A Comparision of Midazolam Coinduction with Propofol Predosing for Induction of Anaesthesia

Senthilkumar, V (2006) A Comparision of Midazolam Coinduction with Propofol Predosing for Induction of Anaesthesia. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: The term co-induction has been used to describe the practice of administering a small dose of sedative or another anaesthetic agent10 to reduce the dose of induction agent required. The term co-induction of anaesthesia has been applied to the use of two or more drugs to induce anaesthesia.11.The term was introduced in 1986 to describe the unplanned induction of anaesthesia by nonanaesthetically trained personnel practicing sedation, unplanned anaesthesia in unsuitable environment leading to several fatalities. Currently, planned coinduction of anaesthesia is practiced by anaesthesiologists exploiting drug interaction particularly synergism.3.The arguments for co-induction are two fold. First, to improve the balance of desired versus adverse effects and secondly to reduce cost. When used this way midazolam has been shown to reduce the dose of propofol required to induce anaesthesia by up to 50% without affecting recovery profile. AIM OF STUDY: This study compares the midazolam co-induction and propofol predosing with regard to 1. Dose of propofol required for induction. 2. Blood pressure variability during induction. 3. Heart rate variability during induction. For adult patients undergoing elective surgeries. MATERIALS AND METHODS: The study was done at Government General Hospital, Madras Medical College, Chennai after getting permission from the ethical committee. All patients gave informed consent. Both the patient and observer were unaware of the group allocations. Inclusion Criteria: ASA 1 and 2 patients, Age 16 to 50 years, Elective surgeries. Exclusion Criteria: ASA 3 and 4patients, Age <15years >50 years, Any co morbid illnesses, Patients on benzodiazepines. Ninety ASA1 patients age 16-50 years scheduled for elective surgery were studied. All patients were pre operatively investigated for baseline investigations like blood sugar, urea, serum creatinine, ECG in 12 leads, chest x-ray PA view and other specific investigations relevant to the disease. All patients were assessed for their physicl status. The subjects were not pre medicated and were randomly allocated to one of the three groups. Group1 received midazolam 2 mg 2min prior to induction. Group 2 received propofol 30 mg 2min prior to induction. Group 3 received 3ml of 0.9%saline 2min prior to induction of anaesthesia. This was given as a bolus over a few seconds. Patients were counseled about the method of study. OBSERVATIONS AND RESULTS: 90 patients were taken up for the study. Group 1 30 patients Group 2 30 patients and Group 3 30 patients. Group1 received midazolam 2 mg 2min prior to induction. Group 2 received propofol 30 mg 2min prior to induction. Group 3 received 3ml of 0.9%saline 2min prior to induction of anaesthesia. STATISTICAL ANALYSIS: Chi-square test, Paired t-test, ANOVA F-test, Multiple comparison by Bonferroni t- test, Qualitative data (sex, weight age) were given in frequencies with their Percentages. Quantitative data (systolic blood pressure, pulse rate, dosage)were given in mean and standard deviation. SUMMARY: In this study pre dosing of 2 mg of midazolam as co-induction agent (Group 1) where propofol is used as an induction agent had Lesser blood pressure variability and Lesser heart rate variability during and after induction. Midazolam co-induction is more cost effective than control (Group3), since it requires only a single vial of propofol for induction. Pre dosing of 30 mg of propofol(Group 2) before propofol induction had Reduced dosage requirement, lesser blood pressure variability, lesser heart rate variability than group 3( control group). It is more cost effective than the control group and midazolm co-induction. control group (Group 3) is less cost effective than the other two groups, since it requires more than one vial of propofol for induction. It produces more hemodynamic variability which is statically significant. When compared with the other two groups. CONCLUSION: Predosing of midazolam for propofol induction had less hemodynamic variability (fall in blood pressure and heart rate during and after induction) and more cost effective since it requires only single vial of propofol for induction, whereas control group had significant hemodynamic variability, significant fall in blood pressure and heart rate .and requires more than a single vial of propofol for induction, hence it is not cost effective. Predosing of propofol for induction with propofol had less hemodynamic variability (fall in blood pressure and heart rate) than the control group. It is more cost effective when compared to control group and midazolam coinduction group.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Midazolam Coinduction ; Propofol Predosing ; Induction ; Anaesthesia.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 16 Apr 2018 17:30
Last Modified: 16 Apr 2018 17:30
URI: http://repository-tnmgrmu.ac.in/id/eprint/7030

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