A 3:1 volume admixture of 1% propofol and 2.5% thiopentone reduces pain on induction in paediatric anaesthesia
Bibliographic record
Abstract
Introduction The incidence of pain on injection with 1% propofol in adult and paediatric patients ranges from 50 to 100% ( 1 ). In paediatric practice, the addition of lignocaine 1 mg·kg −1 to propofol reduces the incidence of pain. The incidence of pain with this technique in a pilot study in our institution was 20%. Thiopentone mixed with propofol may also reduce injection pain ( 2 ). The purpose of this study was to evaluate the incidence of pain on injection during intravenous induction using a 3:1 volume admixture of 1% propofol and 2.5% thiopentone (P/T) compared to a 10:1 volume admixture of 1% propofol and 2% lignocaine (P/L). Methods After ethics committee approval and informed written parental consent, 127 children, aged 1–10 years and weighing < 40 kg were randomised into two groups; group P/L received 5 mg·kg −1 of 1% propofol and 1 mg·kg −1 of lignocaine, group P/T received 3 mg·kg −1 of 1% propofol and 3 mg·kg −1 of 2.5% thiopentone in a standardised fashion. Any subject who was not calm and cooperative immediately prior to induction after establishment of intravenous access was excluded from further study. A single, blinded observer scored pain behavior defined as any one of. a motor response of the arm, a verbal complaint of pain, cry and/or one of three standardised facial expressions of pain. Results The incidence of pain on injection was higher in the P/L group where 34% subjects experienced pain compared with 14% in the P/T group (χ 2 = 7.5, P = 0.006). Motor response was the most frequent pain response in the P/L group (68%). Discussion The hemodynamic effects, immediate in‐hospital or late recovery profile and incidence of postoperative nausea and vomiting of these admixtures were not evaluated in this study. Our clinical impression is that using either the P/L or P/T combination allowed rapid IV induction, and therefore rapid ventilation and LMA insertion without obvious hypotension. The P/T admixture may be less painful to inject simply because propofol is diluted. The optimum ratio of dilution of propofol with thiopentone may not be 3:1 and requires a dose‐finding study evaluating in detail the efficacy and side effects of other ratios of admixtures. Conclusion The use of a 3:1 volume admixture of 1% propofol and 2.5% thiopentone compared to a 10:1 volume admixture of 1% propofol and 2% lignocaine reduces pain on injection at induction of anaesthesia in paediatric patients from 34% to 14%, and is a practical solution for pain on injection in pediatric patients.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".