Anesth Analg 2004;99:953-954
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000131688.18641.22
LETTERS TO THE EDITOR
Don’t Use Thiopental to Decrease Propofol Injection Pain
Timothy Lacy, MD,
Neil Roy Connelly, MD, and
Katharine Freeman, MD
Department of Anesthesiology, Baystate Medical Center
Director of Anesthesia Research, Baystate Medical Center, Associate Professor of Anesthesiology, Tufts University School of Medicine
Department of Anesthesiology, Baystate Medical Center, Assistant Professor of Anesthesiology, Tufts University School of Medicine, Springfield, MA
To the Editor:
We read with interest the article by Agarwal et al. (1) regarding the pretreatment of patients with thiopental for prevention of pain associated with propofol injection. They found that pretreatment with thiopental (0.5 mg/kg) along with venous occlusion for 1 min prevented pain on injection of propofol. They stated that decreasing propofol injection pain is important because it may influence a patient’s acceptability of anesthesia. They concluded that routine administration of thiopental along with 1-min venous occlusion should be undertaken prior to propofol administration.
We strongly disagree with this premise; thiopental increases the rate of postoperative nausea and vomiting as compared to propofol (2,3). This in turn increases PACU time (2,4), and it may increase the hospital admission rate of patients undergoing ambulatory procedures (2–4).
Although decreasing propofol-associated injection pain is a laudable clinical goal, it is a minor consideration compared with the issues brought about by postoperative nausea and vomiting. This article did not report or address postoperative nausea and vomiting associated with their technique.
Although the authors did show that there is a decrease in the incidence of pain associated with propofol injection after pretreatment with thiopental and venous occlusion, we do not agree that this technique should be clinically used.
References
- Agarwal A, Ansari MF, Gupta D, et al. Pretreatment with thiopental for prevention of pain associated with propofol injection. Anesth Analg 2004; 98: 683–6.[Abstract/Free Full Text]
- Fulton B, Goa KL. Propofol: a pharmacoeconomic appraisal of its use in day case surgery. Pharmacoeconomics 1996; 9: 168–78.[Web of Science][Medline]
- Myles PS, Hendrata M, Bennett AM, et al. Postoperative nausea and vomiting: propofol or thiopentone—does choice of induction agent affect outcome? Anaesth Intensive Care 1996; 24: 355–9.[Web of Science][Medline]
- Pfisterer M, Ernst EM, Hirlekar G, et al. Post-operative nausea and vomiting in patients undergoing day case surgery: an international, observational study. Ambul Surg 2001; 9: 13–8.
Response
Anil Agarwal, MD,
Mohammad F. Ansari, MD,
Sanjay Dhiraaj, MD, and
Mehdi Raza, MD
Department of Anesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
In Response:
We would like to thank Timothy et al. for their interest in our article and their valuable comments. We totally agree with them regarding postoperative nausea and vomiting (PONV) being a major cause of morbidity and its significance in terms of increased hospital stay and cost of treatment (1). But do these observations really apply to our study? All the studies quoted by Timothy et al. have observed the incidence of PONV following induction dose of thiopental or propofol (1–3). This does not hold true in our case, as we had administered 0.5 mg/kg of thiopental prior to induction with propofol (4). Propofol, even when administered in subhypnotic doses, has been reported to decreases the incidence of PONV (5). When an admixture of propofol and thiopental is used for induction, the incidence of PONV is the same as that with propofol alone (6,7). Therefore, we feel there should not be any increase in the incidence of PONV after thiopentone 0.5 mg/kg, which was followed by induction of anesthesia with propofol.
References
- Fulton B, Goa KL. Propofol: a pharmacoeconomic appraisal of its use in day case surgery. Pharmacoeconomics 1996; 168–78.
- Myles PS, Hendrata M, Bennett AM, et al. Postoperative nausea and vomiting: propofol or thiopentone—does choice of induction agent affect outcome? Anaesth Intensive Care 1996; 24: 355–9.
- Pfisterer M, Ernst EM, Hirlekar G, et al. Post-operative nausea and vomiting in patients undergoing day case surgery: an international, observational study. Ambul Surg 2001; 9: 13–8.
- Agarwal A, Ansari MF, Gupta D, et al. Pretreatment with thiopental for prevention of pain associated with propofol injection. Anesth Analg 2004; 98: 683–6.
- Ewalenko P, Janny S, Dejonckheere M, et al. Antiemetic effect of subhypnotic doses of propofol after thyriodectomy. Br J Anaesth 1996; 77: 463–7.[Abstract/Free Full Text]
- Chilvers M, Jones D, Rushmer J, et al. Propofol-thiopentone admixture: recovery characteristics. Anaesth Intensive Care 1999; 27: 601–9.[Web of Science][Medline]
- Rashiq S, Gallant B, Grace M, et al. Recovery characteristics following induction of anaesthesia with a combination of thiopentone and propofol. Can J Anaesth 1994; 41: 1166–71.[Web of Science][Medline]
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