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Introduction: Pain during the injection of anesthetic agents may be distressing and can reduce the acceptability of an otherwise useful agent such as propofol during daycare surgeries. Lidocaine and ketamine both are used as pre-treatment to decrease propofol induced pain. This study aims to compare the effectiveness of ketamine injection to decrease propofol-induced pain in comparison to lidocaine injection. Methodology: This is a prospective cross-sectional comparative study. Eighty-nine cases were divided into two groups where group K received ketamine 2 ml (0.2 mg/kg) whereas group L received lidocaine 2% 2ml (0.5 mg/kg) after venous occlusion with rubber tourniquet. One-fourth dose of propofol was injected 1 min after release of tourniquet and pain accessed at 0, 1, and 2 minutes of propofol injection with a verbal response and behavioral signs. Chi-square test and paired T-test were used and a p-value less than 0.05 was considered significant. Result: Regarding hemodynamic, oxygenation, and adverse effects there was no significant difference. Immediately after propofol injection, only 1 patient of the ketamine group had mild pain (2.22%) while 12 patients from the lignocaine group had mild pain (27.27%) with a p-value of 0.009. Also after 2 minutes of propofol injection, only 12 cases had mild pain i.e. 13.48% (1 from ketamine group i.e. 2.22% and 11 from lidocaine group i.e. 25%) with p-value of 0.002. Conclusion: Our study helps prove low-dose ketamine is more effective in reducing the incidence and severity of pain on injection of propofol in comparison to Lidocaine with better hemodynamic stability.

Background: Pain caused by propofol injection is a common occurrence. Aims and Objectives: The aim of this study was to compare and evaluate the efficacy of three drugs, lignocaine, pethidine and ketamine for prevention of pain during propofol injection. Materials and Methods: This double blind, placebo-controlled, parallel multi-arm study was done after written informed consent and ethics clearance. Hundred patients of ASA I and II, 18-65 years of age, and with body mass index 18-30 kg/m2 were included. Exclusion criteria were significant cardiovascular or hepatic diseases, renal insufficiency, and a history of allergy to the study drugs. Group A (Normal Saline), Group B (Ketamine 25 mg), Group C (Lignocaine 20 mg) and Group D (Pethidine 25 mg) were pre-treated with 2 ml of the study agents before propofol injection. The primary outcome was the incidence of pain with propofol injection and the secondary outcomes were the induction time, pain scores at various time intervals, the incidence of recall of pain after surgery, haemodynamic changes and adverse effects. Results: There were highly significant differences (p

BACKGROUND This study was conducted to compare and evaluate the efficacy and safety of prior intravenous dexmedetomidine with intravenous lignocaine as pre-treatment for prevention of propofol injection pain. METHODS In this prospective, randomised and double blinded clinical study, a total of 200 patients aged between 18 and 70 years of American Society of Anaesthesiologists (ASA) grade I or II posted for elective surgery under general anaesthesia utilising propofol as the inducing agent, were randomly allocated into two groups of 100 patients each, using computer generated random number tables. Group I received intravenous lignocaine 0.2 mg / Kg and group II received intravenous dexmedetomidine 0.5 mcg / Kg respectively prior to administration of propofol (2 mg / Kg) for induction during general anaesthesia. Pain during propofol administration was assessed for each patient using the McCririck and Hunter scale. Peri-operative haemodynamic changes and side effects were noted. Data was analysed using chi-square test and a P-value < 0.05 was considered to be statistically significant. RESULTS A total of 200 patients (100 patients in lignocaine group and 100 patients in dexmedetomidine group) were studied. Statistically significant (P < 0.05) diminution in pain score was discovered to be higher in group II (dexmedetomidine) as compared to group I (lignocaine). 80 % in the dexmedetomidine group had no pain compared to 62 % of the patients in the lignocaine group which is statistically significant. Dexmedetomidine also had a more remarkable effect on the heart rate (10 minutes after intubation) compared to lignocaine, with P = 0.054 which is statistically significant. CONCLUSIONS Intravenous dexmedetomidine is a superior pre-medication compared to intravenous lignocaine in the prevention of pain following propofol administration. It also has additional properties of sedation, analgesia, anxiolysis and sympatholytic action making it a better alternative for the anaesthesiologist and the patient. KEY WORDS Analgesia, Anxiolysis, Pre-Treatment, General Anaesthesia, Sedation, Sympatholytic Action

