title: Effect of propofol titration v/s bolus during induction of anesthesia on hemodynamics and bispectral index.
abstract: BACKGROUND
  Propofol when given as 2 mg/kg IV bolus for induction of anesthesia is known to cause hypotension requiring vasopressors. The objective of our study was to compare Propofol 2 mg/kg single IV bolus (Precalculated group, PG) with the titration of Propofol (Titration group, TG) to clinical parameters as 10 mg IV increments every 3 seconds on hemodynamic Parameters and Bispectral Index (BIS), during induction. The effect of titration on dose requirement for induction was also evaluated.
  
  
  METHODS
  Effects on Hemodynamic parameters [Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP)], and vasopressors use were recorded at baseline and every 2 minute intervals for 10 minutes. The percent difference in HR, SBP, DBP, and MAP from baseline at 2, 4, 6, 8 and 10 minutes were calculated, to determine the effect on hemodynamic parameters. BIS was recorded at baseline, after injection of Propofol, at intubation and at 10 minutes. Dose requirement of Propofol in TG was also recorded.
  
  
  RESULTS
  At 2 and 4 minutes, SBP decreased in PG by 21% and 18% vs. 11% and 9% in TG (p = .00 & .02); DBP decreased by 17% and 15% in PG vs. 5% and 4% in TG (p = .02 & .03); MAP decreased by 19% and 17% in PG vs. 5% and 4% in TG (p = .00 & .01). Vasopressors were required in 14/43 patients in PG vs. 5/41 in TG (p = .03). Titration resulted in 30% reduction in dose.
  
  
  CONCLUSIONS
  Titration of Propofol reduces hemodynamic changes, dose requirement and is able to achieve same level of BIS as in bolus.
authors.affiliation: Loma Linda University, Long Beach, CA, USA. nitinshahmd@gmail.com
authors.forename: Nitin K
authors.initials: NK
authors.lastname: Shah
authors.forename: Matthew
authors.initials: M
authors.lastname: Harris
authors.forename: Kavitha
authors.initials: K
authors.lastname: Govindugari
authors.forename: Hamsa B
authors.initials: HB
authors.lastname: Rangaswamy
authors.forename: Heejung
authors.initials: H
authors.lastname: Jeon
mesh_terms: D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage* / Q000494:pharmacology; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol