Induction and Recovery Characteristics of Propofol, Thiopental and Etomidate

Boysen, K.; Sánchez, R; Krintel, J. J.; Hansen, Melissa Voigt; Haar, P. M.; Dyrberg, V.

doi:10.1097/00132582-199007000-00034

Cited by 7 publications

(9 citation statements)

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“…Mac-Kenzie & Grant (19) found less postoperative impairment of choice reaction time and critical flicker fusion threshold, when propofol was used for the induction of anesthesia than following methohexital and thiopental induction. In this, as in a previous study (20), we found that the propofol patients overshot their baseline values already at 30 rnin postoperatively in coin counting. In the first study, the improved performance also applied to the reaction time test in the propofol group, but this difference could not be reestablished in the present study.…”

Section: Methohexitalsupporting

confidence: 91%

Comparison of induction with and first hour of recovery from brief propofol and methohexital anesthesia

Boysen

Sánchez

Ravn

et al. 1990

Acta Anaesthesiol Scand

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Anesthesia and recovery during the first hour after propofol and methohexital anesthesia for termination of pregnancy, lasting about 12 min, were compared, the latter in a double-blind manner by means of psychomotor tests (coin counting and continuous auditory reaction time). Muscle movements and hiccups were seen significantly more frequently during methohexital inductions. No differences were seen regarding pain at the site of injection or apnea between the groups. At 15 min after the last dose of anesthetic, recovery after methohexital was ahead of that after propofol, but after 1 h, psychomotor performance was better in the propofol group. Side-effects during recovery were few, and incidences did not differ significantly. Although the difference in reaction time test was significant, it was hardly large enough to be of any clinical importance. Both drugs are useful for brief outpatient anesthesia, but smoother induction gives propofol an edge over methohexital.

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Section: Methohexitalsupporting

confidence: 91%

Comparison of induction with and first hour of recovery from brief propofol and methohexital anesthesia

Boysen

Sánchez

Ravn

et al. 1990

Acta Anaesthesiol Scand

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“…It describes the return of the patient to the premedication level of vigilance. Other authors have used the test for evaluation of recovery, and our control values are in accordance with their results (8,20). The test proved sensitive to the test model, as a significant rise in the test scores was seen in all groups following premedication.…”

Section: Discussionsupporting

confidence: 83%

“…Propofol, which is a well-accepted alternative to the barbiturates, has slightly different haemodynamic properties, showing decreased systemic vascular resistance and an unchanged heart rate (5). Early recovery is fast after both propofol and the shortacting barbiturates (6,7), whereas intermediate recovery seems to be faster after propofol (8)(9)(10).…”

mentioning

confidence: 99%

Total intravenous anaesthesia for direct laryngoscopy: propofol infusion compared to thiopentone combined with midazolam and methohexitone infusion

Sonne

Clausen

Valentin

et al. 1992

Acta Anaesthesiol Scand

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Total intravenous anaesthesia for direct laryngoscopy was investigated in 40 patients, randomized into four groups of 10 patients each. First, propofol infusion was compared to thiopentone combined with midazolam. Next, a comparison of propofol infusion with methohexitone infusion was undertaken. The propofol group showed significantly lower peroperative blood pressure compared to the thiopentone/midazolam group. The second propofol group required significantly less alfentanil to stabilize the blood pressure, compared to the methohexitone group. Completeness of recovery, assessed by means of a coin counting test, was faster in the propofol group compared to the thiopentone/midazolam group, while no difference could be demonstrated between the second propofol group and the methohexitone group. It is concluded that propofol seems to be superior to both thiopentone/midazolam and methohexitone with respect to the stability of peroperative blood pressure. Concerning recovery, propofol is superior to thiopentone/midazolam, but offers no advantage over methohexitone.

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“…Thus, 283 studies were retrieved as potential clinical trials for further evaluation. A further 106 studies were excluded for the following reasons: reviews (seven studies), 1 3 4 14-17 not carried out in humans (n=2), 18 19 not randomised controlled trials (n=15), 20-34 improper assessment of pain (n=7), [35][36][37][38][39][40][41] duplicate publication (n=2), 42 43 methodological concerns (n=15), [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] did not measure pain on injection of propofol (n=20), [60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] intervention not aimed at pain reduction on injection of propofol (n=3), [80][81][82] incomplete data or inability to extract data (...…”

Section: Discussionmentioning

confidence: 99%

Prevention of pain on injection of propofol: systematic review and meta-analysis

Jalota

Kalira

George

et al. 2011

BMJ

248

227

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Objective To systematically determine the most efficacious approach for preventing pain on injection of propofol. Design Systematic review and meta-analysis. Data sources PubMed, Embase, Cochrane Library, www.clinicaltrials.gov, and hand searching from the reference lists of identified papers. Study selection Randomised controlled trials comparing drug and non-drug interventions with placebo or another intervention to alleviate pain on injection of propofol in adults. Results Data were analysed from 177 randomised controlled trials totalling 25 260 adults. The overall risk of pain from propofol injection alone was about 60%. Using an antecubital vein instead of a hand vein was the most effective single intervention (relative risk 0.14, 95% confidence interval 0.07 to 0.30). Pretreatment using lidocaine (lignocaine) in conjunction with venous occlusion was similarly effective (0.29, 0.22 to 0.38). Other effective interventions were a lidocaine-propofol admixture (0.40, 0.33 to 0.48); pretreatment with lidocaine (0.47, 0.40 to 0.56), opioids (0.49, 0.41 to 0.59), ketamine (0.52, 0.46 to 0.57), or non-steroidal anti-inflammatory drugs (0.67, 0.49 to 0.91); and propofol emulsions containing medium and long chain triglycerides (0.75, 0.67 to 0.84). Statistical testing of indirect comparisons showed that use of the antecubital vein and pretreatment using lidocaine along with venous occlusion to be more efficacious than the other interventions. Conclusions The two most efficacious interventions to reduce pain on injection of propofol were use of the antecubital vein, or pretreatment using lidocaine in conjunction with venous occlusion when the hand vein was chosen. Under the assumption of independent efficacy a third practical alternative could be pretreatment of the hand vein with lidocaine or ketamine and use of a propofol emulsion containing medium and long chain triglycerides. Although not the most effective intervention on its own, a small dose of opioids before induction halved the risk of pain from the injection and thus can generally be recommended unless contraindicated.

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Induction and Recovery Characteristics of Propofol, Thiopental and Etomidate

Cited by 7 publications

References 0 publications

Comparison of induction with and first hour of recovery from brief propofol and methohexital anesthesia

Comparison of induction with and first hour of recovery from brief propofol and methohexital anesthesia

Total intravenous anaesthesia for direct laryngoscopy: propofol infusion compared to thiopentone combined with midazolam and methohexitone infusion

Prevention of pain on injection of propofol: systematic review and meta-analysis

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