title: Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine.
abstract: OBJECTIVE
  The aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.
  
  
  BACKGROUND
  Anesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting surgery is both the attenuation of sympathetic responses to noxious stimuli and the prevention of hypotension.
  
  
  METHODS
  Thirty patients undergoing coronary artery bypass grafting surgery were randomized to receive either ketamine 2 mg.kg(-1) (Group K) or propofol 0.5 mg.kg(-1) (Group P) during induction of anesthesia. Patients also received standardized doses of midazolam, fentanyl, and rocuronium in the induction sequence. The duration of anesthesia from induction to skin incision and sternotomy, as well as the supplemental doses of fentanyl and sevoflurane, were recorded. Heart rate, mean arterial pressure, central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index, systemic and pulmonary vascular resistance indices, stroke work index, and left and right ventricular stroke work indices were obtained before induction of anesthesia; one minute after induction; one, three, five, and ten minutes after intubation; one minute after skin incision; and at one minute after sternotomy.
  
  
  RESULTS
  There were significant changes in the measured and calculated hemodynamic variables when compared to their values before induction. One minute after induction, mean arterial pressure and the systemic vascular resistance index decreased significantly in group P (p<0.01).
  
  
  CONCLUSIONS
  There were no differences between groups in the consumption of sevoflurane or in the use of additional fentanyl. The combination of ketamine, midazolam, and fentanyl for the induction of anesthesia provided better hemodynamic stability during induction and until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.
authors.affiliation: Uludag University School of Medicine, Department of Anesthesiology and Reanimation - Bursa, Turkey. basagan@uludag.edu.tr
authors.forename: Elif
authors.initials: E
authors.lastname: Basagan-Mogol
authors.forename: Suna
authors.initials: S
authors.lastname: Goren
authors.forename: Gulsen
authors.initials: G
authors.lastname: Korfali
authors.forename: Gurkan
authors.initials: G
authors.lastname: Turker
authors.forename: Fatma Nur
authors.initials: FN
authors.lastname: Kaya
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D056346:Sternotomy
chemical_list: D000700:Analgesics; D018686:Anesthetics, Intravenous; D007649:Ketamine; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol