Kosin Med J.  2017 Jun;32(1):36-46. 10.7180/kmj.2017.32.1.36.

Hemodynamic Effects of Co-administration of Midazolam during Anesthesia Induction with Propofol and Remifentanil in Hypertensive Patients

• Kim JD
• Kim JW
• Kung HC
• Kang JH
• Shin HY
• Kim DS
• Ryu SJ
• Kim KH

• KMID: 2384832
• DOI: http://doi.org/10.7180/kmj.2017.32.1.36

Abstract

OBJECTIVES
Propofol, midazolam and remifentanil are commonly used for clinical anesthesia. We compared the effects of midazolam-propofol-remifentanil and propofol-remifentanil on hemodynamic responses during anesthesia induction in hypertensive patients.
METHODS
Seventy-six hypertensive patients with ASA II-III were assigned to receive midazolam-propofol (group MP; n = 38) or propofol (group P; n = 38). Anesthesia was induced with midazolam 0.03 mg/kg (group MP) or saline 0.03 ml/kg (group P). After two minutes, propofol 1.0 mg/kg (group MP) or 1.5 mg/kg (group P) i.v. bolus was administered. Simultaneously, 4 ng/ml of remifentanil target controlled infusion (TCI) was administered in both groups. Anesthesia was maintained using sevoflurane and 2 ng/ml of remifentanil TCI. Systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP) and heart rate (HR) were measured before induction, 2 min after midazolam or normal saline, 2 min after propofol, 1 min after rocuronium, and immediately, 1 min, 2 min, and 3 min after intubation.
RESULTS
SBP, DBP, and MBP decreased after propofol administration and increased immediately after intubation in both groups (P < 0.05). After intubation, SBP, DBP, and MBP decreased more than baseline values in either group. Although the overall BP of Group P was lower than that of Group MP, there were no significant differences except for SBP at 2min after intubation (P < 0.05). HR was no significant difference in either group.
CONCLUSION
Our results suggest that midazolam-propofol-remifentanil has similar hemodynamic effect with propofol-remifentanil during anesthesia induction in hypertensive patients.

Keyword

Drug synergism; Hypertension; Intratracheal intubation; Midazolam; Propofol

MeSH Terms

Anesthesia*
Blood Pressure
Drug Synergism
Heart Rate
Hemodynamics*
Humans
Hypertension
Intubation
Intubation, Intratracheal
Midazolam*
Propofol*
Midazolam
Propofol

Figure

• 

  Fig. 1 Changes in systolic blood pressure (SBP). Values are mean ± SD. Group MP: midazolam-propofol group, Group P: propofol group, B0: baseline, B1: 2 min after midazolam or normal saline, B2: 2 min after propofol B3: 1 min after rocuronium, T0: immediately after intubation, T1: 1 min after intubation, T2: 2 min after intubation, T3: 3 min after intubation. *P < 0.05 compared with baseline value. † P < 0.05 compared with Group MP.

• 

  Fig. 2 Changes in mean blood pressure (MBP). Values are mean ± SD. Group MP: midazolam-propofol group, Group P: propofol group, B0: baseline, B1: 2 min after midazolam or normal saline, B2: 2 min after propofol B3: 1 min after rocuronium, T0: immediately after intubation, T1: 1 min after intubation, T2: 2 min after intubation, T3: 3 min after intubation. *P < 0.05 compared with baseline value.

• 

  Fig. 3 Changes in diastolic blood pressure (DBP). Values are mean ± SD. Group MP: midazolam-propofol group, Group P: propofol group, B0: baseline, B1: 2 min after midazolam or normal saline, B2: 2 min after propofol B3: 1 min after rocuronium, T0: immediately after intubation, T1: 1 min after intubation, T2: 2 min after intubation, T3: 3 min after intubation. *P < 0.05 compared with baseline value.

• 

  Fig. 4 Changes in heart rate. Values are mean ± SD. Group MP: midazolam-propofol group, Group P: propofol group, B0: baseline, B1: 2 min after midazolam or normal saline, B2: 2 min after propofol B3: 1 min after rocuronium, T0: immediately after intubation, T1: 1 min after intubation, T2: 2 min after intubation, T3: 3 min after intubation. *P < 0.05 compared with baseline value.

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