Hemodynamic stability and patient satisfaction after anesthetic induction with thiopental sodium, ketamine, thiopental-fentanyl, and ketamine-fentanyl.
OBJECTIVE
To examine three commonly used anesthetic induction regimens (thiopental sodium, ketamine, and thiopental plus fentanyl) and one newly described regimen (ketamine plus fentanyl) with respect to hemodynamic stability and patient satisfaction.


METHODS
Randomized, double-blind study.


METHODS
University-affiliated Veterans Administration Hospital.


METHODS
Forty-eight ASA physical status I and II patients (47 males, 1 female) scheduled for surgery requiring general anesthesia.


METHODS
Patients were randomized to one of four groups to receive intravenous injections of thiopental 5 mg/kg (Group 1), ketamine 1.5 mg/kg (Group 2), thiopental 3 mg/kg plus fentanyl 4 to 6 micrograms/kg (Group 3), or ketamine 0.5 mg/kg plus fentanyl 4 to 6 micrograms/kg (Group 4) for induction of anesthesia.


RESULTS
Heart rate (HR) and mean arterial pressure (MAP) were measured during anesthetic induction. Evaluation of patient satisfaction/dissatisfaction and pleasantness/unpleasantness by the Anesthesia Experience Rating (AER) was carried out the day following surgery. Groups 3 and 4 showed the least increase from their baseline values in both HR and MAP after tracheal intubation, but only Group 4 exhibited no statistically significant change in hemodynamic parameters after induction but before intubation (p < 0.05). AER showed a higher level of pleasantness in Group 3 as compared with Group 2 (p < 0.03) and higher levels of satisfaction in Groups 3 (p < 0.03) and 4 (p < 0.02) as compared with Group 2.


CONCLUSIONS
The combination of ketamine plus fentanyl provides superior hemodynamic stability with excellent patient satisfaction.
Katz
R I
RI
Department of Anesthesiology, State University of New York, Stony Brook 11794-8480.
Lagasse
R S
RS
Levy
A
A
Alexander
G
G
D000771:Anesthesia, Intravenous; D001290:Attitude; D001794:Blood Pressure / Q000187:drug effects*; D002245:Carbon Dioxide / Q000378:metabolism; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology*; D006339:Heart Rate / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D017060:Patient Satisfaction; D013874:Thiopental / Q000008:administration & dosage / Q000494:pharmacology*; D013990:Tidal Volume; D013997:Time Factors
D004338:Drug Combinations; D002245:Carbon Dioxide; D007649:Ketamine; D013874:Thiopental; D010100:Oxygen; D005283:Fentanyl