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Co-induction of anaesthesia with 0.75 mg kg−1 propofol followed by sevoflurane: a randomized trial in the elderly with cardiovascular risk factors

Published online by Cambridge University Press:  01 March 2008

A. P. Moran ,
K. Stock ,
C. Jenkins ,
D. Uncles ,
S. Panayiotou ,
C. Spring ,
J. O’Dwyer ,
K. Kelley  and
R. Venn
A. P. Moran
Affiliation:
Worthing Hospital, Department of Anaesthesia, West Sussex, UK
K. Stock
Affiliation:
Worthing Hospital, Department of Research and Development, West Sussex, UK
C. Jenkins
Affiliation:
Worthing Hospital, Department of Anaesthesia, West Sussex, UK
D. Uncles
Affiliation:
Worthing Hospital, Department of Anaesthesia, West Sussex, UK
S. Panayiotou
Affiliation:
Worthing Hospital, Department of Anaesthesia, West Sussex, UK
C. Spring
Affiliation:
Worthing Hospital, Department of Anaesthesia, West Sussex, UK
J. O’Dwyer
Affiliation:
Worthing Hospital, Department of Anaesthesia, West Sussex, UK
K. Kelley
Affiliation:
Worthing Hospital, Department of Research and Development, West Sussex, UK
R. Venn*
Affiliation:
Worthing Hospital, Department of Anaesthesia, West Sussex, UK
*
Correspondence to: Richard Venn, Department of Anaesthesia, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex BN11 2DH, UK. E-mail: Richard.Venn@wash.nhs.uk; Tel: +44 1903 205111, Ext. 5942; Fax: +44 1903 286786
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Summary

Background

The induction of general anaesthesia is associated with the greatest cardiovascular changes in elderly patients. Induction can be performed either intravenously or with gaseous induction. Sevoflurane has advantages over propofol for induction of anaesthesia in the elderly, since the lower reduction in mean arterial pressure with sevoflurane is both statistically and clinically significant. This prospective randomized controlled trial investigated the cardiovascular benefits of co-induction of anaesthesia with 0.75 mg kg−1 propofol and 8% sevoflurane, when compared with 8% sevoflurane alone in patients requiring surgery for fractured neck of femur.

Method

In total, 38 patients aged 75 or over were allocated into the two groups, receiving either 0.75 mg kg−1 of propofol followed by 8% sevoflurane or 8% sevoflurane alone. Vital signs were recorded until successful insertion of a laryngeal mask. Induction times, induction events and patient satisfaction scores were also recorded.

Results

Results showed that there were no differences in the cardiovascular parameters between the two groups. Induction times were faster in the propofol and sevoflurane group (62 vs. 81 s; P = 0.028). The postoperative questionnaire showed that the majority of patients in both groups were satisfied with the induction process.

Conclusions

We concluded that 0.75 mg kg−1 of propofol followed by sevoflurane induction is an acceptable alternative to sevoflurane induction. It is associated with similar haemodynamic variables, faster induction times and is very well tolerated.

Keywords

ANAESTHESIA GENERALANAESTHESIA INHALATIONALSEVOFLURANEPROPOFOLELDERLYCARDIOVASCULAR RESPONSES
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 3 , March 2008 , pp. 183 - 187
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Mangano, DT. Perioperative cardiac morbidity. Anesthesiology 1990; 72: 153–184.CrossRefGoogle ScholarPubMed
2.Kirkbride, DA, Parker, JL, Williams, GD, Buggy, DJ. Induction of anaesthesia in the elderly ambulatory patient: a double-blind comparison of propofol and sevoflurane. Anesth Analg 2001; 93: 1185–1187.CrossRefGoogle Scholar
3.Thwaites, A, Edmends, S, Smith, I. Inhalation induction with sevoflurane: a double-blind comparison with propofol. Br J Anaesth 1997; 78: 356–361.CrossRefGoogle ScholarPubMed
4.Walpole, R, Logan, M. Effect of sevoflurane concentration on inhalation induction of anaesthesia in the elderly. Br J Anaesth 1999; 82: 20–24.CrossRefGoogle ScholarPubMed
5.Joo, HS, Perks, WJ. Sevoflurane vs. propofol for anesthetic induction: a meta-analysis. Anesth Analg 2000; 91: 213–219.CrossRefGoogle Scholar
6.Lee, TH, Marcantonio, ER, Mangione, CM et al. . Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100: 1043–1049.CrossRefGoogle ScholarPubMed
7.Reich, DL, Hossain, S, Krol, M et al. . Predictors of hypotension after induction of general anaesthesia. Anesth Analg 2005; 101: 622–628.CrossRefGoogle Scholar
8.Smith, I, Thwaites, A. Target controlled propofol vs. sevoflurane: a double-blind, randomised comparison in day-case anaesthesia. Anaesthesia 1999; 54: 745–752.CrossRefGoogle ScholarPubMed
9.Nishikawa, K, Kanaya, N, Kawamata M et al. . Left ventricular mechanical performance in elderly patients after induction of anaesthesia. A comparison of inhalational induction with sevoflurane and intravenous induction with fentanyl and propofol. Anaesthesia 2004; 59: 948–953.CrossRefGoogle ScholarPubMed
10.Joo, HS, Perks, WJ. Sevoflurane vs propofol for anaesthetic induction: A meta-analysis. Anesth Analg 2000; 91: 213–219.CrossRefGoogle Scholar
11.Yurino, M, Kumura, H. Vital capacity breath technique for rapid anaesthetic induction: a comparison of sevoflurane and isoflurane. Anaesthesia 1992; 47: 946–949.CrossRefGoogle Scholar
12.Luntz, SP, Janitz, E, Motsch J et al. . Cost effectiveness and high patient satisfaction in the elderly: sevoflurane vs. propofol anaesthesia. Eur J Anaesthesiol 2004; 21: 115–122.Google Scholar