Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.07.009
Brazilian Journal of Anesthesiology
Original Investigation

Hemodynamic impact of increasing time between fentanyl and propofol administration during anesthesia induction: a randomised, clinical trial

Impacto hemodinâmico do aumento do tempo entre a administração de fentanil e propofol durante a indução anestésica: um ensaio clínico randomizado

Paula A. Vullo; María I. Real Navacerrada; Ricardo Navarro Suay

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Abstract

Background and objective
Anesthesia induction can produce severe propofol dose-dependent hypotension. Fentanyl coadministration reduces the catecholaminergic response to orotracheal intubation allowing propofol dose reduction. The aim of this study is to determine whether the hemodynamic response is improved by increasing the time between fentanyl and propofol administration and reducing the dose of the latter without increasing the time to achieve optimal hypnosis.

Methods
After approval by the Research Ethics Committee, patients undergoing non-cardiac surgery with endotracheal intubation were randomized by a computer-generated table into six time-dose groups (1 or 2 minutes/ 1, 1.5, or 2 mg.kg-1 of propofol). Patients with high bronchoaspiration risk, a difficult airway, hemodynamic instability, or anesthetic allergies were excluded. After giving intravenous fentanyl (2 μg.kg-1), each group received different doses of propofol after 1 or 2 minutes. Non-invasive blood pressure (BP) and heart rate (HR) were measured at pre-induction, pre-intubation, and post-intubation. Time to hypnosis (bispectral index < 60) was also recorded.

Results
Of the 192 recruited patients, 186 completed the study (1 min group n = 94; 2 min group n = 92). It was observed that HR and BP decreased after propofol administration and increased after intubation in all groups (p < 0.0001). In patients over 55 years, the 2 min – 2 mg.kg-1 group showed the greatest systolic BP reduction (36 ± 12%) at pre-intubation, while the 1 min – 1.5 mg.kg-1 group showed the least hemodynamic alteration between pre- and post-intubation (-4 ± 13%). No significant differences were found in younger patients or in the time to reach hypnosis between the six groups. While no cases of severe bradycardia were recorded, 5,4% of the sample required vasopressors.

Conclusion
Increasing the time between the administration of fentanyl and propofol by up to two minutes results in greater hypotension in patients over 55 years.

Keywords

Fentanyl;  General anesthesia;  Hemodynamics;  Intravenous anesthesia;  Propofol

Resumo

Introdução

A indução da anestesia pode produzir hipotensão grave dependente da dose de propofol. A coadministração de fentanil reduz a resposta catecolaminérgica à intubação orotraqueal, permitindo a redução da dose de propofol. O objetivo deste estudo é determinar se a resposta hemodinâmica melhora aumentando o tempo entre a administração de fentanil e propofol e reduzindo a dose deste último sem aumentar o tempo para atingir a hipnose ideal.

Métodos

Após aprovação do Comitê de Ética em Pesquisa, os pacientes submetidos à cirurgia não cardíaca com intubação endotraqueal foram randomizados por tabela gerada por computador em seis grupos de dose temporal (1 ou 2 minutos/1, 1,5 ou 2mg.kg-1 de propofol). ). Foram excluídos pacientes com alto risco de broncoaspiração, via aérea difícil, instabilidade hemodinâmica ou alergias anestésicas. Após administração de fentanil intravenoso (2μg.kg-1), cada grupo recebeu diferentes doses de propofol após 1 ou 2 minutos. A pressão arterial (PA) e a frequência cardíaca (FC) não invasivas foram medidas na pré-indução, pré-intubação e pós-intubação. O tempo até a hipnose (índice bispectral <60) também foi registrado.

Resultados

Dos 192 pacientes recrutados, 186 completaram o estudo (grupo 1min n=94; grupo 2min n=92). Observou-se que a FC e a PA diminuíram após a administração de propofol e aumentaram após a intubação em todos os grupos (p<0,0001). Em pacientes com mais de 55 anos, o grupo 2 min – 2 mg.kg-1 apresentou a maior redução da PA sistólica (36±12%) na pré-intubação, enquanto o grupo 1min–1,5mg.kg-1 apresentou a menor redução hemodinâmica. alteração entre pré e pós-intubação (-4±13%). Não foram encontradas diferenças significativas em pacientes mais jovens ou no tempo para atingir a hipnose entre os seis grupos. Embora não tenham sido registrados casos de bradicardia grave, 5,4% da amostra necessitaram de vasopressores.

Conclusão

O aumento do tempo entre a administração de fentanil e propofol em até dois minutos resulta em maior hipotensão em pacientes acima de 55 anos.

Palavras-chave

Fentanil; Anestesia geral; Hemodinâmica; Anestesia intravenosa; Propofol

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Submitted date:
10/16/2020

Accepted date:
07/10/2021

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