Postgraduate medical journal
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of methohexitone and propofol ('Diprivan') for induction of enflurane anaesthesia in outpatients.
In 73 unpremedicated patients scheduled for minor outpatient oral surgery or restorative dentistry, enflurane anaesthesia was induced either with an emulsion formulation of propofol (2.5 mg/kg) or with methohexitone (2 mg/kg). Sensations at the site of the injection were more common when the drugs were injected into a vein in the dorsum of the hand (58% for propofol and 28% for methohexitone) when compared to a vein in the forearm or antecubital area (7 to 8% with sensations). After induction of anaesthesia intravenous suxamethonium was given, and endotracheal intubation carried out. ⋯ The incidence of nausea or vomiting was similar (27 to 33%) in both groups. It is concluded that both propofol in emulsion form and methohexitone are satisfactory induction agents in outpatient dentistry. Propofol provided a smoother induction of anaesthesia and recovery was as rapid as after anaesthesia induced with methohexitone.
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Comparative Study
Recovery following propofol ('Diprivan') anaesthesia--a review of three different anaesthetic techniques.
The effect of propofol, in the emulsion formulation, on post-anaesthetic recovery was studied in 80 patients anaesthetized using one of three different techniques. Propofol was administered to 20 day case patients for induction of anaesthesia, to 20 patients for induction and maintenance by intermittent bolus injection to supplement spinal blockade, and to 40 patients for induction and maintenance by continuous infusion with spontaneous ventilation. Its effects were compared with those of methohexitone (all three techniques) and thiopentone (day case study only). ⋯ With the day case and infusion techniques immediate recovery was more rapid after propofol than after methohexitone and thiopentone. Recovery of psychomotor function was more rapid after propofol in the day case study. The frequency of sequelae such as nausea and vomiting (5% of cases), headache (1%) and confusion/restlessness (2.5%) was considerably lower overall after propofol and in each individual study than with the other agents.
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Dispersed guinea-pig adrenal cells or mouse Leydig cells were stimulated with a saturating dose of adrenocorticotrophin (ACTH, 50 ng/1) or luteinizing hormone (LH, 5IU/1), respectively. The incubations were performed in the presence of increasing concentrations (10(-9) - 5 X 10(-4)mol/l) of the anaesthetic agents propofol, thiopentone and etomidate. At the end of this stimulation period, cortisol (from the adrenal preparation) or testosterone (from the Leydig cell culture) were assayed by radioimmunoassay. ⋯ All the stimulators increased cortisol production by > 7-fold over that seen in their absence. Propofol depressed ACTH and dibutyryl cAMP induced cortisol output by > 60% (P < 0.05) but was without effect when the steroid precursors were used, suggestive of an inhibition between the sequence involving ACTH binding -> pregnenolone production. In contrast, etomidate and thiopentone reduced cortisol secretion by > 40% (P < 0.05) regardless of the stimulator used, indicating that at least one site of action was at the level of the final enzymic step of cortisol synthesis, i.e. 11beta-hydroxylase.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cumulative experience with propofol ('Diprivan') as an agent for the induction and maintenance of anaesthesia.
In 60 unpremedicated patients, anaesthesia induction time decreased when the time taken to inject a bolus of 2 mg/kg propofol was decreased from 60 s to 5 s. Apnoea at induction was noted in all groups but the degree of cardiorespiratory depression was not influenced by the rate of injection. ⋯ In comparison with thiopentone 4 mg/kg, propofol produced a greater degree of arterial hypotension and a smaller increase in heart rate. Preliminary results with an infusion of propofol for maintenance of anaesthesia suggest that rapid recovery can be achieved after operations of long duration.
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Propofol as an hypnotic in combination with fentanyl and vecuronium was used for total intravenous anaesthesia in 30 healthy unpremedicated patients undergoing elective surgery scheduled to last no longer than 1 h. Induction with propofol 2 mg/kg and fentanyl 1.875 micrograms/kg resulted in cessation of counting after 39 s and the loss of the eyelash reflex after 57 s. ⋯ During longer procedures there was evidence of accumulation in that propofol utilization rate decreased as the duration of anaesthesia increased. The results obtained are similar to those described with the previous Cremophor formulation although greater variability in induction and recovery times was noted with the emulsion formulation.