comparison between midazolam co-induction and propofol predosing for the induction of anaesthesia in the elderly

Co-induction is the administration of a small dose of a sedative or anaesthetic agent prior to induction of anaesthesia, the aim being to reduce the dose of induction agent required. The aim of this study was to compare the efficacy, safety and cardiovascular stability of low dose midazolam co-induction and propofol pre-dosing using propofol for induction of anaesthesia in elderly patients. In a randomized, placebo-controlled trial, we enrolled 60 patients aged 60 years or more with ASA between I and III attending for opthalmic surgery. The patients were allocated randomly to one of three groups, to receive either midazolam 0.02 mg.kg[-1], propofol 0.25 mg.kg[-1], or normal saline 2 ml [placebo] 2 min prior to induction of anaesthesia using propofol 1% infusion at 5 ml/min. The propofol dose requirements for induction were recorded for two end-points [loss of verbal contact [LOVC] and insertion of an oropharyngeal airway]. cardiovascular parameters, respiratory rate and oxygen saturation were recorded at 1-min intervals for each patient until induction was complete. Intraocular pressure was recorded before and after induction. The time and the dose of propofol required to induce LOVC, jaw relaxation [JR] and insertion of Guedel oropharyngeal airway showed a statistically significant decrease in both the midazolam and the propofol groups, when compared to the saline group, [P<0.05]. There was a statistically significant decrease in the intraocular pressure after induction in the saline and the propofol groups, [P<0.05]. The haemodynamic parameters [bloodpressure [Systolic and diastolic] and heart rate] and the respiratory rate of patients in all groups showed a statistically significant decrease [P<0.05] from baseline reading however the comparison between the groups showed that decrease was non significant. The oxygen saturation of patients in all groups showed a significant increase from preoperative baseline reading [P<0.05]. Midazolam co-induction and propofol predosing reduce the dose of propofol [33.5%] and [10%] respectively and the time required for induction of anesthesia by propofol infusion in the elderly with no improvement of cardiovascular stability

Comparison between Nalbuphine and propofol for Treatment of intrathecal morphine-induced pruritus after cesarean section

Intrathecal opioids are frequently used in management of postoperative pain, but may be associated with many adverse effects such as pruritus, nausea, vomiting, urinary retention, and respiratory depression, which may limit their use. Our study was done to compare between nalbuphine [a mixed opioid agonist antagonist] and propofol [2-6 di-isopropylphenol] in treating intrathecal morphine-induced pruritus after cesarean delivery. It included one hundred forty one parturients undergoing elective cesarean section with spinal anesthesia and post-operative analgesia by intrathecal morphine [0.3 mg]. Ninty four parturients were reported to have moderate to severe pruritus. Without pre-medications, all women were hydrated with 500 to 1000 ml of normal saline before intrathecal injection of 7.5-10 mg of bupivacaine for spinal anesthesia and morphine 0.3 mg for postoperative pain control. Heart rate, mean blood pressure, respiratory rate and oxygen saturation were monitored. The degree and onset of pruritus were also recorded. Those parturients whose pruritus scores was >/= 3 or those who requested antipruritic treatment were assigned to receive either 3mg nalbuphine IV, 20mg propofol IV or placebo. The degree of success was reported when pruritus score decreased to 1 or 2 after treatment and then women were evaluated every 15 minutes for up to 4 hours to determine the duration of antipruritic response. The patients who continued to have pruritus scores >/= 3 were considered treatment failure after only a single dose of the study medicine. Any side effects from spinal anesthesia or from the drugs used were recorded. we were able to demonstrate that the success rate after treatment with 3 mg of nalbuphine was significantly greater than with 20 mg of propofol. Among the successfully treated patients, [8%] in the Nalbuphine group and [5.3%] in the Propofol group reported the recurrence of moderate to severe pruritus [pruritus score >/= 3] within 4 hours after administration of the study drug. Among all the treated patients, [21.9%] in the Nalbuphine group and [40.6%] in the Propofol group reported failure of success [moderate to severe pruritus [pruritus score >/= 3]] within 15 minutes after administration of the study drug. our study showed that nalbuphine [3 mg] was superior to propofol [20 mg] in the treatment of intrathecal morphine induced pruritus after cesarean delivery

role of magnesium sulphate as an adjuvant to propofol sedation in ICU patients, a comparative study

The aim of this study was to determine the effect of the concomitant use of magnesium sulphate infusion together with propofol continuous infusion used for sedation of the ICU patients on the total propofol consumption and on the patients' hemodynamics. Thirty mechanically ventilated ICU patients were randomly divided into two equal groups and allocated to receive either magnesium sulphate or placebo together with profolol continuous infusion. Hemodynamic monitoring included heart rate and invasive blood pressure measurements. Biochemical parameters included serum Na+, K+, Ca++. Mg++, total bilirubin and creatinine, and finally total propofol consumption in 24 hours. The use of magnesium sulphate continuous infusion significantly reduced total propofol consumption in group 2 [p<0.05]. This reduction was observed correlating with significant progressive rise of serum Mg++ [p<0.05]. No significant differences were detected in patients' hemodynamics or other biochemical parameters between both groups after the use of magnesium sulphate. The results indicate that the concomitant use of magnesium sulphate with propofol continuous sedation in ICU patients significantly reduced total propofol consumption with no significant derangements of the patients' hemodynamics or chemistry

effect of midazolam premedication on hypnotic dose of propofol and recovery criteria in outpatient surgery

