Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial

Abstract

Background We aimed to compare the hemodynamic effect of two ratios of propofol and ketamine (ketofol), namely 1:1 and 1:3 ratios, in rapid-sequence induction of anesthesia for emergency laparotomy. Methods This randomized controlled study included adult patients undergoing emergency laparotomy under general anesthesia. The patients were randomized to receive either ketofol ratio of 1:1 (n = 37) or ketofol ratio of 1:3 (n = 37). Hypotension (mean arterial pressure < 70 mmHg) was managed by 5-mcg norepinephrine. The primary outcome was total norepinephrine requirements during the postinduction period. Secondary outcomes included the incidence of postinduction hypotension, and the intubation condition (excellent, good, or poor). Results Thirty-seven patients in the ketofol-1:1 and 35 patients in the ketofol 1:3 group were analyzed. The total norepinephrine requirement was less in the ketofol-1:1 group than in the ketofol-1:3 group, P-values: 0.043. The incidence of postinduction hypotension was less in the ketofol-1:1 group (4 [12%]) than in ketofol-1:3 group (12 [35%]), P-value 0.022. All the included patients had excellent intubation condition. Conclusion In patients undergoing emergency laparotomy, the use of ketofol in 1:1 ratio for rapid-sequence induction of anesthesia was associated with less incidence of postinduction hypotension and vasopressor consumption in comparison to the 1:3 ratio with comparable intubation conditions. Clinical trial registration NCT05166330. URL: https://clinicaltrials.gov/ct2/show/NCT05166330.

Comparison of Hemodynamic Effect of Propofol and Ketofol during Induction of Anaesthesia in General Surgery Patients

“…The proportion of males was 76% in the propofol group and 66% in the ketofol group, while the proportion of females was 24% in the propofol group and 34% in the ketofol group. 13 In this study regarding ASA status, ASA-I was observed in 81.3% cases while ASA-II was observed in 18.7% patients. The findings from previous study by Hailu S et al 5 indicated that the mean age of participants in both the ketofol group 38.16 and the propofol group 36.23 years was comparable.…”

“…Comparatively Qureshi BQ et al 16 reported that a total of 179 patients underwent procedural sedation and analgesia (PSA) using a combination of Ketamine and Propofol and among them, males were 57.0% and females were 43.0%, with an overall mean age of 3.91 ± 2.80 years. According to another study Elsherbiny M et al 13 also reported that the mean age of the patients in Propofol group was 41+15 years and in Ketofol group was 44+16 years. The proportion of males was 76% in the propofol group and 66% in the ketofol group, while the proportion of females was 24% in the propofol group and 34% in the ketofol group.…”

“…Although ketofol has gained recent usage for procedural sedation in various settings such as the operating theater, emergency department, and for critically ill patients in the ICU, there exists a scarcity of reports directly comparing its effectiveness with propofol for anesthesia induction in elective surgeries. 5 Furthermore, given the existing literature's indication of the necessity for additional research to develop the more conclusive evidence, [13][14][15] and the lack of sufficient national data, this study aims to investigate the comparative hemodynamic effects of propofol and ketofol during induction in patients undergoing general surgery.…”