Propofol Priming for Enhancing Induction Safety in Hypertensive Patients: A Prospective Double-blind Randomised Controlled Trial

Introduction: Propofol is popular for inducing general anaesthesia, but it has drawbacks such as hypotension and bradycardia in a dose-dependent manner, especially in hypertensive patients. Reducing the total dose of Propofol using the priming principle has proven to be effective; however, it has not been studied in high-risk hypertensive patients. Therefore, the current study was planned. Aim: To evaluate the effects of priming on Propofol induction in controlled hypertensive patients, with objectives to assess haemodynamic parameters, total dose, and side- effects. Materials and Methods: This prospective, comparative, double-blind randomised controlled trail was performed at the Department of Anaesthesiology, Pt. Bhagwat Dayal Sharma (B.D.) Postgraduate Institute of Medical Sciences (PGIMS) Rohtak, Haryana, India, from April 2023 to April 2024. A total of 60 patients scheduled for elective surgery under general anaesthesia with controlled hypertension were randomly assigned to either Group 1 (study group, n=30), where Propofol priming was used, or Group 2 (control group, n=30). Demographics, total Propofol dose, haemodynamic parameters {Heart Rate (HR), Systolic Blood Pressure (SBP), Mean Arterial Pressure (MAP)}, and adverse events were evaluated using International Bussiness Machine (IBM) Statistical Package of Social Sciences (SPSS) version 25.0. The Kolmogorov-Smirnov test was used for normalisation, and the Mann's-Whitney U test, Independent t-test, and Chi-square test were used for data analysis. Results: In Group 1 (study), the mean age was 49.36 +/- 9.42 years, while in Group 2 (control), it was 49.36 +/- 9.19 years (p=0.91). A lesser dose of Propofol was needed in the study group (Group 1) (90.07 +/- 19.73 mg) compared to the control group (Group 2) (120.00 +/- 21.81 mg) (p=0.001). Haemodynamic alterations were more pronounced in the controls compared to the study group. After induction, a significant fall in MAP was observed in the controls compared to the study group (67.63 +/- 5.86 mmHg vs. 90.63 +/- 4.33 mmHg) (p=0.001). Adverse effects, such as pain at the injection site, were reported in one patient (n=1) in Group 2. Conclusion: The priming principle significantly reduces the total Propofol dose and leads to more stable haemodynamics during general anaesthesia induction in controlled hypertensive patients. Priming with Propofol is advised for patients with hypertension when inducing general anaesthesia.