Published: 2018-07-25

Effective dose of propofol for smooth induction in midazolam premedicated and in unpremedicated children

Veena Shukla, Harpreet Kaur


Background: Propofol, an intravenous (IV) anaesthetic agent, is widely used in paediatric day care surgeries. Present study was conducted to determine clinically effective dose of Propofol for smooth induction in children.

Methods: This randomized controlled study was conducted in 100 children of American Society of Anaesthesia (ASA) grade I and II, posted for short genitourinary surgeries. Group P patients received premedication with injection glycopyrrolate and midazolam IV. Group U patients were unpremedicated. Both groups were split in five subgroups with ten patients in each as per propofol dose of 2.0, 2.5, 3.0, 3.5, and 4.0mgkg-1 respectively. Following observations were made-pain on injection site, facemask tolerance, repeat dose and total dose of Propofol required for smooth induction, time of recovery and complications like post-operative nausea and vomiting (PONV). All data was analyzed by using chi square test and student t test.

Results: Demographic profile showed no significant difference. Mean dose of Propofol in group P was 3.29±0.51 mg kg-1 while for group U was 3.70±0.57mg kg-1. Facemask tolerance was maximum in group P5 (100%) followed by (80%) in U5. Mean dose of Propofol required for younger children 1-3 years (group P 3.46±0.43 mgkg-1 v/s group U 3.94±0.48 mgkg-1) was much higher than dose required for 7-10 years (group P 3.13±0.52 mgkg-1 and group U 3.18±0.59 mgkg-1) for both groups. Recovery time after anaesthesia was delayed in group P and complications were more in group U.

Conclusions: Propofol is the drug of choice for paeditric ambulatory surgery. Midazolam premedication enhances the benefits.


Ambulatory surgical procedures, Midazolam, Postoperative nausea and vomiting, Propofol

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Keskin G, Akin M, SenayY, Saydam S, Özmert S, Kurt DK, Sever F. Evaluation of 865 children who underwent magnetic resonance imaging under propofol-midazolam sedation. Medeniye Medical J. 2017;32(3):141-6.

Biebuyck JF, Smith I, White PF, Nathanson M, Gouldson R. Propofol: An update on its Clinical Use. Anesthesiology. 1994;81(4):1005-43.

Purcell-Jones G, Yates A, Baker J R, James IG. Comparison of The Induction Characteristics of Thiopentone And Propofol in children. BJA. 1987;59(11):1431-6.

Morton N. Johnson G, White M, Marsh B. Propofol in paediatric anaesthesia. Pediatric Anesthesia. 1992;2:89-97.

Kerker A, Hardt C, Schlief HE, Dumoulin FL. Combined sedation with midazolam/propofol for gastrointestinal endoscopy in elderly patients. BMC gastroenterology. 2010 Dec;10(1):11.

Chidambaran V, Costandi AJ, D'Mello A. Propofol: a review of its role in pediatric anesthesia and sedation. CNS drugs,2015;29(7):543-63.

Viitanen H, Annila P, Viitanen M, Yli-HankaJa A. Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1-3 yr. Canadian J Anesthesia. 1999 Aug 1;46(8):766-71.

James H. Nicoll, MB, CM Glasg. The surgery of infancy. BMJ. 1909;753-7.

Sundrani OP, Lalwani J, Sahare KK, Goyal K, Pandey S. Efficacy and safety of propofolv/s ketamine in short surgical/diagnostic procedures in paediatric age group. JEMDS. 2015;4(45):7748-60.

Murat V, Billard J, Vernois M, Zaouter P, Marsol R, Souron R, Farinotti. Pharmacokinetics of propofol after a single dose in children aged 1-3 years with minor burns: comparison of three data analysis approaches. Anesthesiology. 1996;84(3):526-32.

Patel DK, Keeling PA, Newman GB, Radford P. Induction dose of propofol in children. Anaesthesia. 1988;43:949-52.

Smith IP, White P, Nathanson M, Gouldson R. Propofol An update on its clinical use. Anesthesiology. 1994;81(4):1005-43.

Mirakhur RK. Induction characteristics of propofol in children: comparison with thiopentone. Anaesthesia. 1988;43:593-8.

Butt MN, Ahmed A. The induction dose of propofol with ketamine-propofol and midazolam-propofol co-induction. J Anesth Clin Res. 2013;4:371.

Anderson L, Robb H. A comparison of midazolam co-induction with propofol predosing for induction of anaesthesia. Anaesthesia. 1998;53:1117-20.

Djaiani G, Ribes-Pastor MP. Propofol auto-co-induction as analternative to midazolam co-induction for ambulatory surgery. Anaesthesia. 1999;54:51-85.

