Coinduction in anesthesia is a

pharmacological Pharmacology is a branch of medicine, biology and pharmaceutical sciences concerned with drug or medication action, where a drug may be defined as any artificial, natural, or endogenous (from within the body) molecule which exerts a biochemica ...

tool whereby a combination of sedative drugs may be used to greater effect than a single agent, achieving a smoother onset of

general anesthesia General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...

. The use of coinduction allows lower doses of the same anesthetic agents to be used which provides enhanced safety, faster recovery, fewer side-effects, and more predictable

pharmacodynamics Pharmacodynamics (PD) is the study of the biochemical and physiologic effects of drugs (especially pharmaceutical drugs). The effects can include those manifested within animals (including humans), microorganisms, or combinations of organisms ...

.Galvez-Escalera I, Thorpe CM. The effect of coinduction with midazolam on propofol injection pain. ''Eur J Anaesthesiol''. 2004 Jul;21(7):579-81.

/ref>Baykara N, Sahin T, Toker K. The effect of midazolam-thiopental coinduction on recovery in minor surgery. ''J Anesth''. 2001;15(1):6-10.

/ref>Adams HA, Vonderheit G, Schmitz CS, Hecker H. ympathoadrenergic, hemodynamic and stress response during coinduction with propofol and midazolam ''Anasthesiol Intensivmed Notfallmed Schmerzther''. 2000 May;35(5):293-9. German.

/ref>Anderson L, Robb H. Propofol/midazolam coinduction. ''Anasthesiol Intensivmed Notfallmed Schmerzther''. ''Anaesthesia''. 1999 Jun;54(6):609.

/ref> Coinduction is used in human medicine and

veterinary medicine Veterinary medicine is the branch of medicine that deals with the prevention, management, diagnosis, and treatment of disease, disorder, and injury in animals. Along with this, it deals with animal rearing, husbandry, breeding, research on nutri ...

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.

/ref> as standard practice to provide optimum anesthetic induction. The onset or general anaesthesia#Induction, induction phase of anesthesia is a critical period involving the

loss of consciousness Loss may refer to: Arts, entertainment, and media Music * ''Loss'' (Bass Communion album) (2006) * ''Loss'' (Mull Historical Society album) (2001) *"Loss", a song by God Is an Astronaut from their self-titled album (2008) * Losses "(Lil Tjay son ...

and reactivity in the patient, and is arguably the most dangerous period of a general anesthetic. 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 anesthesia. As with all forms of anesthesia the resources available in the environment are a key factor. __TOC__

Commonly used coinduction regimens

A standard coinduction regimen for an adult might consist of a benzodiazepine sedative

amnesic Amnesia is a deficit in memory caused by brain damage or disease,Gazzaniga, M., Ivry, R., & Mangun, G. (2009) Cognitive Neuroscience: The biology of the mind. New York: W.W. Norton & Company. but it can also be caused temporarily by the use ...

such as

midazolam Midazolam, sold under the brand name Versed among others, is a benzodiazepine medication used for anesthesia and procedural sedation, and to treat severe agitation. It works by inducing sleepiness, decreasing anxiety, and causing a loss of ...

, followed by an

opioid Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use ...

analgesic with further sedating properties such as

fentanyl Fentanyl, also spelled fentanil, is a very potent synthetic opioid used as a pain medication. Together with other drugs, fentanyl is used for anesthesia. It is also used illicitly as a recreational drug, sometimes mixed with heroin, cocain ...

which has a fast onset, then an intravenous induction agent: propofol. A

muscle relaxant A muscle relaxant is a drug that affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term "muscle relaxant" is used to refer to two major therap ...

such as

atracurium Atracurium besilate, also known as atracurium besylate, is a medication used in addition to other medications to provide skeletal muscle relaxation during surgery or mechanical ventilation. It can also be used to help with endotracheal intubatio ...

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

, ketamin and

rocuronium Rocuronium bromide (brand names Zemuron, Esmeron) is an aminosteroid non-depolarizing neuromuscular blocker or muscle relaxant used in modern anaesthesia to facilitate tracheal intubation by providing skeletal muscle relaxation, most commonly r ...

. In all cases the choice of agents would be tailored to the situation; for a

neonatal An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...

intubation Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blake ...

the aforementioned regimes would be inappropriate as sedation and especially amnesia are less important.

Fentanyl Fentanyl, also spelled fentanil, is a very potent synthetic opioid used as a pain medication. Together with other drugs, fentanyl is used for anesthesia. It is also used illicitly as a recreational drug, sometimes mixed with heroin, cocain ...

alone would be used, followed by the short-action muscle relaxant

suxamethonium Suxamethonium chloride, also known as suxamethonium or succinylcholine, or simply sux by medical abbreviation, is a medication used to cause short-term paralysis as part of general anesthesia. This is done to help with tracheal intubation or ele ...

: coinduction is typically not used in neonatal anesthesia.

References

{{pain Anesthesia Pharmacology Sedatives