One ampoule of propofol is often divided into several syringes or is sometimes combined with other drugs that may lead to incompatibility and instability. A systematic review of literature (PubMed, Science Direct, and Google Scholar) identified 37 pieces of research which suggest that the data on propofol stability are limited. Results of all of the identified studies indicated that the stability of propofol is less than 24 hours. Additionally, the evidence shows that glass packaging as well as storing in cold and dark conditions promote stability. What is more, propofol was proved to be incompatible with 23 of the 36 drugs tested. In conclusion, there is a relatively small body of literature that measures the physical stability of propofol. The findings of this review recommend keeping propofol in glass and storing it no longer than 24 hours. Compatibility data must be considered in co-administrations with propofol.One ampoule of propofol is often divided into several syringes or is sometimes combined with other drugs that may lead to incompatibility and instability. A systematic review of literature (PubMed, Science Direct, and Google Scholar) identified 37 pieces of research which suggest that the data on propofol stability are limited. Results of all of the identified studies indicated that the stability of propofol is less than 24 hours. Additionally, the evidence shows that glass packaging as well as storing in cold and dark conditions promote stability. What is more, propofol was proved to be incompatible with 23 of the 36 drugs tested. In conclusion, there is a relatively small body of literature that measures the physical stability of propofol. The findings of this review recommend keeping propofol in glass and storing it no longer than 24 hours. Compatibility data must be considered in co-administrations with propofol.

Background: Propofol, most frequently used intravenous anesthetic for induction of routine elective surgical procedure. Pain on propofol injection (POPI) still remains a considerable concern for the anesthesiologist. A number of techniques has been tried to minimize propofol-induced pain with variable results. Objective: This study was performed to determine the effect of ketamine on reducing pain on propofol injection (POPI) at the onset of anesthesia. Materials and Methods: A total of 80 adult healthy patients were selected in this study of either sex, scheduled for routine elective ENT surgery under general anesthesia. The patients enrolled were divided randomly into two groups of 40 patients each. Group I (ketamine group) received 10 mg intravenous ketamine in 10 ml normal saline. Group II (placebo group) received 10 ml of 0.9% intravenous normal saline. Then the patients were induced with propofol and asked to report their pain during injection of propofol and recorded according to the Mc Cririck and Hunter scale. Results: The incidence of pain experienced in ketamine group was 10% patients and in saline group was 60% patients, which is statistically significant p

Background: The objective of the study was to compare effectiveness of intravenous (IV) granisetron (2 milligram) with IV lignocaine (30 milligram) in allaying pain on propofol IV administration measured at 15 seconds after propofol administration. Materials and Methods: 100 patients of age 18-50 years belonging to American Society of Anesthesiologists (ASA) physical status grades I and II, chosen for elective surgery were randomized to two different groups (group L and group G) of 50 each. Patients of group L received IV lignocaine 30 mg and the other group G received IV granisetron 2 mg as pretreatment, before administration of propofol. Patients were assessed for pain after 15 seconds of IV administration of propofol with McCririck and Hunter scale. Results: Both the pretreatments were found to prevent or decrease the pain on propofol administration. Pain assessed at the end of 15 seconds of propofol administration, showed that 76% in lignocaine group & 62%in granisetron group were not having any pain, 12% in lignocaine group and 20% in granisetron group had mild pain, and 12% in lignocaine group and 18% in granisetron group had moderate pain as assessed with McCririck and Hunter scale. There was no significant difference in the pain scores between the groups (c2 = 2.310, P= 0.315). Conclusion: Both IV granisetron (2 mg) and IV lignocaine (30 mg) are equally effective in allaying pain on propofol injection. Keywords: Granisetron, lignocaine, Pretreatment, Propofol-induced pain.

