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Comparison between hemodynamic effects of propofol and thiopental during general anesthesia induction with remifentanil infusion: a double-blind, age-stratified, randomized study

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A Letter to the Editor to this article was published on 24 September 2019



Propofol is commonly used with remifentanil for induction of general anesthesia (GA); however, it often leads to hypotension. Intraoperative hypotension is associated with postoperative adverse events. By contrast, thiopental has less negative inotropic effects on hemodynamics compared to propofol, which could be suitable to prevent hypotension during GA induction. In the present age-stratified, randomized, assessor-blinded study, using the ClearSight® system, we compared the hemodynamic effects of propofol and thiopental during GA induction under remifentanil infusion in non-cardiac surgery.


Patients were divided into young (20–40 year), middle (41–70 year), and elderly (> 70 year) groups (n = 20, each group). General anesthesia was induced with remifentanil 0.3 μg/kg/min, followed by propofol (2.0, 1.5, and 1.2 mg/kg) or thiopental (5.0, 4.0, and 3.0 mg/kg) in the young, middle, and elderly groups, respectively. The primary outcome was the difference in the decrease in mean arterial blood pressure between patients receiving propofol and thiopental in each age group. The secondary outcomes included other hemodynamic parameters and minimal bispectral index values measured up to 10 min after tracheal intubation.


The decrease in mean arterial blood pressure was greater in patients receiving propofol than those receiving thiopental (− 45.4 vs − 26.6 mmHg and − 45.7 vs − 28.9 mmHg, P = 0.003 and 0.007, respectively), whereas no significant difference was observed in the young age group (P = 0.96).


Thiopental is a more suitable agent than propofol for avoiding hypotension during GA induction under remifentanil infusion in the middle and elderly patients.

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The authors would like to thank Associate Professor Mitsuru Fukui (Laboratory of Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan) for help with statistics.

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Correspondence to Hideki Hino.

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Figure S1 Hemodynamic changes in the propofol group (green line) and the thiopental group (red line) in each age group. (a) (g) (m) MAP, (b) (h) (n) heart rate, (c) (i) (o) cardiac index, (d) (j) (p) stroke volume index, (e) (k) (q) systemic vascular resistance index, (f) (l) (r) stroke volume variation for the young, middle, and elderly age groups, respectively (TIFF 245 kb)

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Supplementary material 3 (TIFF 303 kb)

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Hino, H., Matsuura, T., Kihara, Y. et al. Comparison between hemodynamic effects of propofol and thiopental during general anesthesia induction with remifentanil infusion: a double-blind, age-stratified, randomized study. J Anesth 33, 509–515 (2019).

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