A comparative study of profopol and thiopentone with respect to hemodynamic stability used for various surgeries at tertiary health care centre

 

 

Abstract               Background: General anesthesia is a medically induced coma with loss of protective reflexes, resulting from the administration of one or more general anaesthetic agents. Aims and Objectives: A comparative Study profopol and thiopentone with respect to Hemodynamic stability used for various surgeries at tertiary health care centre. Methodology: This was a cross-sectional study carried out in the patients undergoing various surgeries at tertiary health care centre during the one year period i.e. January 2017 to January 2018 . In the one year period there were 50 patients with enrolled into the study with written and explained consent. The patients after all the standard anesthetic protocol were given general anesthesia to the patients and patients randomly allotted to the groups The patients after all the standard anesthetic protocol were given general anesthesia to the patients and patients randomly allotted to the groups i.e. Profopol (Group P) in a dose of Propofol (2.5mg/kg) and Thiopentone (Group T) Thiopentone (5mg/kg), both of them given IV Ketamine 0.5mg/kg as premedication .The hemodynamic parameters like Systemic BP, Diastolic BP and Heart Rate (HR) etc. was noted. The statistical analysis was done Chi –square test , and unpaired t-test and analyzed by SPSS 19 version. Result: In our study we have seen that Average age of the was 35± 3.46 and 36± 4.12 in the Group T and Group P was comparable (t =0.98,df = 49,p>0.05) and the ratio of Male : Female ratio was 1.08 and 1.27 was comparable (X2=0.08,df=49,p>0.05). Preop SBP was 123.4±9.83 and 125±11.21 was comparable (t=1.082,NS) ; SBP at (10 min) Was 156±8.92 and 143±9.13 was significant (t=3.78; P<0.01,S); SBP at (20 min) was 149.32 ±8.12 and 130±5.12 was significant (t=3.98,P<0.01,S); SBP at (30 min) was 139±4.52 and 119±4.92 ( t=4.52 ,P<0.001,HS) . Preop DBP was 78.12±4.54 and 75±7.12 was comparable (t=0.98,NS) ; DBP at (10 min) Was 98±7.82 and 81±6.72 was significant (t=3.78; P<0.01,S); DBP at (20 min) was 86 ±3.42 and 77±4.35 was significant (t=4.75,P<0.01,S); DBP at (30 min) was 78±3.81 and 68±4.91 ( t=5.12 ,P<0.001,HS) Preop HR was 98.4±5.67 and 97±4.98 was comparable (t=0.92,NS) ; HR at (10 min) Was 109±8.92 and 101±9.13 was significant (t=3.29; P<0.01,S); HR at (20 min) was 111.42 ±4.56 and 105±4.92 was significant (t=4.68 ,P<0.01,S); HR at (30 min) was 114±4.79 and 101±3.67 ( t=5.98 ,P<0.001,HS). Conclusion: It can be concluded from our study that the Profopol found to be hemodynamically stable as compared to thiopentone hence whenever there is hemodynamical stability id utmost important in such cases the Profopol should be preferred over thiopentone.

Key Words: Profopol, thiopentone, General anesthesia , Hemodynamic stability.

 

