Hemodynamic impact of increasing time between fentanyl and propofol administration during anesthesia induction: a randomised, clinical trial

Vullo, Paula Agostina; Navacerrada, M.I. Real; Suay, R. Navarro

doi:10.1016/j.bjane.2021.07.009

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…Unlike the infusion of propofol and midazolam, which are known to reduce blood pressure in a dose-dependent manner [23,24], continuous infusion of remimazolam demonstrated no dose-cumulative effect on blood pressure in the present case. This observation aligns with the findings of previous studies involving patients without obesity receiving remimazolam infusion, where changes in blood pressure and heart rate were maintained within 20% of the baseline values during anesthesia induction [25,26].…”

Section: Discussioncontrasting

confidence: 56%

Remimazolam Induction in a Patient with Super-Super Obesity and Obstructive Sleep Apnea: A Case Report

Lee

Han

2023

Medicina

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Background: With the rising prevalence of obesity, anesthesiologists are expected to increasingly encounter patients with obesity, which poses challenges for anesthetic management. The use of remimazolam, an intravenous anesthetic agent approved in 2020, may be beneficial in these patients. However, its use in patients with super-super obesity remains underexplored. Case Description: A 55-year-old woman with a body mass index (BMI) of 60.6 kg/m2 and moderate obstructive sleep apnea (OSA) underwent laparoscopic sleeve gastrectomy under general anesthesia. The transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) technique was used along with the administration of remimazolam at a rate of 6 mg/kg/h based on the total body weight. The patient was sedated within 125 s without any signs of hemodynamic instability, and the surgery was completed successfully. Conclusions: This case study demonstrates the potential effectiveness of remimazolam infusion for inducing general anesthesia in patients with super-super obesity. The infusion rate, derived from the total body weight, yielded an outcome comparable with that observed in individuals without obesity. Further studies with larger cohorts are required to confirm these findings.

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Section: Discussioncontrasting

confidence: 56%

Remimazolam Induction in a Patient with Super-Super Obesity and Obstructive Sleep Apnea: A Case Report

Lee

Han

2023

Medicina

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“…Blood pressure during anaesthesia induction undergoes short-term fluctuations, which are mainly affected by the dose of the induction drugs, the autonomic nervous system, arterial stiffness, baroreflex regulation and other cardiovascular regulatory mechanisms. 15–18 As a good indicator of arterial stiffness, PWTT is sensitive to vascular dilatation. 11 Reduced SBP during anaesthesia induction could be detected by tracking changes in PWTT simultaneously; and changes in PWTT indicate the onset of changes in blood pressure and a 15% decrease in PWTT could predict a ≥30% decrease in SBP.…”

Section: Discussionmentioning

confidence: 99%

The key role of pulse wave transit time to predict blood pressure variation during anaesthesia induction

Chen

Wang

et al. 2021

J Int Med Res

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Objective To establish the relationship between pulse wave transit time (PWTT) before anaesthesia induction and blood pressure variability (BPV) during anaesthesia induction. Methods This prospective observational cohort study enrolled consecutive patients that underwent elective surgery. Invasive arterial pressure, electrocardiography, pulse oximetry, heart rate and bispectral index were monitored. PWTT and BPV were measured with special software. Anaesthesia was induced with propofol, sufentanil and rocuronium. Results A total of 54 patients were included in this study. There was no correlation between BPV and the dose of propofol, sufentanil and rocuronium during anaesthesia induction. Bivariate linear regression analysis demonstrated that PWTT ( r = –0.54), age ( r = 0.34) and systolic blood pressure ( r = 0.31) significantly correlated with systolic blood pressure variability (SBPV). Only PWTT ( r = –0.38) was significantly correlated with diastolic blood pressure variability (DBPV). Patients were stratified into high PWTT and low PWTT groups according to the mean PWTT value (96.8 ± 17.2 ms). Compared with the high PWTT group, the SBPV of the low PWTT group increased significantly by 3.4%. The DBPV of the low PWTT group increased significantly by 2.1% compared with the high PWTT group. Conclusions PWTT, assessed before anaesthesia induction, may be an effective predictor of haemodynamic fluctuations during anaesthesia induction.

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“…Vullo et al [11] studied the hemodynamic impact of the increasing time interval between fentanyl and propofol administration during anesthesia induction. Patients undergoing non-cardiac surgery with endotracheal intubation were randomized into 6-time dose groups (1 or 2 min/1, 1.5 or 2 mg/kg of propofol).…”

Section: Jonsan and Santhimentioning

confidence: 99%

Effect of Varying Time Intervals Between Fentanyl and Propofol Administration on Propofol Requirement for Induction of Anesthesia - An Observational Study

JONSAN,

2024

Asian J Pharm Clin Res

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Objective: The objective of the study is to determine the dose of propofol required for induction when fentanyl was administered just before, 3 min, and 5 min before propofol administration. Furthermore, to determine changes in heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), when fentanyl was given at varying time intervals. Methods: A prospective observational study was conducted in a tertiary care teaching hospital for 12 months. A total of 150 patients belonging to ASA 1 and 2 in the age group of 18–60 years scheduled for elective surgery under general anesthesia were allocated into three groups. Group 1 received propofol immediately after a 2 mcg/kg fentanyl injection and Group 2 and Group 3 received propofol 3 and 5 min, respectively, after the administration of fentanyl. The total dose of propofol required for induction is noted. Heart rate, systolic, diastolic, and MAPs after induction were also noted. Data analysis was done using SPSS version 25. Results: All three groups were comparable concerning demographic variables. The total dose of propofol required for induction was highest in Group 1, where propofol was given immediately after fentanyl, followed by Group 2, and lowest in Group 3 where propofol was given 5 min after fentanyl. Fall in heart rate, SBP, DBP, and MAP after propofol administration was highest in Group 1, followed by Group 2, and least in Group 3 where fentanyl was administered 5 min before propofol. The results were statistically significant. Conclusion: Administering fentanyl 5 min before propofol causes a marked reduction in the dose requirement of propofol along with a significantly decreased incidence of hypotension after induction.

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Hemodynamic impact of increasing time between fentanyl and propofol administration during anesthesia induction: a randomised, clinical trial

Cited by 4 publications

References 23 publications

Remimazolam Induction in a Patient with Super-Super Obesity and Obstructive Sleep Apnea: A Case Report

Remimazolam Induction in a Patient with Super-Super Obesity and Obstructive Sleep Apnea: A Case Report

The key role of pulse wave transit time to predict blood pressure variation during anaesthesia induction

Effect of Varying Time Intervals Between Fentanyl and Propofol Administration on Propofol Requirement for Induction of Anesthesia - An Observational Study

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