A randomized clinical trial comparing hemodynamic responses to ketamine-propofol combination (ketofol) versus etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery

Abstract

IntroductionAnesthesia induction is often accompanied by a period of hemodynamic instability, which could be a significant problem in patients with compromised ventricular function. The aim of this study is to compare the hemodynamic responses to etomidate versus a combination of ketamine and propofol (ketofol) for anesthetic induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery.Material and methodsIn a double-blind randomized clinical study, a total of 84 patients with ischemic left ventricular dysfunction (EF < 40%) were randomly assigned to two groups (A and B). Patients in group A received etomidate 0.2 mg/kg and a placebo (normal saline); group B received a combination of ketamine (1 mg/kg) and propofol (1.5 mg/kg) at the induction of anesthesia. Two minutes after induction, hemodynamic variables, including systolic, diastolic, mean arterial pressure (SAP, DAP, MAP) and heart rate (HR), were measured immediately before and after the laryngoscopy, and before intubation and post-intubation at 1, 2, and 3 min.ResultsThe decrease in all hemodynamic parameters (SBP, DBP, MAP and HR) from induction time to laryngoscopy was greater in the ketofol group (group B) than in the etomidate group (group A) (p < 0.05). The ephedrine prescription rate due to hemodynamic changes was 24.4% (10 patients) and 5% (2 patients) in group B and group A, respectively (p = 0.03).ConclusionsWe found that etomidate provides superior hemodynamic stability as compared to ketofol in patients with left ventricular dysfunction undergoing CABG surgery under general anesthesia.

Effect of dexmedetomidine anesthesia on respiratory function in pediatric patients undergoing retinoblastoma resection

“…However, for infants and young children whose organ systems are not fully developed, conventional general anesthesia often has an inhibitory effect on respiratory function (18). For example, propofol is a widely used opioid analgesic in clinical practice with an excellent analgesic effect (19). However, propofol can decrease vagal tone, resulting in low extent of pulmonary expansion and collapse due to participation of vagus nerve in pulmonary stretch reflexes.…”

The role of entropy monitoring in reducing propofol requirements during open heart surgeries. A prospective randomized study

“…[ 13 ] Propofol, a widely acknowledged intravenous anesthetic used for induction of anesthesia in open heart surgery, possesses dose-dependent cardiovascular depressant properties leading to hypotension. [ 14 ]…”

Efficacy of procaine combined with ketamine and propofol in pediatric epidural anesthesia

“…Furthermore, Zeballos et al ( 17 ) demonstrated that ketamine alone was unable to adequately relax muscles and ease pain, and that a higher dose was required for anesthesia; however, this may result in increased oral secretion, glossocoma, prominent agitation during the recovery period and even respiratory depression in serious cases. Consequently, ketamine is clinically combined with propofol for anesthesia to reduce the side effects and the dose of ketamine required ( 18 ). Hayes et al ( 19 ) reported that children who were administered ketamine and propofol for anesthesia had a lower likelihood of being restless during the recovery period compared with those who received ketamine alone.…”

“…glossocoma, prominent agitation during the recovery period and even respiratory depression in serious cases. Consequently, ketamine is clinically combined with propofol for anesthesia to reduce the side effects and the dose of ketamine required (18).…”