Comparative Study the Effect of Induction of General Anesthesia with Propofol Versus Thiopentone in Pediatric  Age Group on Cardiovascular System

Mahir Hussein Hasan AlSaadawi; Karrar Abed Almonem Hadi Maki Alkhafagy; Mohammed Ali Ibrahim Kareem Al-jibawi

doi:10.17605/cajmns.v4i4.1709

Mahir Hussein Hasan AlSaadawi F.I.C.M.S. Anaesthesia and Intensive Care Specialist, Imam Sadiq Teaching Hospital
Karrar Abed Almonem Hadi Maki Alkhafagy F.I.C.M.S. Anaesthesia and Intensive Care Specialist, Imam Sadiq Teaching Hospital
Mohammed Ali Ibrahim Kareem Al-jibawi F.I.C.M.S. Anaesthesia and Intensive Care Specialist, Imam Sadiq Teaching Hospital

DOI: https://doi.org/10.17605/cajmns.v4i4.1709

Keywords: intravenous, propofol, thiopentone, Anaesthesia: paediatric, Anesthetics: intravenous, cardiac output, Measurement techniques: echocardiography

Abstract

Background:

We compared the hemodynamic responses of i.v. Propofol 2.5 mg/kg with thiopental 5.0 mg/kg in 41 healthy children during anesthesia induction in Imam Sadiq Teaching Hospital and Al Hilla General Teaching Hospital/ AL Hilla IRAQ from February 2014 to December 2016 .

Methods

Four groups were divided according to age and type of injectate received: group 1 (2 years), propofol (n = 9); Group II (2 years), thiopental (n = 9); group III (2–12 years), propofol (n = 12); and group IV (2–12 years), thiopental (n = 11). Anesthesia was maintained by spontaneous breathing with 70% nitrous oxide and 0.5% halothane in oxygen. Blood pressure and heart rate were monitored. Stroke volume was measured using pulse Doppler and echocardiography .

Results

Measurements were taken before induction and at 1-minute intervals for 5 minutes after induction. The reduction in mean arterial pressure was significantly greater after propofol (28–31%) than after thiopental (14–21%) (P = 0.001). There was no significant differences in reduction of cardiac index (10–15%) after induction between the two drugs (p=0.122).

The increases in heart rate and systemic vascular resistance due to activation of Baro receptor reflex were less after propofol than after thiopental alone. The baroreceptor reflex was more weakened in young2-year-olds than in older children. Induction of anesthesia with propofol is associated with a much greater reduction of arterial blood pressure compared to thiopental in both adults [1-4] and children [5-7]. It is one of the main criticisms of the use of propofol. In adults, the hypotension appears to be due to reduction of systemic vascular resistance [2, 4, 8, 9]. There is controversy about the direct effects on the cardiovascular system. However, this appears to have a slightly negative inotropic effect. Due to ethical and technical limitations, pediatric hemodynamic data is limited to noninvasive heart rate and blood pressure measurements [5-7], but these peripheral hemodynamic measurements are insufficient to describe the myocardium effects that result from the anesthetics [10]. With the development of echocardiography, this is now possible The measures cardiac output non-invasively with high accuracy by combining echocardiography technology and the Doppler principle. Measurement of cardiac parameter using the Pulse Doppler technique The echocardiography of proved to be of high quality correlation coefficient (r = 0.90-0.98) versus by dye dilution technique [11, 12].In this study, this technique was used to compare the cardiovascular effects of intravenous anesthesia induction with Propofol versus thiopental.

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