Anesthesia & Clinical Research
Open Access

Abstract

A Comparative Study of Different Doses of Ephedrine on Intubating Conditions and Hemodynamics Using Propofol and Low Dose Rocuronium

Manju Sharma, Anju Jamwal, Anjali Mehta and Ruchika Jyoti

Background: Succinylcholine as muscle relaxant is a norm in emergency department even though it is associated with a multitude of adverse effects. We used low dose rocuronium with ephedrine so as to shorten the onset of rocuronium in accordance with RSI without prolonging the duration as seen with the usual dose used for RSI. Increase in cardiac output caused by Ephedrine can reduce the onset time of Rocuronium. Hypotension associated with bolus dose of Propofol can also be prevented by Ephedrine. Appropriate dose of Ephedrine is advised to achieve the aforementioned benefits without undue side effects such as hypertension and tachycardia. Because of variation in doses and side effects of Ephedrine in various studies, we compared the influence of Ephedrine 30, 70 and 110 mcg/kg on intubating conditions and hemodynamics using Propofol and low dose Rocuronium

Methods: 90 patients of either sex, ranging from 18-50 years belonging to ASA grade 1 and 2 undergoing elective surgeries under general anesthesia were taken up for study. Patients were randomly allocated to one of the three groups of 30 patients each.

Group 1: Rocuronium 0.6 mg/kg and Ephedrine 30 mcg/kg

Group 2: Rocuronium 0.6 mg/kg and Ephedrine 70 mcg/kg

Group 3: Rocuronium 0.6 mg/kg and Ephedrine 110 mcg/kg

Results: It was found that intubating conditions were most favorable in group 2 followed by group 3 and least favorable in group 1. Group 3 was associated with adverse hemodynamic effects such as tachycardia and increased blood pressure. Such effects being least in group 1 and intermediate in group 2.

Conclusion: Ephedrine pre-treatment in the dose of 70 mcg/kg with similar doses of Rocuronium and Propofol provides ideal intubating conditions with acceptable hemodynamic changes. So, the combination of Propofol 2.5 mg/kg, Rocuronium 0.6 mg/kg and ephedrine 70 mcg/kg may be of value when use of Succinylcholine is contraindicated for RSI.