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      Cambios hemodinámicos durante la inducción anestésica con tiopental versus propofol en pacientes asa I y II

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          Abstract

          Objetivo: Determinar los cambios hemodinámicos (frecuencia cardiaca y tensión arterial sistólica, diastólica y media) en la inducción anestésica con el uso de Tiopental versus Propofol en pacientes clasificados como ASA I y II de cirugía programada en el Hospital Universitario Fundación Santa Fe de Bogotá. Adicionalmente determinar el porcentaje requerido de medicamentos vasoconstrictores y líquidos endovenosos para contrarrestar la hipotensión generada por dichos inductores en los primeros 30 minutos de la anestesia. Metodología: experimento clínico aleatorizado controlado con muestreo secuencial por conveniencia. Se dividió en dos grupos, en el primero se realizó inducción anestésica con Tiopental Sódico (3-5 mg/kg) y el segundo con Propofol (1-2 mg/kg), para evitar sesgos se estandarizó la técnica de inducción. Se midieron los cambios hemodinámicos (frecuencia cardiaca, tensión arterial sistólica, diastólica y media) realizándose un promedio de las tres primeras mediciones (T0) las cuales fueron previo a la inducción y sin la colocación de ningún fármaco, posteriormente se realizó la medición antes de la intubación y 3 minutos después de la colocación de relajante neuromuscular (T1), 3 (T2), 5 (T3), 10 (T4) y 15 minutos (T5) después de la intubación. Se cuantificó la cantidad de vasopresores y de líquidos endovenosos utilizados. Resultados: No se encontraron diferencias estadísticamente significativas en los parámetros hemodinámicos medidos, (p = 0,32) ni en el uso de vasoconstrictores (7% versus 8%) (p= 0,69) o en la administración de líquidos endovenosos. Conclusiones: No hay diferencias clínicas ni estadísticamente significativas en los resultados encontrados entre el uso de Tiopental Sódico versus Propofol en pacientes clasificados como ASA I y II.

          Translated abstract

          Objective: To determine hemodynamic changes (heart rate, systolic, diastolic and mean arterial pressure) during anesthetic induction phase in patients ASA I and II scheduled for elective surgery, when using Sodium Thiopental versus Propofol at University Hospital Fundación Santa Fe de Bogotá. As a secondary objective, the proportion of patient requiring vasopressors and intravenous fluids to overcome the hypotension caused by these induction drugs during the first 30 minutes of anesthesia will be determined. Methods: randomized controlled clinical trial with secuential sampling by convenience. Patients where divided in two groups, the first of them received Sodium Thiopental (3-5mg/kg) and the second, Propofol (1-2 mg/kg). In order to avoid bias, the induction technique was standarized. hemodynamic data was captured (heart rate, systolic, diastolic and mean arterial pressure), a mean was calculated from the first three meassurements of each variable previous to anesthetic induction and previous to the administration of any medication, which was named T0. The next measurements where done 3 minutes after one dose of neuromuscular relaxant before intubation (T1), and 3(T2), 5(T3), 10(T4), and 15 minutes (T5) after intubation. Vasopressor and intravenous fluid requirements where quantifyed. Results: There where no statistically significant differences between hemodynamic parameters, use of vasopressors (7% versus 8%) or intravenous fluids between groups. Conclusions: There is no statistical or clinical difference in the outcomes studied between the use of Sodium Thiopental versus Propofol for anesthetic induction in patients ASA I or II.

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          Predictors of hypotension after induction of general anesthesia.

          Hypotension after induction of general anesthesia is a common event. In the current investigation, we sought to identify the predictors of clinically significant hypotension after the induction of general anesthesia. Computerized anesthesia records of 4096 patients undergoing general anesthesia were queried for arterial blood pressure (BP), demographic information, preoperative drug history, and anesthetic induction regimen. The median BP was determined preinduction and for 0-5 and 5-10 min postinduction of anesthesia. Hypotension was defined as either: mean arterial blood pressure (MAP) decrease of >40% and MAP or =50 yr, the use of propofol for induction of anesthesia, and increasing induction dosage of fentanyl. Smaller doses of propofol, etomidate, and thiopental were not associated with less hypotension. To avoid severe hypotension, alternatives to propofol anesthetic induction (e.g., etomidate) should be considered in patients older than 50 yr of age with ASA physical status > or =3. We conclude that it is advisable to avoid propofol induction in patients who present with baseline MAP <70 mm Hg.
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            Effects of thiopentone, etomidate and propofol on the haemodynamic response to tracheal intubation.

            The haemodynamic response to tracheal intubation was compared in 303 patients in whom anaesthesia was induced with either thiopentone 4 mg/kg, etomidate 0.3 mg/kg or propofol 2.5 mg/kg, with and without fentanyl 2 micrograms/kg. There was after propofol alone a significant decrease in arterial blood pressure, which did not increase above control values after intubation. Significant increases in arterial pressure followed intubation in patients induced with thiopentone or etomidate alone. Increases in heart rate occurred with all agents after laryngoscopy. The use of fentanyl resulted in arterial pressures lower than those after the induction agent alone, and in an attenuation, but not abolition of the responses to laryngoscopy and intubation.
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              Comparison of induction characteristics of four intravenous anaesthetic agents.

              The induction characteristics of thiopentone, etomidate and methohexitone have been compared to those of propofol (2,6 di-isopropyl phenol) in unpremedicated patients. Propofol 2.5 mg/kg caused significantly more hypotension, excitatory side effects and pain on injection at the dorsum of hand than thiopentone 5 mg/kg. However, with regard to the latter two sequelae, etomidate 0.3 mg/kg and methohexitone 1.5 mg/kg caused similar or more frequent upset. Propofol 2.0 mg/kg was equipotent with thiopentone 4.0 mg/kg in terms of successful induction of anaesthesia. Hypotension may contraindicate the use of propofol in the hypovolaemic or unfit patient.
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                Author and article information

                Journal
                rca
                Colombian Journal of Anestesiology
                Rev. colomb. anestesiol.
                SCARE-Sociedad Colombiana de Anestesiología y Reanimación (Bogotá, Cundinamarca, Colombia )
                0120-3347
                2256-2087
                March 2007
                : 35
                : 1
                : 53-58
                Affiliations
                [03] orgnameFundación Santa Fe de Bogotá orgdiv1Anestesiología Universidad El Bosque
                [02] orgnameFundación Santa Fe de Bogotá orgdiv1Departamento de Anestesia
                [01] Suecia orgnameUniversidad Javeriana
                Article
                S0120-33472007000100007 S0120-3347(07)03500107
                14bb6bc6-de53-429c-98eb-100c65388f66

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 12, Pages: 6
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                SciELO Colombia

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Investigaciones clínicas o de laboratorios

                pressure, Heart rate,Arterial blood,Hemodynamic changes,Thiopental,Propofol,Frecuencia Cardiaca,Tensión Arterial,Cambios Hemodinámicos,Tiopental

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