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March 1997
Comparison of propofol
and a propofol-methohexitone mixture for induction of day-case anaesthesia
Thompson N, Robertson
GS. British Journal of Anaesthesia, 1996;77:213-216.
[ see abstract below ]
Two short acting intravenous
agents are currently available for the induction of anesthesia in ambulatory
surgery. Propofol is highly popular because of its short recovery time
and low incidence of postoperative sequelae. However, methohexital produces
less cardiovascular and respiratory depression and is less expensive.
This Scottish study investigates the properties of a mixture of propofol
and methohexital with those of propofol alone.
The patients studied averaged 46 years old and had anesthesia lasting
approximately 13 minutes. The two groups showed no significant difference
in pain on injection or cough at induction. Apnea occurred in 25 of 47
propofol only patients and 34 of 52 combination patients. One patient
in the propofol group required atropine to treat bradycardia. There were
no differences in cough, laryngospasm, or hiccoughs on awakening. Times
to awakening to return of consciousness, airway control and response to
command , were the same in b oth groups, approximately 7 minutes.
This study shows that the induction and awakening characteristics of propofol
only and propofol/methohexital are similar, except for a higher incidence
of apnea in the propofol only group. Since methohexital is less expensive
than propofol, a cost savings would be accrued with use of the combination.
However, this Scottish study did not address any recovery parameters after
return of consciousness. Specifically, it did not investigate intermediate
recovery indices such as times to ambulation or to discharge, and did
not address the issue of postprocedural vomiting after the initial recovery
period.
The applicability of these interesting results to practice in an ambulatory
surgery unit will need to be evaluated after the additional recovery data
are obtained.
Return to the Current
Literature Review Front Page, or read the abstract:
ABSTRACT
We studied 99 patients undergoing day-case urological surgery, allocated randomly to receive a sleep dose of either 1% propofol or a mixture of equal volumes of 1% propofol and 0.5% methohexitone, and thereafter a standardized anaesthetic. With the exception of minor differences in intraoperative heart rate there were no significant differences between the two groups in induction properties and complications, intraoperative variables, rate of recovery or postoperative sequelae.
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