Thiopental-sparing properties of butorphanol/diazepam for induction of anesthesia in ambulatory gynecologic surgery

Butorphanol/diazepam was compared with thiopental for induction of anesthesia, and the thiopental-sparing effects of butorphanol/diazepam determined. One hundred women, American Society of Anesthesiology physical status class I, undergoing ambulatory, elective termination of pregnancy were randomized to receive either butorphanol 2 mg plus diazepam 10 mg, or thiopental, until loss of the lid reflex occurred. The butorphanol/diazepam group received supplemental thiopental as necessary to attain adequate induction of anesthesia. The combination of butorphanol and diazepam significantly reduced the thiopental dose required to produce loss of the lid reflex, from 4.2 +/- 0.8 to 0.8 +/- 0.6 mg/kg (p less than 0.005), with 22 percent of the patients not requiring supplemental thiopental. The intraoperative course and anesthetic requirements were similar between the two groups. Lower recovery room rating scale values upon arrival at the recovery room were attributed to significantly higher weight-normalized doses of butorphanol (p = 0.004) and diazepam (p = 0.005). The duration of the recovery room stay was 68.8 +/- 24.9 min for the control group, and 80.8 +/- 29.0 min for the butorphanol/diazepam-treated patients (p = 0.026). There were no clinically significant differences in anesthesia or postanesthesia recovery. The combination of butorphanol and diazepam has a significant thiopental-sparing effect, and is a useful induction technique for short, ambulatory surgical procedures.