Small dose of ephedrine for prevention of hypotension following propofol and fentanyl administration during induction of general anesthesia
Induction of general anesthesia with propofol and fentanyl could result in hypotension and bradycardia. Various methods are being used to prevent these adverse effects. The aim of our study was to assess the efficacy and safety of a small dose of ephedrine in prevention of hypotension following administration of propofol and fentanyl. This prospective, randomized, comparative study was conducted among a total of 50 patients, both genders, age 18 years up to 60 years with ASA grade Ι and ΙΙ and some of class ΙΙΙ, presented for elective surgery under general anesthesia. Patients were randomly allocated into one of two groups (25 patients in each): CG (the control group), which received propofol in a dose of 2 mg/kg, intravenously, over 20–30 s mixed with 2 mL normal saline: and EphG (Ephedrine group), while received propofol in a dose of 2 mg/kg, intravenously, over 20–30 s mixed with 2 mL of ephedrine (10 mg). The Mean Arterial Blood Pressure (MAP) and Heart Rate (HR) were recorded before induction and then every 1 min up to 6 min after induction. The categorical data are presented as a number and percentage and were subjected to Fisher’s exact or Chi-square test for analysis. The statistical significance was p≤0.05. The significant differences in HR were observed in the 3rd,4th, and 5th minutes with P-value, 0.018, 0.000, 0.000, respectively. However, no patient in the study participants had bradycardia. The significant differences in MAP were observed in the 2nd, 3rd,4th, and 5th minutes with P-value, 0.035, 0.000, 0.000, and 0.000, respectively. The percentage of patient in CG who developed hypotension in the 3rd and 4th is 44% and 32% compared to 8% and 0% in EphG, with significant differences (P-value 0.004 and 0.002, respectively). Administration of small dose of ephedrine with propofol could attenuate propofol/fentanyl hypotensive and bradycardic effects.
White P. Propofol: Its Role in Changing the Practice of Anesthesia. Anesthesiol 2008;109:1132-1136. DOI: https://doi.org/10.1097/ALN.0b013e31818ddba8
Tobias J, Leder M. Procedural sedation: A review of sedative agents, monitoring, and management of complications. Saudi J Anaesth 2011;5:395. DOI: https://doi.org/10.4103/1658-354X.87270
Hussein MM, Mostafa RH, Ibrahim IM. Intravenous ephedrine, phenylephrine, and ketamine for attenuation of hypotension associated with induction of general anesthesia with propofol. Ain-Shams J Anaesthesiol 2017;10:182.
Ma G, Bavadekar SA, Davis YM, et al. Pharmacological effects of ephedrine alkaloids on human alpha(1)- and alpha(2)-adrenergic receptor subtypes. J Pharmacol Exp Ther 2007;322:214–21. DOI: https://doi.org/10.1124/jpet.107.120709
Smith C, McEwan AI, Jhaveri R et al. The interaction of fentanyl on the Cp50 of propofol for loss of consciousness and skin incision. Anesthesiol 1994;81:820–8. DOI: https://doi.org/10.1097/00000542-199410000-00008
Lysakowski C, Dumont L, Pellegrini M et al. Effects of fentanyl, alfentanil, remifentanil and sufentanil on loss of consciousness and bispectral index during propofol induction of anaesthesia. Br J Anaesth 2001;86:523–7. DOI: https://doi.org/10.1093/bja/86.4.523
Claeys MA, Gepts E, Camu F. Haemodynamic changes during anaesthesia induced and maintained with propofol. Br J Anaesth 1988;60:3–9. DOI: https://doi.org/10.1093/bja/60.1.3
Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiol 1994;81:1005–43.
Bano F, Zafar S, Sabbar S, et al. Intravenous ketamine attenuates injection pain and arterial pressure changes during the induction of anesthesia with propofol: A comparison with lidocaine. J Coll Physicians Surg Pak 2007;17:390–3.
Larsen R, Rathgeber J, Bagdahn A, et al. Effects of propofol on cardiovascular dynamics and coronary blood flow in geriatric patients. A comparison with etomidate. Anaesthesia 1988;43:25–31. DOI: https://doi.org/10.1111/j.1365-2044.1988.tb09064.x
El-Tahan MR. Preoperative ephedrine counters hypotension with propofol anesthesia during valve surgery: A dose dependent study. Ann Card Anaesth 2011;14:30–40.
Kasaba T, Yamaga M, Iwasaki T, et al. Ephedrine, dopamine, or dobutamine to treat hypotension with propofol during epidural anesthesia. Can J Anaesth 2000;47:237–41. DOI: https://doi.org/10.1007/BF03018919
Michelsen I, Helbo-Hansen HS, Køhler F et al. Prophylactic ephedrine attenuates the hemodynamic response to propofol in elderly female patients. Anesth Analg 1998;86:477–81.
Ozkoçak I, Altunkaya H, Ozer Y et al. Comparison of ephedrine and ketamine in prevention of injection pain and hypotension due to propofol induction. Eur J Anaesthesiol 2005;22:44–8. DOI: https://doi.org/10.1097/00003643-200501000-00010
Masjedi M, Zand F, Kazemi AP, Hoseinipour A. Prophylactic effect of ephedrine to reduce hemodynamic changes associated with anesthesia induction with propofol and remifentanil. J Anaesthesiol Clin Pharmacol 2014;30:217–21. DOI: https://doi.org/10.4103/0970-9185.130024
Gopalakrishna MD, Krishna HM, Shenoy UK. The effect of ephedrine on intubating conditions and haemodynamics during rapid tracheal intubation using propofol and rocuronium. Br J Anaesth 2007;99:191-4. DOI: https://doi.org/10.1093/bja/aem125
Gamlin F, Vucevic M, Winslow L, Berridge J. The haemodynamic effects of propofol in combination with ephedrine. Anaesthesia 1996;51:488–491 DOI: https://doi.org/10.1111/j.1365-2044.1996.tb07799.x
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 DOI: https://doi.org/10.1007/BF03011034
Agarwal A, Sharma K, Parashar S, et al. Prevention of hypotension during propofol induction: a comparison of preloading with Ringer lactate and intravenous ephedrine. J Evol Med Dent Sci 2013;2:6640-50 DOI: https://doi.org/10.14260/jemds/1188
Malla S, Andrabi R, Ashraf S, Saleem B. Prevention of hypotension caused by induction of anaesthesia with propofol, a comparison of preloading with 3.5% polymers of degraded gelatin solution, crystalloid (Ringer lactate) & intravenous ephedrine. J Evol Med Dent Sci 2015;4:365–74. DOI: https://doi.org/10.14260/jemds/2015/56
Dhungana Y, Bhattarai BK, Bhadani UK et al. Prevention of hypotension during propofol induction: a comparison for preloading with 3.5% polymers of degraded gelatin (Haemaccel) and intravenous ephedrine. Nepal Med Coll J 2008;10:16–19.
- Abstract views: 96
- PDF: 42
Copyright (c) 2020 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.