Comparison of the hemodynamic effects of opioid-based versus lidocaine-based induction of anesthesia with propofol in older adults: a randomized controlled trial

Amin, Sarah; Hasanin, Ahmed; ElSayed, Omnia S; Mostafa, Maha; Khaled, Dalia; Arafa, Amany; Hassan, Amany

doi:10.1016/j.accpm.2023.101225

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…The ketofol doses used in this study were within the range of what previously reported during induction of anesthesia [ 9 , 10 , 25 ]. We used lidocaine as an adjuvant which has an anesthetic-sparing effects and this helped in reaching adequate hypnosis using the current doses of ketamine and propofol [ 6 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 76%

“…Another advantage is the use of an opioid-free protocol for induction of anesthesia. Previous data showed that opioid-based protocol for induction of anesthesia increases the risk of postinduction hypotension and that lidocaine-based protocol provided stable postinduction hemodynamic with similar intubating condition in comparison to opioid-based protocol [ 25 ]. In addition, ketamine has good analgesic properties which could compensate for the absence of opioids.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial

Elsherbiny,

Hasanin,

Kasem

et al. 2023

BMC Anesthesiol

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Background We aimed to compare the hemodynamic effect of two ratios of propofol and ketamine (ketofol), namely 1:1 and 1:3 ratios, in rapid-sequence induction of anesthesia for emergency laparotomy. Methods This randomized controlled study included adult patients undergoing emergency laparotomy under general anesthesia. The patients were randomized to receive either ketofol ratio of 1:1 (n = 37) or ketofol ratio of 1:3 (n = 37). Hypotension (mean arterial pressure < 70 mmHg) was managed by 5-mcg norepinephrine. The primary outcome was total norepinephrine requirements during the postinduction period. Secondary outcomes included the incidence of postinduction hypotension, and the intubation condition (excellent, good, or poor). Results Thirty-seven patients in the ketofol-1:1 and 35 patients in the ketofol 1:3 group were analyzed. The total norepinephrine requirement was less in the ketofol-1:1 group than in the ketofol-1:3 group, P-values: 0.043. The incidence of postinduction hypotension was less in the ketofol-1:1 group (4 [12%]) than in ketofol-1:3 group (12 [35%]), P-value 0.022. All the included patients had excellent intubation condition. Conclusion In patients undergoing emergency laparotomy, the use of ketofol in 1:1 ratio for rapid-sequence induction of anesthesia was associated with less incidence of postinduction hypotension and vasopressor consumption in comparison to the 1:3 ratio with comparable intubation conditions. Clinical trial registration NCT05166330. URL: https://clinicaltrials.gov/ct2/show/NCT05166330.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial

Elsherbiny,

Hasanin,

Kasem

et al. 2023

BMC Anesthesiol

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“… 13 Perioperative adverse events were defined as hypotension (mean arterial pressure of ≤70% of baseline and/or <65 mmHg), hypertension (mean arterial pressure of >120% of baseline), bradycardia (heart rate of ≤45 beats/min), and tachycardia (heart rate of >120% of baseline). 14 Adverse events of lidocaine were recorded using a daily questionnaire survey of local anesthetic toxicity symptoms, including hearing loss, metallic taste, slurred speech, perioral numbness, tinnitus, dizziness, and tremor. Two days after surgery, the patients’ satisfaction with pain management was assessed using an 11-point Likert scale (0 = completely dissatisfied, 10 = completely satisfied).…”

Section: Methodsmentioning

confidence: 99%

Effect of Intraoperative Intravenous Lidocaine on Postoperative Delirium in Elderly Patients with Hip Fracture: A Prospective Randomized Controlled Trial