Background: Despite various strategies designed for preventing pain from propofol injection, it is still common and distressing to the patients. The purpose of the present study was to investigate the adequate effect-site concentration (Ce) of remifentanil to prevent pain due to propofol injection. Methods: A total of 160 adults scheduled for elective surgery were randomly assigned to one of four groups receiving normal saline (group S) or remifentanil at a Ce of 2 (group R2), 3 (group R3), or 4 (group R4), administered via target-controlled infusion, followed by the injection of 2 mg/kg of propofol (delivered with 1% lipid propofol). The severity and incidence of injection pain were assessed on a four-point scale. Results: The incidence of propofol injection pain was significantly lower in group R2, R3, or R4 than in group S (30%, 5%, or 2.5% vs. 70%, respectively). Moreover, the intensity of the pain was lesser in group R2, R3, or R4 than in group S. However, the incidence or severity of injection was not different between groups R3 and R4. Conclusions: During the induction of balanced anesthesia using propofol injection, pretreatment with remifentanil at a target Ce of 3 ng/ml effectively reduced propofol injection pain in adults.

In this study, we aimed to investigate the effect of 2 different dosages of tenoxicam in the prevention of propofol injection pain.A total of 120 patients between the ages of 20-50 years who were scheduled for elective surgery were included in this prospective. Patients were randomly divided into 3 groups. Group 1 received 5 mL saline, group 2 received 10 mg tenoxicam in 5 mL saline, and group 3 received 20 mg tenoxicam in 5 mL saline intravenously as a pretreatment. Venous occlusion was applied for 60 seconds with a rubber tourniquet after the injection was completed. After injecting propofol, the pain at the injection site of the patient was questioned according to the Verbal Rating Scale.The overall pain incidence during propofol injection was 85% in group 1, 75% in group 2, and 60% in group 3 (P = .039). While there was no significant difference between groups 1 and 2 (P=.264), there was a significant difference between groups 1 and 3 (P=.012). Moreover, there was a significant decrease in the level of severe pain in group 3 compared to group 1 (P=.008). There was no significant difference between the groups in terms of mild and moderate pain levels (P.05).We found that 20 mg of tenoxicam pretreatment was effective in reducing the incidence and severity of propofol injection pain compared to the control saline group, but the 10 mg dose did not significantly reduce the injection pain.

Background: Propofol, the most frequently used intravenous anaesthetic, is used for induction, maintenance of anaesthesia and for sedation in patients scheduled for routine elective surgical procedure. Pain on propofol injection still remains a considerable concern for the anaesthesiologist. Objective: Aim of this study was to observe the efficacy of metoclopramide as pretreatment for the prevention of pain caused by the propofol injection in patients undergoing elective surgery under general anaesthesia. Materials and method: A total of 80 patients were taken up in the study in the age group of 20 to 50 years of either sex, ASA grade I/II, scheduled for routine elective surgical procedure under general anesthesia with endotracheal intubation and using propofol as induction agent. The patients enrolled were divided randomly into two groups of 40 patients each. Group A received 10 mg metoclopramide IV diluted in 5 ml saline. Group B received 5 ml of normal saline as placebo before propofol injection. The patients were asked to report their pain according to the scale provided to them in the form of none, mild, moderate and severe after injection of propofol. Results: The overall incidence and severity of pain were significantly less in Group A (metoclopramide group) than in group B (placebo group) (p< 0.05). The incidence of mild and moderate pain in Group A versus group B was 15% vs 45% and 5% vs 25% respectively (p

Background and aim of study: Pain on propofol injection (POPI) is a common problem. None of the commonly used methods completely attenuate the pain. Inflammatory response to propofol contributes to the pain. This study was conducted to compare the efficacy of dexamethasone in attenuation of pain following intravenous injection of propofol. Materials and methods: A total of 80 adult patients were scheduled in this study with either sex, ASA (American Society of Anesthesiologists) grade I and II, for routine elective surgical procedure under general anesthesia. The patients enrolled were divided randomly into two groups of 40 patients each. Group I received 0.15 mg/kg of intravenous dexamethasone in 5 ml normal saline and Group II (placebo group) received 5 ml of 0.9% intravenous normal saline, following exsanguination and occlusion of the vein of the arm. This was followed by 0.5 mg/kg of propofol intravenously.The patients were asked to report their pain during injection of propofol according to the McCririck and Hunter scale. Results: The incidence of pain experienced in dexamethasone group was 45% patients and in saline group was 70% patients (p

