Comparison of arterial hypotension incidence during general anesthesia induction – target-controlled infusion vs. bolus injection of propofol: a randomized clinical trial
Comparação da incidência de hipotensão arterial durante a indução da anestesia geral – infusão alvo-controlada vs. injeção em bolus de propofol: um ensaio clínico randomizado
Ana G.G. Vale, Catia S. Govêia, Gabriel M.N. Guimarães, Laíze R. Terra, Luís C.A. Ladeira, Guilherme A. Essado
Abstract
Background
The incidence of arterial hypotension during induction of general anesthesia is influenced by the method of propofol administration, but there is a dearth of randomized clinical trials comparing bolus injection and target-controlled infusion in relation to arterial hypotension. This study seeks to compare the incidence of arterial hypotension between these two methods of propofol administration.
Methods
This prospective, randomized, single-center, non-blinded study included 60 patients (aged 35 to 55 years), classified as ASA physical status I or II, who were undergoing non-cardiac surgeries. They were randomly allocated using a computer to two groups based on the method of propofol administration during the induction of general anesthesia: the Target Group, receiving target-controlled infusion at 4 μg.mL−1, and the Bolus Group, receiving a bolus infusion of 2 mg.kg−1. Both groups also received midazolam 2 mg, fentanyl 3 μg.kg−1, and rocuronium 0.6 mg.kg−1. Over the first 10 minutes of anesthesia induction, Mean Arterial Pressure (MAP), Heart Rate (HR), level of Consciousness (qCON), and Suppression Rate (SR) were recorded every 2 minutes.
Results
Twenty-seven patients remained in the TCI group, while 28 were in the Bolus group. Repeated measure analysis using mixed-effects models could not reject the null hypothesis for the effect of group-time interactions in MAP (p = 0.85), HR (p = 0.49), SR (p = 0.44), or qCON (p = 0.72). The difference in means for qCON (60.2 for TCI, 50.5 for bolus, p < 0.001), MAP (90.3 for TCI, 86.2 for bolus, p < 0.006), HR (76.2 for TCI, 76.9 for bolus, p = 0.93), and SR (0.01 for TCI, 5.5 for bolus, p < 0.001), irrespective of time (whole period means), revealed some significant differences.
Conclusion
Patients who received propofol bolus injection exhibited a lower mean arterial pressure, a greater variation in the level of consciousness, and a higher suppression rate compared to those who received it as a target-controlled infusion. However, the interaction effect between groups and time remains inconclusive.
Keywords
Resumo
Introdução
A incidência de hipotensão arterial durante a indução da anestesia geral é influenciada pelo método de administração do propofol, mas há escassez de ensaios clínicos randomizados comparando injeção em bolus e infusão alvo-controlada em relação à hipotensão arterial. Este estudo busca comparar a incidência de hipotensão arterial entre esses dois métodos de administração de propofol.
Métodos
Este estudo prospectivo, randomizado, unicêntrico e não cego incluiu 60 pacientes (35 a 55 anos), classificados como estado físico ASA I ou II, submetidos a cirurgias não cardíacas. Eles foram alocados aleatoriamente, por meio de computador, em dois grupos com base no método de administração de propofol durante a indução da anestesia geral: Grupo Alvo, recebendo infusão alvo-controlada de 4 μg.mL−1, e Grupo Bolus, recebendo infusão em bolus. de 2 mg.kg−1. Ambos os grupos também receberam midazolam 2 mg, fentanil 3 μg.kg−1 e rocurônio 0,6 mg.kg−1. Durante os primeiros 10 minutos da indução da anestesia, a pressão arterial média (PAM), a frequência cardíaca (FC), o nível de consciência (qCON) e a taxa de supressão (SR) foram registrados a cada 2 minutos.
Resultados
Vinte e sete pacientes permaneceram no grupo TCI, enquanto 28 permaneceram no grupo Bolus. A análise de medidas repetidas usando modelos de efeitos mistos não pôde rejeitar a hipótese nula para o efeito das interações grupo-tempo em PAM (p = 0,85), FC (p = 0,49), TS (p = 0,44) ou qCON (p = 0,72). ). A diferença nas médias para qCON (60,2 para TCI, 50,5 para bolus, p < 0,001), MAP (90,3 para TCI, 86,2 para bolus, p < 0,006), FC (76,2 para TCI, 76,9 para bolus, p = 0,93), e a TS (0,01 para TCI, 5,5 para bolus, p < 0,001), independentemente do tempo (média de todo o período), revelou algumas diferenças significativas.
Conclusão
Os pacientes que receberam injeção em bolus de propofol apresentaram pressão arterial média mais baixa, maior variação no nível de consciência e maior taxa de supressão em comparação com aqueles que receberam como infusão alvo-controlada. No entanto, o efeito da interação entre grupos e tempo permanece inconclusivo.
Palavras-chave
References
1. Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth. 2018;121:706−21.
2. Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after non-cardiac surgery. Anesth Analg. 2005;100:4−10.
3. Chen L, Lu K, Luo T, Liang H, Gui Y, Jin S. Observer’s Assessment of Alertness/Sedation-based titration reduces Propofol consumption and incidence of hypotension during general anesthesia induction: A randomised controlled trial. Sci Prog. 2021;104:1−14.
4. Walsh M, Kurz A, Turan A, et al. Relationship between Intraoperative Mean Arterial Pressure and Clinical Outcomes after Noncardiac Surgery. Anesthesiology. 2013;119:507−15.
5. Gregory A, Stapelfeldt WH, Khanna AK, et al. Intraoperative Hypotension Is Associated with Adverse Clinical Outcomes after Non-cardiac Surgery. Anesth Analg. 2021;132(6): 1654−65.
6. Maheshwari K, Turan A, Mao G, et al. The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis. Anaesthesia. 2018;73:1223−8.
7. De Wit F, Van Vliet AL, De Wilde RB, et al. The effect of Propofol on haemodynamics: Cardiac output, venous return, mean systemic filling pressure, and vascular resistances. Br J Anaesth. 2016;116:784−9.
8. Sahinovic MM, Struys MMRF, Absalom AR. Clinical Pharmacokinetics and Pharmacodynamics of Propofol. Clin Pharmacokinet. 2018;57:1539−58.
9. Choi GJ, Kang H, Baek CW, Jung YH, Lee JJ. Comparison of bolus versus continuous infusion of Propofol for procedural sedation: a meta-analysis. Curr Med Res Opin. 2017;33:1935−43.
10. Rather ZM, Islam MN, Afaq B, Farooq U, Majid NA. The effect of Propofol when injected at different speeds for induction of general anesthesia: an observational study. Int J Clin Trials. 2018;5(2):107.
11. Shah NK, Harris M, Govindugari K, Rangaswamy HB, Jeon H. Effect of Propofol titration v/s bolus during induction of anesthesia on hemodynamics and bispectral index. M E J Anesth. 2011;21:275−84.
Submitted date:
09/18/2023
Accepted date:
04/03/2024
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