Association of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65

Schonberger, Robert B.; Dai, Feng; Michel, George; Vaughn, Michelle T.; Burg, Matthew M.; Mathis, Michael R.; Kheterpal, Sachin; Akhtar, Shamsuddin; Shah, Nirav; Bardia, Amit

doi:10.1016/j.jclinane.2022.110846

Cited by 19 publications

(10 citation statements)

References 35 publications

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“…Induction of general anesthesia is often accompanied by fluctuations in hemodynamics which may result in perioperative organ hypoperfusion that increases the postoperative morbidity and mortality risks ( 7 ), especially for patients with tumors whose tolerance to stress is worse. Commonly used anesthetic propofol induces cardiovascular depression with a decrease in blood pressure (BP), and 22.6% of patients undergoing propofol-led anesthetic induction experienced pre-incision severe hypotension (MAP ≤ 55 mmHg) ( 8 ). Intravenous DEX induces a biphasic BP response through peripheral vasoconstriction.…”

Section: Introductionmentioning

confidence: 99%

Determination of the effective dose of dexmedetomidine to achieve loss of consciousness during anesthesia induction

et al. 2023

Front. Med.

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BackgroundDexmedetomidine (DEX) is a sedative with greater preservation of cognitive function, reduced respiratory depression, and improved patient arousability. This study was designed to investigate the performance of DEX during anesthesia induction and to establish an effective DEX induction strategy, which could be valuable for multiple clinical conditions.MethodsPatients undergoing abdominal surgery were involved in this dose-finding trial. Dixon's up-and-down sequential method was employed to determine the effective dose of DEX to achieve the state of “loss of consciousness”, and an effective induction strategy was established with continuous infusion of DEX and remifentanil. The effects of DEX on hemodynamics, respiratory state, EEG, and anesthetic depth were monitored and analyzed.ResultsThrough the strategy mentioned, the depth of surgical anesthesia was successfully achieved by DEX-led anesthesia induction. The ED50 and ED95 of the initial infusion rate of DEX were 0.115 and 0.200 μg/kg/min, respectively, and the mean induction time was 18.3 min. The ED50 and ED95 of DEX to achieve the state of “loss of consciousness” were 2.899 (95% CI: 2.703–3.115) and 5.001 (95% CI: 4.544–5.700) μg/kg, respectively. The mean PSI on the loss of consciousness was 42.8 among the patients. During anesthesia induction, the hemodynamics including BP and HR were stable, and the EEG monitor showed decreased α and β powers and increased θ and δ in the frontal and pre-frontal cortices of the brain.ConclusionThis study indicated that continuous infusion of combined DEX and remifentanil could be an effective strategy for anesthesia induction. The EEG during the induction was similar to the physiological sleep process.

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Section: Introductionmentioning

confidence: 99%

Determination of the effective dose of dexmedetomidine to achieve loss of consciousness during anesthesia induction

et al. 2023

Front. Med.

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“…The effects of propofol on CO and the vascular system are dose- and time-dependent. Therefore, the net effect may vary from patient to patient, depending on the induction dose, duration, technique, and patient characteristics [ 7 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Hypotension after Anesthesia Induction: Target-Controlled Infusion Versus Manual Anesthesia Induction of Propofol

