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. 2016 Jan 10;6(1):e30071.
doi: 10.5812/aapm.30071. eCollection 2016 Feb.

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

Afshin Gholipour Baradari  1 , Abolfazl Firouzian  1 , Alieh Zamani Kiasari  1 , Mohsen Aarabi  2 , Seyed Abdollah Emadi  1 , Ali Davanlou  1 , Nima Motamed  3 , Ensieh Yousefi Abdolmaleki  4
Affiliations

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

Afshin Gholipour Baradari et al. Anesth Pain Med. .

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.

Keywords: Etomidate; Hemodynamics; Ketamine; Laryngoscopy; Propofol; Thiopental.

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Figures

Figure 1.
Figure 1.. Flow Diagram of the Study
Figure 2.
Figure 2.. SBP and DBP Changes During the Study in the Three Treatment Groups (Mean and 95% CI)
Figure 3.
Figure 3.. MAP and HR Changes During the Study in the Three Treatment Groups (Mean and 95% CI)
See this image and copyright information in PMC

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