Postgraduate medical journal
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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.
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In younger patients, 2.25 mg/kg is a reliable induction dose of propofol, whereas this level falls to 1.5 mg/kg in older patients. The incidence of hypotension and apnoea is dose-dependent in all patients.
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A standard method (fixed initial dose of 1.25 mg/kg followed by 10 mg every 15 s) for studying the induction dose of propofol showed a marked falling off in requirements in fit unpremedicated patients aged 60 y and over. With this slow technique of administration, side effects were rare, even in the elderly.