Adnan M, Furqan A, Sattar MK. Effect of midazolam premedication on doses of propofol for laryngeal mask airway insertion in children. J Ayub Med Coll Abbottabad. 2017;29(1):98-101.

Short TG, Chui PT. Propofol and midazolam act synergistically in combination. Br J Anaesth. 1991 Nov;67(5):539-45.

Bhaskar P, Malik A, Kapoor R, Kohli M, Agarwal J, Harjai M. Effect of midazolam premedication on the dose of propofol for laryngeal mask airway insertion in children. JOACP. 2010;26:503-6.

Coté CJ, Goudsouzian NG, Liu LM, Dedrick DF, Rosow CE. The dose response of intravenous thiopental for the induction of general anesthesia in unpremedicated children. Anesthesiology. 1981;55(6):703-5.

Cummings GC, Dixon J, Kay NH, Windsor JP, Major E, Morgan M, et al. Dose requirements of ICI 35,868 (propofol, 'Diprivan') in a new formulation for induction of anaesthesia. Anaesthesia. 1984;39(12):1168-71.

Hannallah RS, Baker SB, Casey W, McGill WA, Broadman LM, Norden JM. Propofol: effective dose and induction characteristics in unpremedicated children. Anesthesiology. 1991;74(2):217-9.

Aun CS, Short SM, Leung DH, Oh TE. Induction dose-response of propofol in unpremedicated children. British J anaesthesia. 1992 Jan 31;68(1):64-7.

Westrin P. The induction dose of propofol in infants 1-6 months of age and in children 10-16 years of age. Anesthesiology. 1991;74(3):455-8.

Manschot HJ, Meursing AE, Axt P, Byttebier GO, Erdmann W. Propofol requirements for induction of anesthesia in children of different groups. Anesth Analg. 1992;75(6):876-9.

Hertzog JH, Dalton HJ, Anderson BD, Shad AT, Gootenberg JE, Hauser GJ. Prospective evaluation of propofol anesthesia in the pediatric intensive care unit for elective oncology procedures in ambulatory and hospitalized children. Pediatrics. 2000;106(4):742-7.

Steur R, Perez R, De Lange J. Dosage scheme for propofol in children under 3years of age. Pediatric Anesthesia. 2004;14:462-7.

Elwood T, Huchcroft S, MacAdams C, Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1-3 yr. Can J Anaesth. 1995;42:114-8.

Puttick N, Rosen M. Propofol induction and maintenance with nitrous oxide in paediatric outpatient dental anaesthesia. Anaesthesia. 1988;43:646-9.

Doyle E, McFadzean W, Morton NS. IV anaesthesia with propofol using a target-controlled infusion system: comparison with inhalation anaesthesia for general surgical procedures in children. Br J Anaesth. 1993May;70(5):542-5.

Kay B. ICI 35868, a new intravenous induction agent. Acta Anaesthesiol Belg. 1977;28:303-16.

Cameron E, Johnston G, Crofts S, Morton NS. The minimum effective dose of lignocaine to prevent injection pain due to propofol in children. Anaesthesia. 1992;47(7):604-6.

Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesthesia and analgesia. 2000;90(4):963-9.

Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. B MJ.2011;342.

McCulloch MJ, Lees NW. Assessment and modification of pain on induction with propofol (Diprivan). Anaesthesia. 1985 Nov;40(11):1117-20.

Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia. 1988;43(6):492-4.

Brooker J, Redfern N. Pain on injection with propofol. Anaesthesia. 1986;41:1062-2.

Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth. 1992;69(7 Suppl 1):24S-32S.

Gan TJ, Glass PS, Howell ST, Canada AT, Grant AP, Ginsberg B. Determination of plasma concentrations of propofol associated with 50% reduction in postoperative nausea. Anesthesiology. 1997;87(4):779-84.

Erdem AF, Yoruk O, Alici HA, Cesur M, Atalay C, Altas E, et al. Subhypnotic propofol infusion plus dexamethasone is more effective than dexamethasone alone for the prevention of vomiting in children after tonsillectomy. Paediatric anaesthesia. 2008;18(9):878-83.

Erdem AF, Yoruk O, Silbir F, Alici HA, Cesur M, Dogan N, et al. Tropisetron plus subhypnotic propofol infusion is more effective than tropisetron alone for the prevention of vomiting in children after tonsillectomy. Anaesth Intensive Care. 2009;37(1):54-9.

Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. New Eng J Med. 2004;350(24):2441-51.

Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia and analgesia. 2014;118(1):85-113.