Hemodynamic Responses to Etomidate Versus Ketamine-Thiopental Sodium Combination for Anesthetic Induction in Coronary Artery Bypass Graft Surgery Patients with Low Ejection Fraction: A Double-Blind, Randomized, Clinical Trial

Mr, Habibi; Ag, Baradari; Soleimani, Aria; Zeydi, Amir Emami; Hs, Nia; Habibi, Ali Faghih; Onagh, N

doi:10.7860/jcdr/2014/10237.5006

Cited by 21 publications

(35 citation statements)

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“…Anesthesia induction is one of the most critical periods in cardiac anesthesia, especially for patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery, who constitute a high-risk group [ 1 , 2 ]. Anesthetics often interfere with cardiovascular function through direct myocardial depression and/or altering cardiovascular control mechanisms [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Anesthesia induction is often accompanied by a period of hemodynamic instability, especially hypotension, which could be a significant problem in patients with compromised ventricular function, because these patients cannot tolerate such depression [ 3 , 4 ]. On the other hand, laryngoscopies and orotracheal intubations are potent noxious stimuli provoking untoward hemodynamic responses such as hypertension and tachycardia, which can be detrimental to patients with poor myocardial reserve [ 2 , 5 ]. Such variations in hemodynamic status may change the fine balance between myocardial oxygen demand and supply, thus accelerating myocardial ischemia in these patients.…”

Section: Introductionmentioning

confidence: 99%

“…Such variations in hemodynamic status may change the fine balance between myocardial oxygen demand and supply, thus accelerating myocardial ischemia in these patients. Therefore, preserving hemodynamic stability during anesthesia induction is critically important [ 2 , 3 , 6 ]. Numerous studies have evaluated the effects of a wide variety of induction agents and their combinations used to attain hemodynamic stability during anesthesia induction.…”

Section: Introductionmentioning

confidence: 99%

“…Numerous studies have evaluated the effects of a wide variety of induction agents and their combinations used to attain hemodynamic stability during anesthesia induction. However, there is no single anesthetic agent suitable for all patients [ 1 , 2 , 4 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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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

Baradari¹,

Alipour²,

Habibi³

et al. 2017

aoms

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Baradari¹,

Alipour²,

Habibi³

et al. 2017

aoms

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“…Although there is a regularly taught principle that ketamine will cause patients to become hypertensive and tachycardic, multiple studies have examined the use of ketamine for sedation and induction for RSI and found that ketamine, alone or in combination with other drugs, maintains hemodynamic neutrality without causing severe hypertensive or tachycardic responses (50,(57)(58)(59)(60)(61)(62)(63)(64).…”

Section: Resultsmentioning

confidence: 99%

Intubation of the Neurologically Injured Patient

Bucher

Koyfman

2015

The Journal of Emergency Medicine

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Comparison the Effect of Etomidate vs. Thiopentone on Left Ventricular Strain and Strain Rate at the Time of Anesthesia Induction in Patients Undergoing Elective Coronary Artery Bypass Surgery: A Randomized Double Blind Controlled Trial

Singh

Choudhury

et al. 2021

Journal of Cardiac Critical Care TSS

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Myocardial strain imaging with speckle tracking echocardiography (STE) is getting popularity because it does not depends on insonation angle and has shown good correlation with intraoperative and postoperative ventricular function in patients with coronary artery disease. The impact of thiopentone and etomidate induction on myocardial function was studied and compared on sixty patients undergoing elective coronary artery bypass grafting. Three loops for each views (apical 4 chamber, apical 2 chamber, and apical long axis ) were acquired at base line (T0) and 1 minute (T1) after induction for offline analysis. In Group T, significant increase in HR from the base line values (67.8 ± 13.8 vs 79.2 ± 15.6, p = 0.001) occurred post induction, where as in Group E it remain near to the base line (71.7 ± 8.3 vs 70.1± 8.9, p = 0.345). A reduction in mean arterial pressure (MAP) was noted in both the groups after the injection of the allocated drug. There was no significant difference in the index of contractility (ICON) (T0 vs T1: 48.7 ± 10.6 vs 47.0 ± 11.7, p = 0.120) in Group E where as in Group T there was a reduction in the ICON value (T0 vs T1: 45.0 ± 10.7 vs 41.0 ± 8.4, p = 0.005). A similar picture was also noted in systemic vascular resistance index. A significant decrease in cardiac index (CI) was seen in Group E (T0 vs T1: 2.7 ± 0.4 vs 2.5 ± 0.4, p = 0.027), however it remain near to the base line in Group T. There occurred no changes in stroke index (SI) in Group E (T0 vs T1: 38.7 ± 6 vs 37.0± 5.3, p = 0.134), where as a significant decrease was noted after injection of thiopental (T0 vs T1: 38.0 ± 6.2 vs 36.1± 4.9, p = 0.049). A significant decline in cardiac performance index (CPI) was also recorded in Group E (T0 vs T1: 0.57 ± 0.15 vs 0.52 ± 0.12, p = 0.032), and not in Group T. There was decrease in left ventricular ejection fraction (LVEF) after the injection of both the drugs (Group E, T0 vs T1: 57 ± 3.7 vs 54± 3.7, p= 0.001; and Group T, T0 vs T1: 57 ± 3.7 vs 54± 3.7, p = 0.001). In Group E, global longitudinal peak systolic strain (GLPSS) showed no change after the injection of the drug (T0 vs T1: −13.2 ± 2.2 vs −13.1± 2.3, p = 0.631). However, a significant decrease in GLPSS (T0 vs T1: −13.5 ± 1.5 vs – 10 ± 1.8, p = 0.001) after injection of thiopental. Longitudinal peak systolic strain rate (LPSSR) was significantly decreased in all echocardiographic views after the injection of respective drugs. However, the decrease in LPSSR was significantly less in Group E in comparison to Group T.To conclude, STE provides accurate and reliable real time quantitative regional and global LV assessment. Use of thiopentone for anesthesia induction is associated with more profound impairment of LV function in comparison to etomidate as assessed by a decreased longitudinal peak systolic strain rate and global longitudinal peak systolic strain. Further studies are warranted to understand the exact clinical impact, which may influence the choice of intravenous induction agent based upon preoperative patient characteristics.

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Hemodynamic Responses to Etomidate Versus Ketamine-Thiopental Sodium Combination for Anesthetic Induction in Coronary Artery Bypass Graft Surgery Patients with Low Ejection Fraction: A Double-Blind, Randomized, Clinical Trial

Cited by 21 publications

References 14 publications

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

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

Intubation of the Neurologically Injured Patient

Comparison the Effect of Etomidate vs. Thiopentone on Left Ventricular Strain and Strain Rate at the Time of Anesthesia Induction in Patients Undergoing Elective Coronary Artery Bypass Surgery: A Randomized Double Blind Controlled Trial

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