Does the time to administration of lidocaine propofol admixtures affect induction times
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Does the time to administration of lidocaine-propofol admixtures affect induction times?. CDR Gregory G. Nezat, PhD, CRNA Naval Medical Center Portsmouth Professional Military Education Directorate And Department of Anesthesia. Disclaimer.

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Does the time to administration of lidocaine propofol admixtures affect induction times l.jpg

Does the time to administration of lidocaine-propofol admixtures affect induction times?

CDR Gregory G. Nezat, PhD, CRNA

Naval Medical Center Portsmouth

Professional Military Education Directorate

And

Department of Anesthesia


Disclaimer l.jpg
Disclaimer admixtures affect induction times?

The views expressed in this article are those of the author(s) and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.


Introduction l.jpg
Introduction admixtures affect induction times?

  • Propofol is the most commonly used induction agent in the United States

  • Induction agents are medications which induce loss of consciousness within 30-45 seconds


Hypothesis l.jpg
Hypothesis admixtures affect induction times?

The addition of lidocaine to propofol will increase induction times.


Methods of induction l.jpg
Methods of Induction admixtures affect induction times?

  • The standard induction

    • Induction agent ==> confirmation of induction ==> muscle relaxant

  • The rapid sequence induction

    • Induction agent ==> muscle relaxant


Clinical practice l.jpg
Clinical Practice admixtures affect induction times?

  • Intravenous Propofol causes pain and burning upon administration

  • Propofol and Lidocaine commonly mixed

  • 10:1 ratio usually reduces burning/pain

  • Impacts the chemical formulation of propofol


Untoward chemical interaction l.jpg
Untoward Chemical admixtures affect induction times? Interaction

  • Propofol is a substituted isoprophylphenol

  • Only slightly soluble in water

  • Formulated as an oil-in-water emulsion

  • Emulsion composed of soybean oil, glycerol, and egg lecithin


Laboratory research l.jpg
Laboratory Research admixtures affect induction times?

  • Adding lidocaine to propofol decreases the zeta potential (electrostatic repulsive forces) within the emulsion

  • Increases droplet size within emulsion in a linear fashion over time


Clinical implication l.jpg
Clinical Implication admixtures affect induction times?

  • Possible clinical effect—prolongation of induction of general anesthesia

  • Allow the muscle relaxant to work prior to the induction

  • Predispose patients to recall or awareness during intubation


Research question l.jpg
Research Question admixtures affect induction times?

  • Does induction time increase in patients administered a lidocaine-propofol admixture when prepared >60 minutes before induction?


Methods l.jpg
Methods admixtures affect induction times?

  • Experimental, prospective, randomized study

  • Subjects were randomly assigned to the control group or the experimental group

  • Control - propofol 2mg/kg plus 0.2-mg/kg lidocaine formulated 10 minutes prior to administration

  • Experimental group received the same formulation prepared approximately 110 minutes before induction


Methods12 l.jpg
Methods admixtures affect induction times?

  • Inclusion Criteria

    • Convenience sample

    • Physical status I or II (generally healthy)

    • Male or female

    • Scheduled for surgery under GA

    • Ages 18-60

  • Exclusion criteria

    • -Pregnancy

    • -Risk of aspiration of gastric contents and/or GERD

    • -Suspected or known difficult airway

    • -Presence of central nervous system disease

    • -Significant cardiac or liver dysfunction

    • -Morbid obesity (body mass index >30kg/m2)


Methods13 l.jpg
Methods admixtures affect induction times?

  • Subject held fluid-filled syringe between index finger and thumb of dominant hand

  • Admixture administered via rapid IV bolus

  • Timer started as admixture given

  • Timing ended with the syringe drop


Results l.jpg
Results admixtures affect induction times?

  • A total of 116 subjects were included in final analysis

    • No significant differences in demographic variables or other measured variables

    • Statistically significant difference noted in time to syringe drop (p < .001)


Time to induction p 001 l.jpg
Time to Induction admixtures affect induction times?(p < .001)


Clinical implications l.jpg
Clinical Implications admixtures affect induction times?

  • The 14 second difference may be clinically significant during rapid sequence induction in trauma cases

    • Patient may have partial or full muscle relaxation, but not be completely unconscious possibly leading to awareness under anesthesia


Recommendations l.jpg
Recommendations admixtures affect induction times?

  • Consider not mixing lidocaine with propofol when dealing with trauma patients

  • Consider administering IV lidocaine prior to propofol

  • If they are mixed, consider administering them soon after mixing (<10min)


Does the time to administration of lidocaine propofol admixtures affect induction times18 l.jpg

Does the time to administration of lidocaine-propofol admixtures affect induction times?


Does the time to administration of lidocaine propofol admixtures affect induction times19 l.jpg

Does the time to administration of lidocaine-propofol admixtures affect induction times?

Yes


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