Propofol-diazepam or propofol-midazolam co-induction in healthy dogs: effects on propofol dosages, cardiovascular and respiratory events

PICO question In healthy dogs, does the use of diazepam or midazolam administered in co-induction with propofol result in a reduction in the dose of propofol required to induce anaesthesia and a decrease in adverse cardiovascular and respiratory events?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Eight papers were critically reviewed. A total of six manuscripts were prospective, randomised, blinded, clinical studies. One trial was prospective, randomised, blinded, clinical with a Latin square, incomplete design. One study was retrospective, randomised, blinded, crossover, experimental Strength of evidence Moderate Outcomes reported Variables assessed in this Knowledge Summary included: propofol dose required to induce anaesthesia (considering successful orotracheal intubation as an end point), changes in cardiovascular variables (heart rate, systolic, mean and diastolic blood pressure) and changes in respiratory variables (development of apnoea, changes in respiratory rates) Conclusion In healthy dogs, using propofol-diazepam or propofol-midazolam co-induction resulted in a reduction in propofol dose required to induce anaesthesia in some trials only. Midazolam appeared more effective than diazepam in this context. The dosages, timing and sequence of drug administration seemed relevant. No evidence suggested that using propofol-diazepam or propofol-midazolam co-induction resulted in a reduction of adverse cardiovascular or respiratory events. In addition, although this was out of the scope of the PICO question addressed here, adverse events (e.g. excitement, poorer quality of induction) were reported in several studies when diazepam or midazolam were used in co-induction   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.