Comparison of the induction characteristics of thiopentone and propofol in children
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G Purcell-Jones1, A Yates, J R Baker
1Department of Anaesthesia, Hospital for Sick Children, London.
Insights
Propofol and thiopentone showed similar apnea rates in children, but propofol induction resulted in more pain and excitatory effects. Thiopentone provided a better quality of induction overall.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
Background:
- Propofol and thiopentone are commonly used intravenous anesthetics for induction.
- Pediatric anesthesia requires careful consideration of induction agents due to potential side effects.
Purpose of the Study:
- To compare the induction characteristics of propofol and thiopentone in children.
- To evaluate pain, excitatory effects, apnea, hemodynamic changes, and overall induction quality.
Main Methods:
- A comparative study involving 60 fit children aged 3-16 years.
- Patients received intramuscular premedication with papaveretum and hyoscine.
- Induction was achieved with propofol (2.0-2.5 mg/kg) or thiopentone (4-5 mg/kg).
Main Results:
- Propofol caused more pain (24% vs 10%) and excitatory effects (33% vs 16%) than thiopentone.
- Apnea >30s occurred in 13% of each group; mean duration was similar.
- Propofol induced a greater decrease in systolic blood pressure; heart rate increased with thiopentone but not propofol.
- Overall induction quality was rated good in 66% for propofol versus 100% for thiopentone.
Conclusions:
- Thiopentone demonstrated a superior overall quality of induction compared to propofol in this pediatric cohort.
- While both agents are viable, propofol's induction is associated with more adverse events like pain and excitation.
Abstract:
The induction characteristics of propofol 2.0-2.5 mg kg-1 were compared with those of thiopentone 4-5 mg kg-1 in 60 fit children aged between 3 and 16 yr. All patients received i.m. premedication with papaveretum 0.4 mg kg-1 (maximum dose 15 mg) and hyoscine 0.008 mg kg-1 (maximum dose 0.3 mg). Seven children (24%) complained of pain after injection with propofol, compared with three (10%) after thiopentone. No child in either group complained of severe pain. Excitatory effects were observed in 10 children (33%) receiving propofol as opposed to five children (16%) after thiopentone, but these were transient and minor and all occurred after completion of injection. Apnoea lasting longer than 30 s occurred in only four children (13%) in each group despite the use of opioid premedication. The mean duration of apnoea was similar in both groups. Propofol caused greater decreases in arterial pressures (systolic, diastolic, mean) than thiopentone, but only the difference in systolic arterial pressure achieved significance. There was a significant difference in heart rate, which did not change after propofol, but increased with thiopentone. The overall quality of induction was assessed as being good in all children receiving thiopentone compared with 20 (66%) of those receiving propofol.