Key result
Co-induction with sevoflurane and propofol reduced respiratory adverse events compared to sevoflurane alone (68.6% transient apnea, p<0.001) and improved hemodynamic stability versus propofol alone.
Why the study?
Achieving a safe perioperative approach in elderly patients is challenging due to age-related functional organ deterioration, motivating evaluation of a co-induction technique to minimize anesthesia-related complications.
Does a co-induction technique with sevoflurane and propofol improve respiratory and hemodynamic safety compared to either agent alone in elderly patients undergoing endoscopic urological procedures?
RCT (n=105)
Does a co-induction technique with sevoflurane and propofol improve respiratory and hemodynamic safety compared to either agent alone in elderly patients undergoing endoscopic urological procedures?
A co-induction technique using sevoflurane followed by propofol provides a safer perioperative profile with fewer respiratory and hemodynamic adverse events in elderly patients compared to either agent alone.
Supports co-induction for safer induction in elderly endoscopic urology patients; extends RCT evidence for balanced techniques over single agents.
Background and Objectives: Elderly patients constitute a large segment of healthcare receivers. Considering the functional deterioration of multiple organ systems with aging, achieving a safe perioperative approach is challenging. Our aim is to study the safety and effectiveness of a genuinely regimented co-induction technique in order to minimize anesthesia-related complications. Materials and Methods: One hundred and five patients were assigned to three groups according to the induction technique: propofol, sevoflurane and co-induction group. Inclusion criteria: patients with age ≥65 and American Society of Anesthesiologists physical status classification (ASA) II-III who underwent endoscopic urological procedures. The propofol group received a dose of 1.5 mg kg−1 of propofol over two minutes for induction. The sevoflurane group received 8% of sevoflurane and 100% oxygen through a plastic facemask with the fresh gas flow set at 8 L min−1. The co-induction group received 4% sevoflurane through plastic facemask for two minutes, followed by a 0.75 mg kg−1 dose of propofol. After ensuring full range jaw relaxation, the laryngeal mask airway (LMA) was inserted. Results: Overall, the co-induction technique had a favorable profile in terms of respiratory adverse events, while the sevoflurane group had a favorable profile in terms of hemodynamic stability. Furthermore, 24 (68.6%) patients receiving inhalational sevoflurane had episodes of transient apnea, which constitutes 77.4% of the 31 episodes of transient apnea in the studied sample (p < 0.001). Moreover, six (17.1%) patients in the sevoflurane group had an episode of partial laryngospasm (p = 0.034). Compared with the co-induction group, we found that the propofol group had significantly less systolic and diastolic blood pressures in the second minute, with p values of (0.018) and (0.015), respectively. Conclusions: The co-induction technique utilizing 4% sevoflurane at 8 L min−1 flow of oxygen inhaled over two minutes followed by 0.75 mg kg−1 of propofol achieved less respiratory adverse events compared with the sevoflurane group, and less hemodynamic instability compared with the propofol group.
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Ababneh et al. (2020) conducted an RCT in Endoscopic urological procedures (n=105). Co-induction technique (sevoflurane and propofol) vs. Propofol alone (1.5 mg/kg) or Sevoflurane alone (8%) was evaluated on Respiratory adverse events and hemodynamic stability. Co-induction with sevoflurane and propofol reduced respiratory adverse events compared to sevoflurane alone (68.6% transient apnea, p<0.001) and improved hemodynamic stability versus propofol alone.
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