ARTICLE INFO

Article Type

Original Research

Authors

Shabanian   Gh. (1)
Rafie   M. (1)
Heidari-Soureshjani   S. (2)
Shabanian   A.R. (3)
Shabanian   M.R. (*)






(*) Medicine Department, Medicine Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
(1) Anesthesiology Department, Medicine Faculty, Shahrekord University of Medical Sciences, Shahrekord, Iran
(2) Deputy of Research & Technology, Shahrekord University of Medical Sciences, Shahrekord, Iran
(3) Dentistry Department, Medicine Faculty, Isfahan University of Medical Sciences, Isfahan, Iran

Correspondence

Address: Medicine Faculty, Isfahan University of Medical Sciences, Hezar Jarib Street, Isfahan, Iran
Phone:
Fax: +98212228600
shabanian.mohammadreza@gmail.com

Article History

Received:  August  22, 2015
Accepted:  May 10, 2016
ePublished:  June 30, 2016

BRIEF TEXT


Propofol is of the most common drug that is used for rapid induction and maintenance of anesthesia or sedation performance in different doses and in order to do different treatments [1, 2].

… [3-7]. The effective Dose of this drug in some patients is still disputable [8]. …[9]. A study regarding the comparison of different Propofol doses for anesthesia induction based on Bispectral Index Monitoring System (BIS) indicates that the amount of 1/5 mg per kg of Propofol is the best dose to achieve the desirable level of BIS with afore mentioned dose of Remifentanil [10]…[11-18].

The aim of this study was the comparison of 1 mg per kg and 2.5 mg per kg of Propofol in hemodynamic changes, the Myoclonus degree and BIS level in Patients under anesthesia induction.

This study is a double-blind randomized clinical trial.

This study was performed on patients who were candidate for surgery and had referred to the Shahrekord Ayatollah Kashani Center in 2013. Patients were between the ages of 20 and 80 and in class I and II of ASA (American Society of Anesthesiologists) that a surgery was performed under general anesthesia induction.

A hundred patients were selected by simple sampling method and divided into two groups of 50 patients randomly; the first group was anesthetized with 1 mg per kg dose and second group with 2.5 mg per kg dose of Propofol [19]. Exclusion criteria of the study were the issues such as dissatisfaction of participants in the study, finding any unpredictable complications after Propofol injection, having more than class I and II of ASA, drug allergy, contraindications in patient through drug use and inadequate anesthesia depth.

Nitrous oxide was used during Anesthesia for Amnesia of patients. Anesthesia induction in patients started after monitoring, equipment preparation, installation of forehead lead of BIS devise and controlling of blood pressure and heartbeat and recording of them. Thiopental was injected immediately after the first decreasing symptoms of anesthesia depth of the patient. In each group 1-3 microgram per kg dose of Fentanyl was used according to the need for premedication and 0.5 mg per kg of relaxant atracurium was used for muscle flaccidity and facilitating intubation. After locating the patient on surgical operating table, systolic and diastolic blood pressure, pulse rate and the mean arterial pressure were measured by anesthesia intern 5 minutes before anesthesia induction, 1 minute and 5 minutes after anesthesia induction and immediately after intubation. Also myoclonus was evaluated one minute after anesthesia induction and was recorded according to the impulsivity [20]. The impulsivity is a triple scale in which zero means the absence of any abnormal movements, one means abnormal movements in one or two limbs and two means abnormal movements in more than 2 organs or limbs and body [17]. Also, after anesthesia induction, the consciousness level was evaluated and recorded by BIS device. Information related to the patients is collected in two checklists including demographic variables checklist and Hemodynamic variables, myoclonus and BIS level checklist. In addition to calculation of the mean, standard deviation and relative frequency distribution, T test was used to study both in terms of the mean age, chi-square test was used to study ASA class and other demographic variables, independent T test was used to compare hemodynamic index and BIS level in both groups and repeated measures ANOVA was used to compare these variables in different time. Also, fisher test was used to compare the myoclonus in both groups. Data analysis was carried out by SPSS-17 software.

Eight (4 from each group) out of 100 patients participated in the study were excluded due to cooperation refusal and ultimately data for 92 patients was finally analyzed. Age mean of patients in first group was 48.63±16.85 and in second group was 45.92±13.26. There was no significant difference in terms of age between the two groups and both groups were similar in this regard (P=0.519). Also, there was no significant difference between the two groups in terms of other demographic variables (Table1). Hemodynamic variables such as systolic blood pressure, diastolic, the mean arterial pressure and pulse rate in four times (5 min before anesthesia induction, 1 min and 5 min after anesthesia induction and immediately after intubation) had no significant statistical difference between the two groups (P>0.05) . With respect to BIS index in both groups, the highest level of BIS was 5 minutes before anesthesia and the lowest one was about 1 minute after anesthesia. Also, there was no significant difference between the two groups in process of indexes changes of systolic blood pressure, diastolic, the mean arterial pressure and anesthesia depth that demonstrated the equal function of two Propofol doses on these indexes. However, the process of pulse rate changes showed significant difference between the two groups (Table2). Regarding the myoclonus frequency of distribution, in the first group, the myoclonus of 35 patients (%76.1) was zero, 9 patients (%19.6) myoclonus one and 2 patients (%4.3) myoclonus two. Also in the second group the myoclonus of 41 patients (%89.1) was zero, 4 patients (%8.7) myoclonus one and 1 patients (%2.2) myoclonus two that there was no significant difference in the myoclonus in both groups (P=0.382).

The study conducted by Naderi et al. has shown that 1 mg per kg dose of the drug is not enough to achieve immovability during tracheal intubation, but group of 1.5 and 2 mg per kg was appropriate in this regard[10] that this finding was not consistent with the results of current study. …[21-23].

It is recommended to select suitable dose of the drug by considering clinical condition of patient and specialist diagnosis to achieve an adequate level of anesthesia.

Deficiency of BIS leads and resistance from people against participating in the study were the limitations of the study.

The hemodynamic changes, the myoclonus and BIS level in two doses of 1 mg per kg and 2.5 mg per kg of propofol are the same in patients under anesthesia induction.

We appreciate Vice president of Shahrekord Medical Sciences University for financial support, patients and all those who some how has collaborated with us to implement and complete this research.

Non-declared

The current study in IRCT database has registered with clinical trial code IRCT2015030218099N3. Also, its ethical license has been taken by ethics committee of Shahrekord Medical Sciences University (ethic code: 91-4-18).

This article is from general medical thesis No. 1025 at Shahrekord Medical Sciences University and this research was financially supported by vice chancellor of research and technology of Shahrekord Medical Sciences University.

TABLES and CHARTS

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CITIATION LINKS

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