Hemodynamic Responses with Different Dose of Ketamine and Propofol in Day Care Gynecological Surgeries

Garg, Kamakshi; Grewal, Gurpreeti; Grewal, Anju; Singh, Avtar; Mishra, Atul; Nar, Amandeep Singh; Bawa, Ashvind

doi:10.7860/jcdr/2013/6860.3607

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…The anesthesia literature does offer data suggesting that the stimulant effects of higher‐dose ketamine may counterbalance any deleterious impacts from sedation 30 . Anesthesia literature similarly supports the notion that the hemodynamic impacts of etomidate are stable across the range of etomidate doses typically used in clinical practice 31 .…”

Section: Discussionmentioning

confidence: 93%

Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study

April

Araña

Schauer

et al. 2020

Academic Emergency Medicine

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Background: The hemodynamic impact of induction agents is a critically important consideration in emergency intubations. We assessed the relationship between peri-intubation hypotension and the use of ketamine versus etomidate as an induction agent for emergency department (ED) intubation. Methods: We analyzed ED intubation data for patients aged >14 years from the National Emergency Airway Registry performed in 25 EDs during 2016 through 2018. We excluded patients with preintubation hypotension (systolic blood pressure <100 mm Hg) or cardiac arrest prior to intubation. The primary outcome was periintubation hypotension. Secondary outcomes included interventions for hypotension (e.g., intravenous fluids or vasopressors). We report adjusted odds ratios (aOR) from multivariable logistic regression models controlling for patient demographics, difficult airway characteristics, and intubation modality. Results: There were 738 encounters with ketamine and 6,068 with etomidate. Patients receiving ketamine were more likely to have difficult airway characteristics (effect size difference = 8.8%, 95% confidence interval [CI] = 5.3% to 12.4%) and to undergo intubation with video laryngoscopy (8.1%, 95% CI = 4.4% to 12.0%). Periintubation hypotension incidence was 18.3% among patients receiving ketamine and 12.4% among patients receiving etomidate (effect size difference = 5.9%, 95% CI = 2.9% to 8.8%). Patients receiving ketamine were more likely to receive treatment for peri-intubation hypotension (effect size difference = 6.5%, 95% CI = 3.9% to 9.3%). In logistic regression analyses, patients receiving ketamine remained at higher risk for peri-intubation hypotension (aOR = 1.4, 95% CI = 1.2 to 1.7) and treatment for hypotension (aOR = 1.8, 95% CI = 1.4 to 2.0). There was no difference in the aOR of hypotension between patients receiving ketamine at doses ≤1.0 mg/kg versus >1.0 mg/kg or patients receiving etomidate at doses ≤0.3 mg/kg versus >0.3 mg/kg. Conclusions: Pending additional data, our results suggest that clinicians should not necessarily prioritize ketamine over etomidate based on concern for hemodynamic compromise among ED patients undergoing intubation.

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Section: Discussionmentioning

confidence: 93%

Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study

April

Araña

Schauer

et al. 2020

Academic Emergency Medicine

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“…In a study by Garg et al aimed to evaluate hemodynamic effects of different doses of propofol, ketamine and their combination as induction agents in ambulatory gynecological surgeries, combination of 1 mg/kg Propofol and 1 mg/kg Ketamine produced better hemodynamic stability ( 18 ). Saleem et al showed that ketamine-propofol combination provides superior hemodynamic stability compared to propofol-thiopental combination during anesthesia induction, laryngoscopy and tracheal intubation ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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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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Hemodynamic Responses with Different Dose of Ketamine and Propofol in Day Care Gynecological Surgeries

Cited by 5 publications

References 11 publications

Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study

Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study

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

Intubation of the Neurologically Injured Patient

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