium bromide. At the end of surgery, neuromuscular blockage is reversed and patients were extubated. All the patients were assessed at 6, 12 and 24 hours postoperatively to evaluate the incidence and severity of myalgia. Anova test was applied for quantitative data and Chi-square test for qualitative data. P value < 0.05 was taken as significant. Results: The demographic data of patients of the three groups were comparable. The total incidence of fasciculations were 25(75.76%), 16(48.48%) and 26(78.79%) in group P1, P2 and T respectively (p<0.001). Total score of fasciculations was 44(44.44%), 22(22.22%) and 53(53.54%) in group P1, P2 and T respectively. The severity of fasciculations was reduced more in group P2 than group P1 and T (p=0.0006). The total incidence of myalgia were 19(57.57%), 10(30.3%) and 23(69.7%) in group P1, P2 and T respectively (p<0.001). Total score of myalgia was 35(35.35), 18(18.18) and 45 (45.45) in group P1, P2 and T respectively. The severity of myalgia was reduced more in group P2 than group P1 and T (p<0.001). There was no correlation between fasciculations and myalgia in the present study (Pearson’s r correlation, r = - 0.139). Conclusion: Propofol 3.5 mg/kg in comparison with propofol 2.5 mg/kg and thiopentone sodium 5 mg/kg is effective in reducing the incidence and severity of succinylcholine induced fasciculations and myalgia.
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BACKGROUND: The purpose of this study was to determine the incidence of side effects, rate of recovery, and maintenance of anesthesia when using a mixture of propofol and thiopentone as compared with propofol alone. METHODS: Fifty ASA Physical Status I or II patients aged between 12 and 60 years scheduled for minor surgical procedures were randomly allocated to group P (propofol) or group PT (propofol mix with thiopentone) in which a loading dose of propofol 2 mg/kg (group P) or propofol 1 mg/kg and thiopentone 2.5 mg/kg (group PT) was applied. At induction of anesthesia, an independent anesthesiologist graded the incidence and severity of pain. After administering the induction dosage, he also checked spontaneous movements. The duration of operation time and the duration of anesthesia were also noted. RESULTS: There was a significant decrease of the incidence of pain on injection and spontaneous movements in group PT compared with group P (P < 0.05). The propofol maintenance dose was also significantly decreased (P < 0.05). There were no significant differences in recovery indexes between the two groups except delay in time to eye opening. CONCLUSIONS: Our data indicate that a propofol-thiopentone mixture for induction, maintenance and recovery are satisfactory during anesthesia undergoing minor surgery. In addition, there were significant reductions in pain on injection, spontaneous movement, and cost-effectiveness.
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Humanos , Anestesia , Incidencia , Propofol , Procedimientos Quirúrgicos Menores , TiopentalRESUMEN
BACKGROUND: The aim of this study was to compare the effect of propofol with succinylcholine and thiopentone with succinylcholine on serum potassium concentration during induction of general anesthesia. METHODS: Forty patients scheduled for elective surgery were allocated at random into two groups, one to receive propofol with succinylcholine or other to receive thiopentone with succinylcholine. We measured serum potassium concentration at preinjection and at 1, 5 and 10 minutes after injection of propofol with succinylcholine or thiopentone with succinylcholine respectively. RESULTS: There was significant increase in the serum potassium concentrations at 1, 5 and 10 minutes after injection of propofol-succinylcholine and thiopentone-succinylcholine compared with those before injection in two groups. No significant difference in serum potassium concentrations was observed between the two groups. CONCLUSIONS: The changes in serum potassium due to injection of propofol and succinycholine were very similar to those found during injection of anesthesia with thiopentone and succinylcholine. It was reassuring that such small changes of serum potassium occur when propofol-succinycholine and thiopentone-succinylcholine were used and that these changes within normal ranges were unlikely to be of clinical significance.
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Humanos , Anestesia , Anestesia General , Potasio , Propofol , Valores de Referencia , Succinilcolina , TiopentalRESUMEN
Objective To compare the effects of propofol with thiopentone on preventing riskiness of tracheal intubation. Methods In 224 elective surgical patients under general anesthesia, the riskiness of tracheal intubation was evaluated following the administration of fentanyl 2?g/kg combined with propofol 2.0mg/kg (group P) or thiopentone 5.0 mg/kg (group T) respectively, with multivariate analysis. Results Risk rate was 36. 04 % in group T and 17. 70 % in group P (P 0 .05). Conclusions There is certainly clinical advantage of propofol compared to thiopentone in terms of preventing riskiness of tracheal intubation if hypotension of propofol is unconcerned.
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Objective To investigate the influence of thiopentone, midazolam, etomidate and propofol on the suxamethonium-induced serum potassium increase, muscle fasciculations and myalgia Methods Sixty patients, ASA class Ⅰ-Ⅱ were allocated randomly to receiving intravenous thiopentone 5mg/kg(thiopentone-group), midazolam 0.3mg/kg( midazolam-group), etomidate 0.3mg/kg(etomidate-group)or propofol 2mg/kg(propofol-group) respectively, followed by intravenous suxamethonium and tracheal intubation. Serum potassium concentration was measured before induction and intubation and after intubation. The incidences of muscle fasciculation during induction and postoperative mylgia were observed .Results As compared with that before induction ,the serum potassium levels in thiopentone- and etomidate-group increased significantly by 3.4% and 5.3% respectively after induction (P0.05).The incidences of muscle fasciculation and postoperative myalgia inmidazolam- and propofol -group were significantly lower than in thiopentone- and etomidate -group (P
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Thiopentone was compared with propofol as an induction agent of anesthesia in 30 women in ASA class I or II undergoing elective or emergency cesarean section. Patients were randomly assigned to either thiopentone(n=15) or propofol(n=15) group. Anesthesia was induced with an IV bolus of thiopental sodium(4mg/Kg) or propofol (2mg/Kg), and maintained with 50% nitrous oxide in oxygen supplemented with enflurane for both groups. The systolic and diastolic blood pressure, heart rate, induction-to-delivery time(IDT), uterine incision-to-delivery time(UDT), Apgar score at 1 and 5 minutes, maternal arterial, umbilical arterial and venous blood gas analyses, degree of uterine contraction, pre-operative and postoperative hemoglobin and hematocrit were measured. The results were as follows ; 1) The hemodynamic response to thiopentone and propofol were similar, but increase in maternal systolic blood pressure and heart rate were less in the propofol group than in the thiopentone group immediately after intubation. 2) The mean IDT was longer in the propofol group compared with thiopentone group, but the average UDT was similar. The average Apgar score at 1 and 5 minutes were no significantly different between the induction agents. 3) The mean maternal arterial, umbilical venous & arterial blood gas analyses at delivery were within the normal range and comparable for the two groups. 4) No significant difference in the degree of uterine contraction and decrease in the hemoglobin and hematocrit levels 72 hour after cesarean section was noted between the two groups.In conclusion, propofol was found to be similar to thiopentone in the effects on the moth- er and neonate. Therefore propofol appears to be a suitable alternative to thiopentone as an induction agent for anesthesia in cesarean section, if, sufficient precaution about hemody- namic changes after induction should be considered.