Key result
Sevoflurane cuts ephedrine required for haemodynamic stability by ~80% versus propofol.
Why the study?
Inhalation induction with sevoflurane may offer advantages over propofol induction, but comparative hemodynamic data in thoracotomy patients were needed.
Does induction of anaesthesia with sevoflurane improve hemodynamic stability compared to propofol in patients undergoing thoracotomy?
RCT (n=24)
Single-blind
Computer-generated sequence with sealed envelopes
No
Does induction of anaesthesia with sevoflurane improve hemodynamic stability compared to propofol in patients undergoing thoracotomy?
Absolute Event Rate: 4.2% vs 20.8%
p-value: p=0.03
In patients undergoing thoracotomy, induction with sevoflurane results in greater circulatory stability and lower ephedrine requirements compared to propofol.
May favor sevoflurane induction in thoracotomy to minimize vasopressors; extends RCT evidence on anesthetic hemodynamic effects.
Inhalation induction with sevoflurane would appear to offer several objective advantages compared to induction with propofol. In our study, the hemodynamic results of sevoflurane vs. propofol induction in patients undergoing thoracotomy were studied. In a prospective, randomized, blinded study 24 patients were randomly allocated to one of 2 groups: sevoflurane (S) and propofol (P) (n=12 each). For hemodynamic monitoring the LIDCO plus system was used. Patients in group S were induced into anaesthesia with sevofluran, remifentanil and vecuronium, whereas patients in group P with propofol, remifentanil and vecuronium. The anaesthesia was maintained with the same agents. Hemodynamic stability was guided using a special algo-rithm. The goal was oxygen delivery index (DO2I) > 500 mL min-1 m-2. According to the algorithm, patients received colloids or vasoactive drugs. Hemodynamic parameters were recorded before induction, 3 minutes after induction and 3 minutes after intubation and commencement of one lung ventilation. The consumption of vasoactive drugs and colloids and the time from the beginning of induction to intubation were documented. No statistically significant differences in measured hemodyna-mic parameters, remifentanil and colloid consumption between the S and P group were found. In group P, statistically more ephedrine was used (S: 4.2, P:20.8, p<0.05). Patients undergoing thoracotomy induced with sevoflurane are circulatory more stable than those induced with propofol.
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Potoënik et al. (2011) conducted an RCT in Elective anterolateral thoracotomy (n=24). Sevoflurane vs. Propofol was evaluated on Amount of supplemental ephedrine required to maintain oxygen delivery index > 500 mL min-1 m-2 (p=0.03). Induction of anaesthesia with sevoflurane significantly reduced the amount of ephedrine required to maintain haemodynamic stability compared to propofol (4.2 mg vs 20.8 mg, p=0.03).
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