Background and aim of study: Propofol is a commonly used drug for general anesthesia. It can irritate the skin, mucous membrane and venous intima. The main drawback is the pain during intravenous injection. Aim of this prospective randomized study is to observe the efficacy of intravenous dexmedetomidine as pretreatment for the prevention of pain caused by the propofol injection. Methods: A total of 80 adult patients were selected in this study with either sex, ASA (American Society of Anesthesiologists) grade I and II, scheduled for routine elective surgical procedure under general anesthesia. The patients enrolled were divided randomly into two groups of 40 patients each. Group received 0.25 mcg of intravenous dexmedetomidine in 5 ml. Group II (placebo group) received 5 ml of 0.9% intravenous normal saline one minute before injection of propofol. The patients were asked to report their pain during injection of propofol according to the McCririck and Hunter scale. Results: The incidence of pain experienced in dexmedetomidine group was 35% patients and in saline group was 70% patients (p

Introductions: Propofol is a popular intravenous anesthetic agent. One disadvantage of propofol is pain on its injection which can be excruciating at times. Various agents and methods have been tried to attenuate this unpleasant effect. Ondansetron, primarily used as an antiemetic has also been studied to reduce it. Methods: This randomized, prospective, double-blinded, placebo-controlled study was conducted on patients of either sex, American Society of Anesthesiologists (ASA) physical status I & II, undergoing elective surgeries requiring general anesthesia. The patients were randomly divided into ondansetron (A, received intravenous ondansetron 4 mg) and placebo (B, received equivalent volume of normal saline) groups. Manual occlusion of venous drainage was done at mid-arm by an assistant for 1 minute after which 25% of the calculated dose (2 mg/kg) of propofol (1% w/v in lipid base) was injected. Patients were asked by a blinded investigator to score the pain on injection of propofol on 4-point scale: 0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain and compared in between two groups. The p

BACKGROUND Propofol is an ideal intravenous anaesthetic agent which provides smooth induction and recovery, but its adverse effect is considerable pain on injection of unknown cause. Various drugs like lignocaine, tramadol, ketorolac, opioids, metoclopramide can be co-administered to alleviate pain. The purpose of this study is to compare the analgesic effect of lignocaine and tramadol in ameliorating propofol injection pain. MATERIALS AND METHODS In this prospective placebo controlled double blinded study, one hundred and fifty patients under general anaesthesia with propofol as inducing agent of ASA grade 1 and grade 2, were randomly allocated into three groups (A, B, C). In all cases, the drugs were administered slowly one minute prior to the injection of propofol and pain scores were measured immediately. Verbal responses for pain were also recorded. RESULTS Results were analysed by Z-test. p value 0.05). However, both the drugs effectively reduced the incidence of pain on propofol injection when compared to placebo group. (p value 1.96). CONCLUSION There is no statistically significant difference between lignocaine and tramadol with regard to their efficacy in reducing propofol injection pain. Both the drugs (Lignocaine 60 mg and Tramadol 50 mg), can be given one minute prior to the propofol injection and they could prevent the pain of propofol injection in patients undergoing general anaesthesia, as compared to the placebo group.

Background: Current evidence on the effect of anesthetic-ECT time interval (AETI) is controversial. This study aimed to investigate the factors affecting the time interval between propofol injection and electro-convulsion induction and the relationship between these factors and the duration of convulsion. Methods: In this study, 102 patients (616 sessions of ECT) were studied. Demographic and clinical data (age, gender, receiving or not receiving medications that affected the seizure threshold, the total number of ECT sessions, clinical severity of admission scores, clinical diagnosis, propofol dose, seizure duration, and AETI) were collected in special forms and analyzed by appropriate statistical methods. Results: Sessions with long-term AETI had longer seizure time than sessions with short-term AETI (33.47 ± 8.46 vs. 28.68 ± 9.74, P value < 0.05). The duration of seizures was significantly longer in the group with long AETI in sessions 1, 2, and 4 than in the other group (P value < 0.05). There was a significant relationship between the duration of seizures and propofol dose, AETI, and receiving drugs effective in the seizure threshold (P value < 0.05). Conclusions: The results showed that increasing AETI and injecting a lower dose of propofol to induce anesthesia would increase the duration of seizures. Also, taking medications that would affect the seizure threshold reduces the duration of seizures.

