Ketamine, but not priming, improves intubating conditions during a propofol-rocuronium induction.
OBJECTIVE
Both ketamine and priming may shorten the onset time of rocuronium. This study investigates the effects of ketamine and priming as components of a propofol induction on intubating conditions and onset of neuromuscular block.


METHODS
This prospective randomized double-blind study was performed in 120 American Society of Anesthesiologists (ASA) I-II patients who were assigned to one of four groups of 30 patients each: control, priming, ketamine, and ketamine-priming. Ketamine 0.5 mg x kg(-1) or saline was given before priming and induction. Rocuronium 0.06 mg x kg(-1) or saline was injected 2 min before propofol 2.5 mg x kg(-1). This was followed by rocuronium 0.6 mg x kg(-1) or by rocuronium 0.54 mg x kg(-1) if priming was given. Intubation was performed one minute later. Intubating conditions were graded as excellent, good, or poor. Heart rate, noninvasive blood pressure, and train-of-four (TOF) response were monitored.


RESULTS
Intubating conditions were graded excellent in 20% of the control group, 30% of the priming group, 47% of the ketamine group, and 57% of the ketamine-priming group. Analysis using forward stepwise regression indicated that ketamine improved intubating conditions (P = 0.001) but priming did not (P = 0.35). Time to reach a TOF count of zero was shortened by ketamine (P = 0.001) but not by priming (P = 0.94): 216 +/- 20 s in the control group, 212 +/- 27 s in the priming group, 162 +/- 18 s in the ketamine group, and 168 +/- 22 s in the ketamine-priming group.


CONCLUSIONS
A low-dose ketamine used with a propofol-rocuronium induction improved intubating conditions and shortened onset time. Priming did not influence intubating conditions or onset time.
Topcuoglu
Pelin Traje
PT
Department of Anaesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey.
Uzun
Sennur
S
Canbay
Ozgur
O
Pamuk
Gulsun
G
Ozgen
Saadet
S
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000732:Androstanols / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use; D015742:Propofol / Q000627:therapeutic use*; D011446:Prospective Studies; D012044:Regression Analysis; D000077123:Rocuronium; D013997:Time Factors; D055815:Young Adult
D000700:Analgesics; D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D007649:Ketamine; D000077123:Rocuronium; D015742:Propofol