Effect of Etomidate Versus Combination of Propofol-Ketamine and Thiopental-Ketamine on Hemodynamic Response to Laryngoscopy and Intubation: A Randomized Double Blind Clinical Trial

Abstract

Background:Laryngoscopy and intubation frequently used for airway management during general anesthesia, is frequently associated with undesirable hemodynamic disturbances.Objectives:The aim of this study was to compare the effects of etomidate, combination of propofol-ketamine and thiopental-ketamine as induction agents on hemodynamic response to laryngoscopy and intubation.Patients and Methods:In a double blind, randomized clinical trial a total of 120 adult patients of both sexes, aged 18 - 45 years, scheduled for elective surgery under general anesthesia were randomly assigned into three equally sized groups. Patients in group A received etomidate (0.3 mg/kg) plus normal saline as placebo. Patients in group B and C received propofol (1.5 mg/kg) plus ketamine (0.5 mg/kg) and thiopental sodium (3 mg/kg) plus ketamine (0.5 mg/kg), respectively for anesthesia induction. Before laryngoscopy and tracheal intubation, immediately after, and also one and three minutes after the procedures, hemodynamic values (SBP, DBP, MAP and HR) were measured.Results:A repeated measurement ANOVA showed significant changes in mean SBP and DBP between the time points (P < 0.05). In addition, the main effect of MAP and HR were statistically significant during the course of study (P < 0.05). Furthermore, after induction of anesthesia, the three study groups had significantly different SBP, DBP and MAP changes overtime (P < 0.05). However, HR changes over time were not statistically significant (P > 0.05). Combination of propofol-ketamine had superior hemodynamic stability compared to other induction agents.Conclusions:Combination of propofol-ketamine may be recommended as an effective and safe induction agent for attenuating hemodynamic responses to laryngoscopy and intubation with better hemodynamic stability. Although, further well-designed randomized clinical trials to confirm the safety and efficacy of this combination, especially in critically ill patients or patients with cardiovascular disease, are warranted.

Propofol Inhibits Lung Cancer A549 Cell Growth and Epithelial‐Mesenchymal Transition Process by Upregulation of MicroRNA-1284

“…Propofol is one of the most commonly used intravenous anesthetic agents and is widely used in various kinds of cancer resections due to its rapid onset and short duration of action 5 . Numerous studies have recently found that propofol is able to influence the cell proliferation, migration, and invasiveness of cancers, such as ovarian cancer 6 , breast cancer 7 , liver cancer 8 , and lung cancer 9 .…”

Emergency intubation outside operating room/intensive care unit settings: Are we following the recommendations for safe practice?

“…[ 33 ] Combination of ketamine and propofol (ketofol) is a popular combination with few studies reporting its efficacy. [ 34 35 ] Our survey found the use of propofol and ketamine in 44% of the respondents. Choice of induction agent is not uniform among respondents that are quite understandable due to heterogeneity in the patient population.…”

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

“…In spite of the potential benefits of using etomidate as an induction agent, one area of concern exists regarding its use in anesthesia. Researchers believe that etomidate could possibly lead to profound and persistent adrenocortical steroid synthesis [ 40 ]. However, the evidence surrounding this concern is conflicting, and the effect of a single bolus of etomidate on patient morbidity and mortality remains unclear [ 41 ].…”