Objective To review our use of pharmacologic provocative testing (PT) and intraoperative neurophysiologic monitoring (IONM) during endovascular embolization for eloquent arteriovenous malformations (AVMs), and better define their clinical utility. Methods This is a prospective study between 1 June 2018 and 1 June 2020. Prior to endovascular embolization, superselective PTs with propofol injection were performed. The PT results were assessed by IONM. The impact of different doses of propofol on PT results was compared. Results Under general anesthesia, 111 PTs and 48 endovascular embolizations were performed in 22 patients. For the initial 48 PTs before planned embolization, 38 PTs with 5 mg propofol were negative and repeat PTs with 7 mg propofol were also negative. For the remaining 10 positive PTs, the microcatheter tip was adjusted to an alternative site until repeat PTs were negative to ensure a subsequent safe embolization. In comparison, 5-mg-propofol PT results were consistent with 7-mg-propofol PTs in larger-sized feeders, whereas for smaller-sized vessels, 3-mg-propofol PT results were consistent with 5-mg-propofol PTs. The negative predictive value of PTs was 97.9% (47 of 48), as only 1 of the 48 embolizations with negative PTs resulted in postoperative hemorrhage and none of the other 47 embolizations led to a postoperative neurologic deficit. Conclusions PTs and IONM are valuable techniques to predict neurologic deficits and improve procedure decision-making during AVM embolization under general anesthesia. A 5-mg dose of propofol may be sufficient for PTs in larger-sized feeders and a 3-mg dose may be sufficient in smaller-sized feeding branches.

Anaesthetists commonly debate whether lidocaine should be added to propofol for anaesthetic induction. The benefits include pain relief and improved patient satisfaction, but disadvantages include the effect on the emulsion itself, the efficacy of propofol once it has been mixed, and the effect on growth of bacteria in the syringe.

Pain during injection of anesthetic agents may be distressing to the patients and can reduce the acceptability of an otherwise useful agent. It may be a limiting factor in commonly used anaesthetic...

Objective Lidocaine alleviates propofol injection pain. However, whether lidocaine works through a local anesthetic effect at the site of intravenous injection or through a systemic effect on the central nervous system remains unknown. This study aimed to determine the pain-alleviating mechanism of lidocaine. Design A randomized controlled study. Setting A gastroscopy facility. Methods The study was divided into two parts. Part 1 involved 717 patients who were randomly assigned into five groups. Groups PR, RL20, and RL40 received normal saline or saline containing 20 or 40 mg of lidocaine, injected via the vein on the right hand. Groups LL20 and LL40 received 20 or 40 mg of lidocaine, injected via the vein on the left hand. Part 2 involved 378 patients who were randomly assigned into five groups. Groups RL40, RL1.2, and RL1.5 received 40 mg, 1.2 mg/kg, and 1.5 mg/kg of lidocaine, injected via the vein on the right hand. Groups LL1.2 and LL1.5 received 1.2 or 1.5 mg/kg of lidocaine, injected via the vein on the left hand. All received 2 mg/kg of propofol via the vein on the right hand two minutes later. Injection pain and patient satisfaction were recorded. Results The incidence of pain of group RL40 was lower than that of group PR. The incidence of pain of group LL1.2 was higher than that of other groups. Conclusions A dosage of 40 mg lidocaine is an appropriate dosage to alleviate propofol injection pain within the same vein. Lidocaine reduces propofol injection pain through both a local anesthetic effect and a central analgesic effect when the dosage reaches 1.5 mg/kg.

Background Pain on injection with propofol is still a major problem associated with anesthesia. Several factors involved in this event have been studied with respect to their pain attenuating effects. Objectives The purpose of this study was to evaluate the effect of propofol infusion before administration of its bolus dose of propofol on the resulted pain at its induction dose and on serum complement C3 levels. Methods This clinical trial was performed on patients undergoing surgery under general anesthesia divided into three groups, including A (without intervention), B (propofol infusion at a dose of 50 µg/kg/min before anesthesia induction), and C (propofol infusion at a dose of 100 µg/kg/min 100 before anesthesia induction). During anesthesia induction by propofol, the presence, absence or severity of pain was determined using the Numerical Rating Pain Scale. Serum complement C3 levels were measured and their relationships with pain scores were compared between three groups. The data were analyzed using SPSS V. 22 software. Results There were significant differences in the mean pain scores between three groups (P < 0.05). However, no significant difference in the mean pain scores was observed between the groups B and C (P > 0.05). The mean and standard deviation of the differences in complement C3 values in the three groups before and after injection were 72.15 ± 14.9, 27.65 ± 9.82, and 18.95 ± 4.68, respectively, which demonstrated a significant difference between three groups (P < 0.05). However, the difference in complement C3 values between the groups B and C was not significant (P > 0.05). Conclusions According to the obtained results, the low doses of infused propofol, 2 minutes before administration of its bolus dose, seems to have a considerable attenuating effect on its pain score.

