Coinduction (anaesthetics)

The anesthetic area of an operating room. Induction of anaesthesia, where the patient loses consciousness and passes through the Guedel stages of anaesthesia, commonly takes place here.

Coinduction in anaesthesia is a pharmacological tool whereby a combination of sedative drugs may be used to greater effect than a single agent, achieving a smoother onset of general anaesthesia. The use of coinduction allows lower doses of the same anaesthetic agents to be used which provides enhanced safety, faster recovery, fewer side-effects, and more predictable pharmacodynamics.[1][2][3][4] Coinduction is used in human medicine and veterinary medicine[5] as standard practice to provide optimum anaesthetic induction. The onset or induction phase of anaesthesia is a critical period involving the loss of consciousness and reactivity in the patient, and is arguably the most dangerous period of a general anaesthetic. A great variety of coinduction combinations are in use and selection is dependent on the patient's age and health, the specific situation, and the indication for anaesthesia. As with all forms of anaesthesia the resources available in the environment are a key factor.

## Commonly used coinduction regimens

A standard coinduction regimen for an adult might consist of a benzodiazepine sedative amnesic such as midazolam, followed by an opioid analgesic with further sedating properties such as fentanyl which has a fast onset, then an intravenous induction agent: propofol. A muscle relaxant such as atracurium would be administered after this, though this would not strictly be a part of coinduction. For a child on the other hand, a commonly used regimen would be fentanyl, ketamin and rocuronium. In all cases the choice of agents would be tailored to the situation; for a neonatal intubation the aforementioned regimes would be inappropriate as sedation and especially amnesia are less important. Fentanyl alone would be used, followed by the short-action muscle relaxant suxamethonium: coinduction is typically not used in neonatal anaesthesia.

## References

1. ↑ Galvez-Escalera I, Thorpe CM. The effect of coinduction with midazolam on propofol injection pain. Eur J Anaesthesiol. 2004 Jul;21(7):579-81. PMID 15318476 [1]
2. ↑ Baykara N, Sahin T, Toker K. The effect of midazolam-thiopental coinduction on recovery in minor surgery. J Anesth. 2001;15(1):6-10. PMID 14566540 [2]
3. ↑ Adams HA, Vonderheit G, Schmitz CS, Hecker H. [Sympathoadrenergic, hemodynamic and stress response during coinduction with propofol and midazolam]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2000 May;35(5):293-9. German. PMID 10858838 [3]
4. ↑ Anderson L, Robb H. Propofol/midazolam coinduction. Anasthesiol Intensivmed Notfallmed Schmerzther. Anaesthesia. 1999 Jun;54(6):609. PMID 10403887 [4]
5. ↑ Liao P, Sinclair M, Valverde A, Mosley C, Chalmers H, Mackenzie S, Hanna B. Induction dose and recovery quality of propofol and alfaxalone with or without midazolam coinduction followed by total intravenous anesthesia in dogs. Vet Anaesth Analg. 2017 Sep;44(5):1016-1026. PMID 28967477 [5]

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