Co-induction of anaesthesia with 0.75 mg kg propofol followed by sevoflurane: a randomized trial in the elderly with cardiovascular risk factors

• Published in: European journal of anaesthesiology Vol. 25; no. 3; p. 183
• Main Authors: Moran, A P, Stock, K, Jenkins, C, Uncles, D, Panayiotou, S, Spring, C, O'Dwyer, J, Kelley, K, Venn, R
• Format: Journal Article
• Language: English
• Published: England 01-03-2008
• Subjects: Aged; Aged, 80 and over; Anesthesia, General - adverse effects; Anesthesia, General - methods; Anesthetics, Combined - adverse effects; Anesthetics, Combined - therapeutic use; Anesthetics, Inhalation - adverse effects; Anesthetics, Inhalation - therapeutic use; Anesthetics, Intravenous - adverse effects; Anesthetics, Intravenous - therapeutic use; Blood Pressure - drug effects; Drug Therapy, Combination; Female; Femoral Neck Fractures - surgery; Heart Rate - drug effects; Humans; Male; Methyl Ethers - adverse effects; Methyl Ethers - therapeutic use; Oximetry; Patient Satisfaction; Propofol - adverse effects; Propofol - therapeutic use; Prospective Studies; Risk Factors; Time Factors
• ISSN: 1365-2346
• DOI: 10.1017/S026502150700138X

The induction of general anaesthesia is associated with the greatest cardiovascular changes in elderly patients. Induction can be performed either intravenously or with gaseous induction. Sevoflurane has advantages over propofol for induction of anaesthesia in the elderly, since the lower reduction in mean arterial pressure with sevoflurane is both statistically and clinically significant. This prospective randomized controlled trial investigated the cardiovascular benefits of co-induction of anaesthesia with 0.75 mg kg(-1) propofol and 8% sevoflurane, when compared with 8% sevoflurane alone in patients requiring surgery for fractured neck of femur.
In total, 38 patients aged 75 or over were allocated into the two groups, receiving either 0.75 mg kg(-1) of propofol followed by 8% sevoflurane or 8% sevoflurane alone. Vital signs were recorded until successful insertion of a laryngeal mask. Induction times, induction events and patient satisfaction scores were also recorded.
Results showed that there were no differences in the cardiovascular parameters between the two groups. Induction times were faster in the propofol and sevoflurane group (62 vs. 81 s; P = 0.028). The postoperative questionnaire showed that the majority of patients in both groups were satisfied with the induction process.
We concluded that 0.75 mg kg(-1) of propofol followed by sevoflurane induction is an acceptable alternative to sevoflurane induction. It is associated with similar haemodynamic variables, faster induction times and is very well tolerated.