Abstract Background: Propofol injection pain (PIP) is common and may decrease patient comfort. The aim of this study was to compare the effects of dezocine with lidocaine on prevention of PIP. Methods: 235 patients, who scheduled for elective surgery, aged 18-80 years and ASA (American Society of Anesthesiologists) I or II, were randomly assigned into five groups (n = 47 each). All patients were induced through the dor­sal hand vein or antecubital vein. The five groups were given the following medication intravenously: saline (Group I), lidocaine 20 mg (Group II), lidocaine 40 mg (Group III), dezocine 2 mg (Group IV) and dezocine 4 mg (Group V). Twenty seconds later all patients received a propofol infusion and were asked to grade pain or discomfort in the hand or forearm according to a four-point scale until anesthesia. Results: Three groups showed a significantly lower incidence of total PIP than Group Ⅰ: Group III (OR (Odds ratio): 0.39 (0.16, 0.93)); Group IV (OR: 0.21 (0.09, 0.51)) and Group V (OR: 0.12 (0.05, 0.30)). Group Ⅳ showed a significantly lower incidence of total PIP than Group Ⅱ (OR: 0.32 (0.13, 0.77)). Group Ⅴ showed a significantly lower incidence of total PIP than Group Ⅱ (OR: 0.15 (0.06, 0.39)) or Group Ⅲ (OR: 0.30 (0.13, 0.72)). Conclusion: Dezocine is a novel agent to alleviate PIP and appears to some extent to be more effective than lidocaine.

BACKGROUND Propofol is a commonly used intravenous drug during anesthetic induction because of its rapid onset and short duration. However, the injection pain that patients experience is so severe that they recall the induction of anesthesia as the most painful part of the perioperative period. Therefore, the objective of this study was to determine the effect of heated carrier fluids (40℃) in decreasing propofol injection pain. METHODS A randomized, controlled clinical trial was conducted in 90 patients aged 18 to 65 who were scheduled for either elective or urgent surgery under general anesthesia classified as American Society of Anesthesiologists physical status I or II. Patients were allocated into the following 3 groups: 1) Group W (n = 30) who received 200 ml of heated carrier fluids for 20 minutes prior to propofol injection; 2) Group L (n = 30) who received 200 ml of heated carrier fluids for 20 minutes prior to 0.5 mg/kg 1%lidocaine 1 minute before propofol injection; 3) Group C (control group, n = 30) who received 200 ml of room temperature fluids prior to propofol injection. Pain was evaluated using verbal pain score (VPS). RESULTS Group W and Group L showed significant reduction (P = 0.001) in the incidence and severity of injection pain compared to Group C. VPS scores were significantly lower in Group W and Group L compared to those of Group C. Incidence of propofol injection pain was statistically different between Group W (P = 0.005) and Group L (P = 0.037) compared to Group C, but not statistically different between Group W and Group L (P = 0.432). CONCLUSIONS Both sole injection of heated carrier fluids and the combination of 0.5 mg/kg 1%lidocaine pretreatment effectively reduced propofol injection pain.

