A randomized comparative study of preloading with Ringers lactate and intravenous Ephedrine for the prevention of hypotension due to propofol during induction of general anesthesia

Authors

  • Manisha Pradhan Patan Academy of Health Sciences, Patan, Lalitpur
  • Brahma Dev Jha Kathmandu Model Hospital, Kathmandu

Keywords:

anesthetic agents, ephedrine, hypotension, propofol, ringers lactate

Abstract

Background: The ideal method to prevent hypotension due to intravenous propofol for induction of anesthesia is still debatable. The aim of the study was to compare the hemodynamic response of ephedrine and volume loading with ringer lactate in preventing the hypotension caused by propofol as inducing agent in patients scheduled for elective surgeries requiring general anesthesia with endotracheal intubation.

Methods: This was prospective randomized study conducted in 40 patients of ASA physical status I, aged 20-50 years, scheduled for elective surgeries requiring general anesthesia with endotracheal intubation. Group I received intravenous ephedrine sulphate (70 mcg/kg) just before induction of anaesthesia, and patients assigned to Group II received preloading with Ringer's lactate (12 ml/kg) over the 10-15 minutes before the administration of propofol. The variables compared were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure following induction of anesthesia till 10 minutes after intubation of trachea.

Results: We found that there were increase in systolic blood pressure, diastolic blood pressure and mean arterial pressure after induction in both the groups but the difference between the groups was not significant. The increase in heart rate was found to be significantly higher in ephedrine group in comparison to volume loading group.

Conclusion: Our study showed that both the methods used were equally effective in preventing hypotension induced by propofol in the adult ASA physical status I patients requiring general anesthesia with endotracheal intubation. However, the heart rate was significantly higher in patients receiving ephedrine in comparison to volume loading group.