Yildirim

Doğan

Sarıkaya

et al. 2023

JCM

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Background: Post-induction hypotension frequently occurs and can lead to adverse outcomes. As target-controlled infusion (TCI) obviates the need to calculate the infusion rate manually and helps safer dosing with prompt titration of the drug using complex pharmacokinetic models, the use of TCI may provide a better hemodynamic profile during anesthesia induction. This study aimed to compare TCI versus manual induction and to determine the hemodynamic risk factors for post-induction hypotension. Methods: A total of 200 ASA grade 1–3 patients, aged 24 to 82 years, were recruited and randomly assigned to the TCI (n = 100) or manual induction groups (n = 100). Hemodynamic parameters were monitored with the pressure-recording analytic method. The propofol dosage was adjusted to keep the Bispectral Index between 40 and 60. Results: Post-induction hypotension was significantly higher in the manual induction group than in the TCI group (34% vs. 13%; p < 0.001, respectively). The propofol induction dose did not differ between the groups (TCI: 155 (135–180) mg; manual: 150 (120–200) mg; p = 0.719), but the induction time was significantly longer in the TCI group (47 (35–60) s vs. 150 (105–220) s; p < 0.001, respectively). In the multivariable Cox regression model, the presence of hypertension, stroke volume index (SVI), cardiac power output (CPO), and anesthesia induction method were found to predict post-induction hypotension (p = 0.032, p = 0.013, p = 0.024, and p = 0.015, respectively). Conclusion: TCI induction with propofol provided better hemodynamic stability than manual induction, and the presence of hypertension, a decrease in the pre-induction SVI, and the CPO could predict post-induction hypotension.

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“…TCI requires a lower dose of propofol to achieve loss of consciousness than manual infusion [17][18][19]. Remimazolam and propofol decrease blood pressure in a dose-dependent manner [21][22][23][24]. The Food and Drug Administration (FDA) recommends a 1.5 mg/kg maximum dose of propofol for inducing anesthesia in elderly patients [25].…”

Section: Discussionmentioning

confidence: 99%

Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: A single-center, randomized, controlled trial

Sekiguchi

Kinoshita

Kawanishi

et al. 2022

Preprint

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Background Remimazolam confers a lower risk of hypotension than propofol. However, no studies have compared efficacy of remimazolam and propofol administered using target-controlled infusion (TCI). This study aimed to investigate hemodynamic effects of remimazolam and target-controlled propofol in middle-aged and elderly patients during the induction of anesthesia. Methods Forty adults aged 45–80 years with the American Society of Anesthesiologists Physical Status 1–2 were randomly assigned to remimazolam or propofol group (n = 20 each). Patients received either remimazolam (12 mg/kg/h) or propofol (3 µg/mL, TCI), along with remifentanil for inducing anesthesia. We recorded the blood pressure, heart rate (HR), and estimated continuous cardiac output (esCCO) using the pulse wave transit time. The primary outcome was the maximum change in mean arterial pressure (MAP) after induction. Secondary outcomes included changes in HR, cardiac output (CO), and stroke volume (SV). Results MAP tended to decrease after induction of anesthesia in both the groups, without significant differences between the groups (-41.1 [16.4] mmHg and − 42.8 [10.8] mmHg in remimazolam and propofol groups, respectively; mean difference: 1.7 [95% confidence interval: -8.2 to 4.9]; p = 0.613). Furthermore, HR, CO, and SV decreased after induction in both groups, without significant differences between the groups. Remimazolam group had significantly shorter time until loss of consciousness than propofol group (1.7 [0.7] min and 3.5 [1.7] min, respectively; p < 0.001). However, MAP, HR, CO, and SV were not significantly different between the groups despite adjusting time until loss of consciousness as a covariate. Remimazolam group tended to have a lower frequency of hypotension (MAP < 65 mmHg) than propofol group (7 [35%] and 11 [55%] cases, respectively; p = 0.341). Conclusions Hemodynamics were not significantly different between remimazolam and target-controlled propofol groups during induction of anesthesia. Thus, the choice, dose, and usage of anesthetics are important for hemodynamic stability while inducing anesthesia. Clinicians should monitor hypotension while inducing anesthesia with remimazolam as well as propofol. Trial registration: UMIN-CTR (UMIN000045612).

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Association of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65

Cited by 19 publications

References 35 publications

Determination of the effective dose of dexmedetomidine to achieve loss of consciousness during anesthesia induction

Determination of the effective dose of dexmedetomidine to achieve loss of consciousness during anesthesia induction

Hypotension after Anesthesia Induction: Target-Controlled Infusion Versus Manual Anesthesia Induction of Propofol

Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: A single-center, randomized, controlled trial

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