Introduction: This review compares the ondansetron, lidocaine and magnesium-sulfate in the reduction of pain during the introduction with propofol. Methods: The study included 40 patients. Patients were divided into 4 groups: placebo, ondansetron, lidocain and magnesium-sulfate. In addition to pain, heart rate and mean arterial pressure were recorded. Patients allergic to propofol or study drugs, who received regional anesthesia and patients with heart blocks were excluded from the study. Results: The study included 23 males (57.5%) and 17 females (42.5%). There were no statistically significant differences between groups by gender. Pain was reported by 10% of patients who received ondansetron, 20% of patients treated with lidocaine, 10% of patients treated with magnesium-sulfate and 70% of patients who were given placebo, The difference in the incidence of chron- ic pain was statistically significant, p = 0.006. 10% of patients who received ondansetron had moderate pain, 20% of patients treated with lidocaine had mild pain, as well as 10% of patients who were treated with magnesium-sulfate. In relation to this, 20% of patients who received placebo reported a mild pain, 30% severe pain and 20% moderate pain. The difference in the incidence of pain quality was statistically significant p = 0.032. Conclusion: Ondansetron, lidocaine and magnesium-sulfate can prevent propofol injection pain. The study included small number of patients, however, it showed statistically significant differences related to the pain between placebo and study groups.

Background To compare the effect of premedication with 2 different doses of oral paracetamol to prevent pain at propofol intravenous injection. Methods We conducted a double-blind randomized controlled trial in which patients scheduled for induction of general anesthesia with intravenous propofol received either a placebo, 500 mg or 1000 mg of oral paracetamol (P500 and P1000, respectively) 1 h prior to induction. Two mg/kg of propofol was injected at a rate of 600 ml/hr. After 1/4 of the full dose had been injected, the syringe pump was paused, and patients were asked to rate pain at the injection site using a verbal numerical rating score (VNRS) from 0 to 10. Results Three hundred and twenty-four patients were included. Pain intensity was lower in both P500 and P1000 groups (median VNRS [interquartile range] = 2 [0–3] and 4 [2–5], respectively) than in the placebo group (8 [7–10]; P

Background: This clinical study was designed to evaluate the effect of midazolam as a premedication on the onset of propofol and rocuronium during propofol target-controlled infusion (TCI). Methods: Seventy four patients (ASA class I or II) were randomly allocated to receive either no premedication (control group) or premedication with 0.04 mg/kg intravenous midazolam (midazolam group). Anesthesia was induced and maintained with propofol TCI. Time from propofol injection to loss of consciousness (LOC) and estimated effect concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was injected. We monitored the degree of neuromuscular blockade by acceleromyography. The following parameters were measured and compared between groups: Time from rocuronium injection to depression of twitch height below 25%, time to maximal depression of twitch height (defined as rocuronium onset time). Results: Systolic blood pressure before induction was lower in midazolam group (125±15 vs 135±20 mmHg), however, there was no difference in blood pressure at LOC between groups (111±16 vs 106±21 mmHg). In midazolam group, time to LOC in propofol TCI was shorter (63±22 vs. 203±118 sec) and estimated effect site concentration of propofol was significantly lower than control group (0.9±0.3 vs. 2.2±0.4 μl/ml). The onset time of rocuronium was not different between groups (120±39 vs. 137±42 sec). Conclusions: Midazolam pretreatment fastens the onset time of propofol and decreases the propofol requirement for LOC. However, it does not influence the onset of rocuronium. (Korean J Anesthesiol 2009;57:434∼7)

Purpose of review Electroconvulsive therapy (ECT) is a well established and effective therapy in treatment-resistant depression. It is performed under general anesthesia, but no consensus exists regarding the optimal anesthetic drugs. A growing interest in optimizing adjunctive medication regimes in ECT anesthesia has emerged in recent years. Moreover different methods of seizure induction have been evaluated. Recent findings Pretreatment with dexmedetomidine eased the propofol injection pain and reduced the hyperdynamic response to ECT, but prolonged recovery. Remifentanil exhibited no proconvulsive effect and had no effect on seizure quality. Ketamine showed an antidepressive effect but was associated with cardiovascular side effects and an increased recovery time. A bispectral index-guided anesthesia or a time delay between anesthesia and seizure induction resulted in a better seizure quality presumably by avoiding high concentrations of (anticonvulsive) hypnotics. Seizure induction by magnetism seems to be an alternative to ECT, as the former is associated with less cognitive side effects but comparable antidepressive efficacy. Summary The current practice of anesthesia for ECT should not be modified, as the evidence of studies is either too low or the results are inconsistent. Some approaches are promising but require validation in further studies with a higher number of participants.