Author Biographies

Manisha Pradhan, Patan Academy of Health Sciences, Patan, Lalitpur

Lecturer, Department of Anesthesia

Brahma Dev Jha, Kathmandu Model Hospital, Kathmandu

Professor, Department of Anesthesia

References

1. Smith I, White PF, Nathason M, Gouldson R. Propofol: an update on its clinical use. Anesthesiology 1994;81:1005-435.
http://dx.doi.org/10.1097/00000542-199410000-00028
[PMID:7943815]
2. Hug Jr CC, McLeskey CH, Nahrwold ML, Roizen MF, Stanley TH, Thisted RA, et al. Hemodynamic effects of propofol: data from over, 25,000 patients. Anaesth Analg 1993;77:521-30.
[PMID:8214693]
3. van Aken H, Meinshausen E, Prien T, Brussel T, Heinecke A, Lawin P. The influence of fentanyl and tracheal intubation on the hemodynamic effect of anaesthesia induction with propofol/N2O in humans. Anesthesiology 1988;68:157-63.
http://dx.doi.org/10.1097/00000542-198801000-00031
[PMID:3257362]
4. Briggs MLP, Dundee JW, Bahar M, Clarke RSI. Comparison of the effect of disopropyl phenol and thiopentone on response to somatic pain. BJA 1982;54:307-11.
http://dx.doi.org/10.1093/bja/54.3.307
[PMID:6978144]
5. Mc Collum JS, Milligan KR, Dundee JW. The antiemetic action of propofol. Anaesthesia 1988;43:239-40.
http://dx.doi.org/10.1111/j.1365-2044.1988.tb05551.x
[PMID:3259081]
6. Turner RJ, Gatt SP, Kam PC, Ramzan I, Daley M. Administration of a crystalloid fluid does not prevent the decrease in arterial blood pressure after induction of anaesthesia with propofol and fentanyl. BJA 1998;80:737-41.
http://dx.doi.org/10.1093/bja/80.6.737
[PMID:9771299]
7. Al Ghamdi A. Hydroxyethyl starch 6.0% preload does not prevent the hypotension following induction with propofol and fentanyl. Middle East J Anaesthesiol 2004;17:959-68.
[PMID:15449752]
8. Chiu CL, Tew GP, Wang CY. The effect of prophylactic metaraminol on systemic hypotension caused by induction of anaesthesia with propofol in patients over 55 years old. Anaesthesia 2001;56:893-9.
http://dx.doi.org/10.1046/j.1365-2044.2001.02059-4.x
[PMID:11531679]
9. Kasaba T, Yamaga M, Iwasaki T, Yoshimura Y, Takasaki M. Ephedrine, dopamine, dobutamine to treat hypotension with propofol during epidural anaesthesia. Can J Anaesth 2000;47:237-41.
http://dx.doi.org/10.1007/BF03018919
[PMID:10730734]
10. Coates DP, Monk CR, Prys-Roberts C, Turtle M. Hemodynamic effects of infusions of the emulsion formulation of propofol during nitrous oxide anesthesia in humans. Anesth Analg 1987;66:64-70.
http://dx.doi.org/10.1213/00000539-198701000-00011
[PMID:3492156]
11. Claeys MA, Gepts E, Camu F. Hemodynamic changes during anaesthesia induced and maintained by propofol. BJA 1988;60:3-9.
http://dx.doi.org/10.1093/bja/60.1.3
[PMID:3257393]
12. Monk CR, Coates DP, Prys-Roberts C, Turtle MJ, Spelina K. Hemodynamic effect of the prolonged propofol infusion supplemented nitrous oxide anesthesia for peripheral vascular surgery. BJA 1987;59:954-60.
http://dx.doi.org/10.1093/bja/59.8.954
[PMID:3498505]
13. Stephan H, Sonntag H, Schenk HD, Kettler D, Khambatta HJ. Effects of propofol on cardiovascular dynamics, myocardial blood flow and myocardial metabolism in patients with coronary heart disease. BJA 1986;58:969-75.
http://dx.doi.org/10.1093/bja/58.9.969
[PMID:3489478]
14. Robinson BJ, Ebert TJ, O'brien TJ, Colinco MD, Muzi M. Mechanism whereby propofol mediates vasodialatation in humans: Sympathoinhibition or direct vascular relaxation? Anaesthesiology 1997;86:64-72.
http://dx.doi.org/10.1097/00000542-199701000-00010
[PMID:9009941]
15. Ebert TJ, Muzi M, Berens R, Goff D, Kampine JP. Symphathetic response to induction of anaesthesia in humans with propofol or etomidate. Anesthesiology 1992;76:725-33.
http://dx.doi.org/10.1097/00000542-199205000-00010
[PMID:1575340]
16. Michelsen I, Helbo-Hansen HS, Kohler F, Lorenzen AG, Rydlund E, Bentzon MW. Prophylactic ephedrine attenuates the hemodynamic response to propofol in elderly female patient. Anaesth Analg 1998;86:477-81.
http://dx.doi.org/10.1097/00000539-199803000-00004
[PMID:9495396]
17. El Beheiry H, Kim J, Milne B, Seegobin R. Prophylaxis against the systemic hypotension induced by propofol during rapid sequence intubation. Can J Anaesth 1995;42:875-8.
http://dx.doi.org/10.1007/BF03011034
[PMID:8706196]
18. Weeks S. Reflection of hypotension during caesarean section under spinal anesthesia: do we need to use colloid? Can J Anaesth 2000;47:607-10.
http://dx.doi.org/10.1007/BF03018990
[PMID:10930197]

Downloads

Published

2016-03-20

How to Cite

Pradhan, M., & Jha, B. D. (2016). A randomized comparative study of preloading with Ringers lactate and intravenous Ephedrine for the prevention of hypotension due to propofol during induction of general anesthesia. Journal of Society of Anesthesiologists of Nepal, 3(1), 22-27. Retrieved from http://www.jsan.org.np/jsan/index.php/jsan/article/view/104

Issue

Vol. 3 No. 1 (2016): 2016 March Issue

Section

Original Article

License

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.