Li,

Wu,

Lan

et al. 2023

DDDT

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Purpose This study was performed to evaluate the effects of intraoperative intravenous lidocaine on postoperative delirium in elderly patients with hip fracture. Patients and methods In total, 100 elderly patients undergoing hip fracture surgery were randomized to the lidocaine group (Group L) or saline (control) group (Group C). Before anesthetic induction, Group L received lidocaine at 1 mg/kg for more than 10 minutes followed by continuous infusion at 1.5 mg/kg/h until the end of surgery. Group C received normal saline, and the injection methods were consistent with those in Group L. General anesthesia was induced with propofol, sufentanil, and cis-atracurium. Anesthesia was maintained by propofol and remifentanil. The primary outcome was the incidence of postoperative delirium in the first 7 postoperative days. The secondary outcomes included the severity of delirium, onset and duration of delirium, emergence agitation, adverse events, total propofol dose, intraoperative opioid dosage, length of post-anesthesia care unit stay, extubation time, and patient satisfaction with postoperative pain management. Results All 100 patients completed the study. The incidence of postoperative delirium was lower in Group L than in Group C (14% vs 36%, P = 0.011). The delirium severity scores were lower in Group L (3 [3–4]) than in Group C (4 [4–5]) ( P = 0.017). In addition, the incidences of hypertension, tachycardia, and emergence agitation were significantly lower in Group L than in Group C. No cases of local anesthetic toxicity occurred in either group. Conclusion Patients received lidocaine at 1 mg/kg for more than 10 minutes followed by continuous infusion at 1.5 mg/kg/h until the end of surgery, which can reduce the incidence of postoperative delirium in elderly patients undergoing hip fracture. In addition, the used regimen of lidocaine would not increase the risk of local anesthetic toxicity.

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“…The observation period of postoperative adverse events was from the end of surgery to discharged from the PACU. Postoperative adverse events included hypotension (MAP ≤ 70% of baseline and/or < 65 mmHg), hypertension (MAP ≥ 120% of baseline), bradycardia (HR ≤ 45 beats/min), and tachycardia (HR of ≥ 120% of baseline), 10 postoperative nausea and vomiting (PONV), laryngospasm, cough (Cough level: 0= no coughing; 1= single cough; 2= persistent cough lasting< 5s; 3= persistent cough lasting ≥ 5s) .If these events occurred, intravenous injection of drugs such as ephedrine, urapidil, atropine, esmolol, and tropisetron can be used to treate.…”

Section: Secondary Outcomesmentioning

confidence: 99%

Remimazolam for the prevention of emergence agitation in adult following nasal surgery under general anesthesia: A randomized controlled study

Xu,

Wu,

et al. 2024

Preprint

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The purpose of this study was to evaluate the effectiveness of postoperative use of remimazolam in preventing emergence agitation (EA) in adult following nasal surgery. In total, 86 patients underwent nasal surgery were randomly divided into two groups. Propofol, sufentanil and cis-atracuriumwere used for induction of anaesthesia, then sevoflurane concentration and propofol were used for maintenance of anaesthesia. After surgery, patients were randomly assigned to receive either remimazolam 0.1 mg/kg (Group R, n = 43) or 0.9% normal saline (Group C, n = 43). The outcomes included the incidence of EA, severe EA, extubation time, length of PACU stay and the maximal RSAS score. In this study. The incidence of EA was lower in Group R than in Group C (21% vs 49%, P = 0.007). The incidence of severe EA was also lower in Group R than in Group C (2% vs 19%, P = 0.035). The maximal RSAS score during emergence was lower in Group R (4 [4–4]) than in Group C (5 [4–6]) (P < 0.001). Therefore, postoperative injection of remimazolam 0.1 mg/kginto adult patients underwent nasal surgerycan significantly reduce the incidence of EA and severe EA.

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Comparison of the hemodynamic effects of opioid-based versus lidocaine-based induction of anesthesia with propofol in older adults: a randomized controlled trial

Cited by 4 publications

References 31 publications

Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial

Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial

Effect of Intraoperative Intravenous Lidocaine on Postoperative Delirium in Elderly Patients with Hip Fracture: A Prospective Randomized Controlled Trial

Remimazolam for the prevention of emergence agitation in adult following nasal surgery under general anesthesia: A randomized controlled study

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