In most of the patients, propofol caused pain or discomfort during injection. Injection of various intravenous drugs prior to propofol is one of the methods for relieving propofol-induced pain. Different sources suggested unclear and confounding results on the effect of Sufentanil injection on the pain from propofol. Prophylactic effect of sufentanil on the severity of pain from propofol injection was investigated in this double-blind study in which 118 relevant patients have participated. The patients were randomly given 5 micrograms of Sufentanil to 59 patients and normal Saline to the remaining 59 ones. Pain severity, systolic and diastolic blood pressures, mean arterial pressure and heart beat rate were measured before and after propofol injection. The pain during injection was found to be significantly lower in the Sufentanil group. Sufentanil also reduced systolic and diastolic blood pressures, mean arterial pressure and heart rate.

Background: The aim of this study is to investigate the characteristics of propofol abuse based on the results of a survey analysis of abusers among non-healthcare professionals in Korea. Methods: Thirty-eight propofol abusers were questioned between October and December 2010, and were enrolled and voluntarily participated in a structured survey consisting of an interview and completing a previously prepared questionnaire. The questionnaire was divided into three distinct parts: part 1 dealt with the history of propofol abuse; part 2 highlighted the problems caused by propofol abuse; and part 3 enquired regarding demographics of abusers. Results: Thirty-one (81.6%) of the 38 interviewees abused propofol for more than one year. During the last 12 months, 34 (89.0%) received propofol at two or three times a week. The minimum and maximum amounts of propofol (median, range) administered each time were 500 (100, 1000) and 2000 (500, 4000) mg, respectively. Stress relief and the maintenance of a sense of well-being were quoted the most important reasons for the first-time administration of propofol and its subsequent abuse, respectively. The majority of abusers (36.0, 97.3%) reported a sense of pleasure or euphoria at the time of their propofol injection. Withdrawal symptoms occurred in five abusers (13.2%). Thirteen (36.1%) reported disruptions in their work life. None of the respondents had previously admitted to and or reported abuse of any other controlled substances. Conclusions: These results provided reference data for the regulation of propofol in Korea as a controlled substance and may also be of interest to international agencies in other countries.

Postoperative pain may lead to delayed mobilization, persisting pain, and psychosocial distress. There are no simple and reliable techniques for prediction of postoperative pain. This study was designed to evaluate if pain induced by venous cannulation or propofol injection can be used to predict postoperative pain.This prospective study included 180 patients scheduled for laparoscopic cholecystectomy. Pain intensity associated with peripheral venous cannulation and administration of propofol preoperatively and pain intensity, and use of opioid postoperatively was recorded.Patients scoring cannulation-induced pain intensity2.0 VAS units were given postoperative opioid more often (65% vs. 36%; P0.001), earlier (12 min vs. 90 min; P0.001), and in higher doses (4.8 mg vs. 0 mg; P0.001), and also reported higher levels of postoperative pain intensity (5.8 vs. 2.9 VAS units; P0.001). There were also significant (P0.01) correlations with postoperative pain intensity (rs = 0.24), time to opioid administration (rs = -0.26), and total dose of opioid (rs = 0.25). Propofol-induced pain intensity correlated significantly (P0.05) with postoperative pain intensity (rs = 0.19).Pain intensity associated with venous cannulation and propofol infusion can easily be evaluated at bedside before surgery without specific equipment or training. Patients scoring2.0 VAS units on venous cannulation were found to have 3.4 times higher risk of postoperative pain after laparoscopic cholecystectomy. Low pain intensity associated with venous cannulation and propofol infusion indicate lower risk of postoperative pain.

Intravenous injection of Propofol causes pain at the site of injection. Aim of this study was to compare the analgesic effect of two drugs (Tramadol & 2% Xylocard) in ameliorating Propofol injection pain. The study was randomized and prospective. 100 adult patients of both sexes of ASA status 1 & 2 were randomly assigned into 2 groups of 50 each, where Group 1 received Tramadol intravenously & Group 2 received 2% Xylocard intravenously 1 minute before injection of Propofol. The efficacy of the analgesic effect of Tramadol & 2% Xylocard was compared in ameliorating Propofol injection pain. It was observed that 2% Xylocard has got more petent analgesic action compared to Tramadol (P value < 0.05).