COINDUCTION OF ANESTHESIA - THE RATIONALE

Combination therapy with two or more different drugs, with the intenti on of reaching the same therapeutic goal, was heavily criticized for a long time. However, it is accepted today, especially when advantages over monotherapy can be shown. For the induction of anaesthesia or for long-term sedation in the intensive care unit, combination therapy ma y offer an improved effect profile, a more balanced ratio of desired v ersus adverse effects, an improved time-course of effect, simpler trea tment requirements or lower costs. Midazolam and propofol have been in vestigated as potential partners for those two indications. The mechan ism of action, pharmacokinetic properties, pharmacological effect, the way in which they interact at the receptor site, the differences in p harmaceutical formulations, the side-effect profiles and economic cons iderations were compared. Animal experiments and clinical pharmacology studies have shown that midazolam and propofol have synergy with othe r centrally active drugs. it could be expected that the relationship b etween desired effects and adverse effects could be improved by skilfu l use of the synergism between midazolam and propofol. Go-induction of anaesthesia and co-administration in long-term sedation can offer imp rovements in therapeutic situations compared with monotherapy. These i mprovements are in terms of a more suitable effect profile, a more fav ourable ratio of desirable effects to side-effects, optimization of th e time-course of effects and reduced costs.