Post-induction hypotension following entropy guided equipotent doses of propofol and thiopental in elderly surgical patients
Abstract
Background & Objective: Geriatric patients with reduced vascular auto regulation ability are susceptible to blood pressure fluctuations after anesthesia induction and specifically may suffer from hypotension, showing heightened sensitivity to anesthetics. It is unclear which induction agent, thiopental or propofol, is preferable with regard to hemodynamic stability after anesthesia induction. EEG “entropy” may help titrate induction doses and thus reduce their adverse effects in this category of patients. We conducted this research to compare the two drugs, using entropy to guide the induction dose, regarding hemodynamic stability.
Methodology: Sixty patients, over 65 years old, were randomly divided into two groups based on the anesthetic induction agent: Group P (propofol) and Group T (thiopental). Arterial blood pressure (ABP), heart rate (HR), induction doses, and postoperative Troponin I levels denoting myocardial injury secondary to hypotension were measured.
Results: Group P had more post-induction hypotension and less HR changes than Group T (P < 0.001). Induction doses in both groups were less than the conventional range. Troponin I levels in both groups were similar and statistically insignificant.
Conclusion: Induction technique with thiopental guided with entropy provided greater hemodynamic stability, with reduced fall in systolic, diastolic and mean arterial pressure in elderly surgical patients compared to those who were administered propofol guided with entropy.
Trial Registry: PACTR202406560110826.
Abbreviations: EEG - Electroencephalography; EMG - electromyography; PIH - post-induction hypotension; SE- state entropy; RE - response entropy;
Keywords: Propofol; Thiopental; Post-induction hypotension; Entropy; Elderly.
Citation: Ghaly SI, Zaki GFS, Shmas Eldin MMK, El Emary YIMM. Post-induction hypotension following entropy guided equipotent doses of propofol and thiopental in elderly surgical patients. Anaesth. pain intensive care 2024;28(5):824−829; DOI: 10.35975/apic.v28i5.2551
Received: June 22, 2024; Reviewed: July 16, 2024; Accepted: July 20, 2024