INTRODUCTION

General anaesthesia is a medically induced coma with loss of protective reflexes, resulting from the administration of one or more general anaesthetic agents. It is carried out to allow medical procedures that would otherwise be intolerably painful for the patient; or where the nature of the procedure itself precludes the patient being awake. A variety of drugs may be administered, with the overall aim of ensuring unconsciousness, amnesia, analgesia, loss of reflexes of the autonomic nervous system, and in some cases paralysis of skeletal muscles. The optimal combination of drugs for any given patient and procedure is typically selected by an anaesthetist, or another provider such as an operating department practitioner, anaesthetist practitioner, physician assistant or nurse anaesthetist (depending on local practice), in consultation with the patient and the surgeon, dentist, or other practitioner performing the operative procedure. Propofol has been used in recent years as an effective alternative to the time-tested thiopentone for intravenous induction of anesthesia. Induction with propofol is smoother, almost equally rapid, has rapid awakening and orientation times, better intubating conditions and upper airway integrity compared to thiopentone sodium. ¹ However, the major disadvantages of rapid induction with propofol are impaired cardiovascular and respiratory function which may put patients at greater risk from hypotension, bradycardia, and apnea. A decrease of 26-28% of systolic blood pressure, 19% of diastolic blood pressure and 11% of mean arterial pressure (MAP) without changes in stroke volume and cardiac output are observed when anesthesia is induced with 2 mg/kg body weight of propofol. ^2,3 Sodium thiopental, also known as Sodium Pentothal (a trademark of Abbott Laboratories, not to be confused with pentobarbital), thiopental, thiopentone, or Trapanal (also a trademark) or Fatal-Plus in veterinary euthanasia contexts, is a rapid-onset short-acting barbiturate general anesthetic that is an analogue of thiobarbital. Sodium thiopental was a core medicine in the World Health Organization's List of Essential Medicines,⁴ which is a list of minimum medical needs for a basic healthcare system, but was supplanted by propofol.⁵ Despite this thiopental is still listed as an acceptable alternative to propofol, depending on local availability and cost of these agents.⁵ So, being these two drugs are used routinely and cardiac stability is very important for general anesthesia hence we have used the effectiveness of profopol versus thiopentone for cardiac stability.

 

METHODOLOGY

This was a cross-sectional study carried out in the patients undergoing various surgeries at tertiary health care centre during the one year period i.e. January 2017 to January 2018 . In the one year period there were 50 patients with enrolled into the study with written and explained consent. The patients after all the standard anesthetic protocol were given general anesthesia to the patients and patients randomly allotted to the groups i.e. Profopol (Group P) in a dose of Propofol (2.5mg/kg) and Thiopentone (Group T) Thiopentone (5mg/kg), both of them given IV Glycopyrolate 0.2mg, IV Ketamine 0.5mg/kg and IV Midazolam 0.03mg/kg as premedication The hemodynamic parameters like Systemic BP, Diastolic BP and Heart Rate (HR) etc. was noted. The statistical analysis was done Chi –square test, and unpaired t-test and analyzed by SPSS 19 version.

 

RESULT

Table 1: Distribution of the patients as per the age and sex

Average age of the was 35± 3.46 and 36± 4.12 in the Group T and Group P was comparable (t=0.98,df=49,p>0.05) and the ratio of Male : Female ratio was 1.08 and 1.27 was comparable (X2=0.08,df=49,p>0.05)

 

Table 2: Distribution of the patients as per the systolic BP

Preop SBP was 123.4±9.83 and 125±11.21 was comparable (t=1.082,NS) ; SBP at (10 min) Was 156±8.92 and 143±9.13 was significant (t=3.78; P<0.01,S); SBP at (20 min) was 149.32 ±8.12 and 130±5.12 was significant (t=3.98,P<0.01,S); SBP at (30 min) was 139±4.52 and 119±4.92 ( t=4.52 ,P<0.001,HS)

 

Table 3: Distribution of the patients as per the diastolic BP

Preop DBP was 78.12±4.54 and 75±7.12 was comparable (t=0.98,NS) ; DBP at (10 min)Was 98±7.82 and 81±6.72 was significant (t=3.78; P<0.01,S); DBP at (20 min) was 86 ±3.42 and 77±4.35 was significant (t=4.75,P<0.01,S); DBP at (30 min) was 78±3.81 and 68±4.91 ( t=5.12 ,P<0.001,HS)

 

Table 4: Distribution of the patients as per the heart rate

Preop HR was 98.4±5.67 and 97±4.98 was comparable (t=0.92,NS) ; HR at (10 min) Was 109±8.92 and 101±9.13 was significant (t=3.29; P<0.01,S); HR at (20 min) was 111.42 ±4.56 and 105±4.92 was significant (t=4.68 ,P<0.01,S); HR at (30 min) was 114±4.79 and 101±3.67 ( t=5.98 ,P<0.001,HS).