We investigated the effect of two small doses of midazolam on the hypnotic dose of propofol and recovery criteria in ambulatory gynecologic laparoscopic surgery. Sixty adult female patients, aging 18-40 years. ASA status I and II, scheduled for elective laparoscopic surgery were included. They were divided into three groups, in a random and double-blind fashion according to the drug given for premedication: group "A" given 2 ml of normal saline, group "B" given 20 micro g/kg midazolam and group "C" given 40 micro g/kg midazolam. All drugs were given I.V. 15 minutes before induction of general anesthesia using standardized technique. Dose of propofol and the time needed to reach complete hypnosis were recorded. Recovery times from end of surgery till start of spontaneous respiration, extubation, spontaneous eye opening, obeying commands, ambulation and discharge from post-anesthesia care unit [PACU] and ambulatory surgical unit [ASU] were also recorded by blinded observer. We found that no significant difference was recorded between patients in groups "A" and "B" in all data [P < 0.05]. Group "C" patients showed significantly lower dose of propofol required for induction of general anesthesia and significantly shorter time required to reach complete hypnosis [P < 0.05]. Moreover, significantly longer time was needed to start spontaneous respiration, extubation and eye opening [P < 0.05], while no significant difference between the three groups in other recovery criteria. So, 40 micro g/kg midazolam given for premedication in outpatient surgery markedly decreases hypnotic dose of propofol required for induction of general anesthesia with minimal effect on recovery criteria and overall hospital discharge time

Effects of different intravenous anaesthestics on free radicals in polytraumatized patients

Oxygen free radicals are highly reactive and potentially destructive. In the normal cells there are always a small number of free radicals produced, but cell enzymes easily deal with them. The aim of this study is to detect the effects of trauma and thereafter different intravenous anaesthesia on free radical production in individuals with multiple injuries. This study was performed on 40 individuals. They were divided into 2 groups; trauma group [n = 20] and non trauma control group [n =20]. Both groups were matched as regard age, sex and body weight. Each group was classified according to the type of intravenous anaesthesia used into ketamine- fentanyl group [n =10] and propofol- fentanyl group [n=10]. Estimation of plasma malondialdhyde [MDA] and blood superoxide dismutase [SOD] and glutathione per-oxidase [GPX] levels was done. The results of this study revealed significant increase in MDA levels and significant decrease in SOD and GPX level in trauma group in comparison with control one. On the other hand, propofol and ketamine induced decrease MDA levels during the three stages of study in both groups in comparison to their corresponding basal values. Also, propofol and ketamine induced significant increase in GPX levels after induction in traumatic and control groups when compared with their basal values. However, propofol produced significant increase in SOD levels after induction in traumatic and control groups when compared with their basal values. From this study, we conclude that propofol and ketamine decrease free radicals generation while propofol increased the antioxidant scavengers than ketamine. So, propofol could be more beneficial than ketamine for anaesthesia of polytraumatized individuals, which have oxidant and antioxidant imbalances

Comparison study of propofol infusion as a sole anaesthetic virsus other anaesthetic techniques in children

Poropofol has been shown to have a superior recovery compared with thiopentone and halothane anaesthesia in both adult and children undergoing a brief surgical procedures. Fourty patients had been included in this study and these patients are allocated in 4 groups each of 10 patients. The first group [Gp 1] was anaesthetized by using propofol in induction and maintenance of anaesthesia, the second group [Gp 2] was anaesthetized by using propofol in induction and maintained by halothane, the third group [Gp 3] was anaesthetized by using thiopentone in induction and maintained by halothane and the fourth group [Gp 4] was anatsthetized by using halothane in induction and maintenance. The results of this study shown that the quality of induction in Gp 1 was 5 good, 3 adequate and 1 poor, in Gp 2 was 5 good, 4 adequate and 1 poor. In Gp 3 was 7 good, 2 adequate and 1 poor.In Gp 4 was 7 good and 3 adequate.The intraoperative problems were in Gp 1 one case developed arrythmia and one case in Gp 3, one case developed apnea in Gp 1 also one case developed cough in Gp 1. The recovery postoperative shown that, the mean +/- SD of Steward score in Gp 1 was 12.4 +/- 1.71minutes, in Gp 2 was 21.3 +/- 1.16 minutes, In Gp 3 was 21.5 +/- 1.08 minutes and in Gp 4 was 21.4 +/- 0.84 minutes. The mean +/- SD of open eyes on commoned in Gp 1 was 14 +/- 1.63mirwtes, in Gp 2 was 22.5. +/- 1.27 minutes, In Gp 3 was 22.7 +/- 1.06 minutes and in Gp 4 was 29.6 +/- 0.97 minutes. The mean +/- SD of orientation in Gp I was 15.6 +/- 1.78 minutes, in Gp 2 was 24 +/- 1.05 minutes. In Gp 3 was 24.2 +/- 1.91 minutes and Gp 4 was 24.1 +/- 0.88 minutes

Evaluation of the effect of I. M. lignocaine or bupivacaine on the hypnotic requirements of ketamine and propofol

We have studied the effect of i.m. lignocaine or bupivacaine on the hypnotic requirements of Ketamine and propofol in sixty patients of ASA I and II undergoing minor elective surgery under general anaesthesia. These patients were allocated randomly into two groups, ketamine group and propofol group. Each group was further subdivided into 3 subgroups A, B and C [n = 10 for each subgroup] where patients received saline, lignocaine or bupivacaine i.m. respectively before induction of anaesthesia. Anaesthesia was induced by ketamine or propofol in bolus doses of 0.2 mg/Kg every 30 sec. until loss of verbal response to verbal command was achieved. We found that lignocaine and bupivacaine significantly reduced the hypnotic doses of ketamine by 39.7% and 32.6% and that of propofol by 25.9% and 30.8% respectively. We concluded that the hypnotic doses of i.v. ketamine or propofol should be reduced if their administration is preceded by lignocaine or bupivacaine