Key result
Titrated propofol administration reduced post-intubation hypotension (11.3% vs 23.8%; p=0.04) and total propofol dosage (93.6 mg vs 116.8 mg; p<0.01) compared to conventional dosing.
Why the study?
Administration of a single propofol bolus dose for anesthesia induction causes hypotension.
Does Observer's Assessment of Alertness/Sedation-based titration of propofol reduce propofol consumption and the incidence of hypotension during general anesthesia induction in patients undergoing elective surgery?
RCT (n=160)
simple randomization
Does Observer's Assessment of Alertness/Sedation-based titration of propofol reduce propofol consumption and the incidence of hypotension during general anesthesia induction in patients undergoing elective surgery?
Titrating propofol based on the Observer's Assessment of Alertness/Sedation scale during anesthesia induction significantly reduces total propofol consumption and the incidence of post-intubation hypotension compared to conventional bolus dosing.
Titrated propofol dosing lowers post-induction hypotension risk; supports OAA/S-guided titration for elective anesthesia induction.
Administration of a single propofol bolus dose for anesthesia induction causes hypotension. We included 160 patients (74 males and 86 females; mean age, 42.4 ± 10.7 [range: 18–60] years) with the American Society of Anesthesiologists status I–II undergoing elective surgery under general anesthesia. Using simple randomization, the patients were divided into a conventional group ( n = 80; received 2 mg/kg propofol at a rate of 250 mg/min) and titrated group ( n = 80; received propofol at a rate of 1 mg/kg/min until the Observer's Assessment of Alertness/Sedation scale score reached 1 point). Fentanyl (4 µg/kg) and cisatracurium (0.2 mg/kg) were administered, as appropriate. Systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate were recorded at different time points. Propofol consumption, hypotension, and other adverse events were recorded. All the patients were intubated without awareness. Compared with the conventional group, the titrated group showed more stable blood pressure ( p < 0.05), as well as a lower decrease in systolic blood pressure, mean blood pressure at 1 and 3 min, and diastolic blood pressure at 1 min after propofol administration ( p < 0.01). Moreover, compared with the conventional group, the titrated group showed a lower post-intubation hypotension incidence (9 vs. 19 cases; p = 0.04), as well as lower total propofol dosage and propofol dose per kilogram of body weight (93.57 ± 14.40 mg vs. 116.80 ± 22.37 mg and 1.73 ± 0.27 mg/kg vs. 2.02 ± 0.08 mg/kg, respectively, p < 0.01). Compared with conventional propofol usage, titrated propofol administration can reduce the incidence of hypotension and propofol consumption during anesthesia induction.
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Chen et al. (2021) conducted an RCT in Elective surgery under general anesthesia (n=160). Observer's Assessment of Alertness/Sedation-based titration of propofol vs. Conventional propofol (2 mg/kg at a rate of 250 mg/min) was evaluated on post-intubation hypotension incidence (p=0.04). Titrated propofol administration reduced post-intubation hypotension (11.3% vs 23.8%; p=0.04) and total propofol dosage (93.6 mg vs 116.8 mg; p<0.01) compared to conventional dosing.
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