title: The effects of propofol-midazolam-ketamine co-induction on hemodynamic changes and catecholamine response.
abstract: OBJECTIVE
  To compare the clinical efficacy of co-induction with propofol-midazolam-ketamine with etomidate as the sole induction agent.
  
  
  METHODS
  Prospective, double-blinded, randomized controlled trial.
  
  
  METHODS
  Operating room of a university hospital.
  
  
  METHODS
  60 ASA physical status 1 and 2 patients scheduled for limited elective surgery requiring general anesthesia.
  
  
  METHODS
  Patients were randomized to two groups to receive etomidate 0.3 mg/kg (single-drug group) or propofol 0.6 mg/kg + ketamine 0.8 mg/kg + midazolam 0.06 mg/kg (three-drug group).
  
  
  METHODS
  Hemodynamic responses (systolic and diastolic blood pressure, and mean arterial pressure) were examined at baseline and at one, three, and 5 minutes after tracheal intubation. Plasma catecholamine levels were measured at baseline, one, and 5 minutes after tracheal intubation.
  
  
  RESULTS
  Heart rate (HR) changes differed significantly between the two groups at three minutes (P = 0.01) and 5 minutes (P = 0.00) after tracheal intubation. However, the HR increase in the three-drug group was in the acceptable range. Percentage changes of epinephrine level differed between the two groups at 5 minutes after tracheal intubation (P = 0.03).
  
  
  CONCLUSIONS
  The higher norepinephrine/epinephrine ratio noted in the single-drug group may be implicated in lower adrenal sympathetic activity. Propofol-midazolam-ketamine co-induction may be used instead of etomidate for anesthesia induction in patients with hemodynamic instability.
authors.affiliation: Department of Anesthesiology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Rahman
authors.initials: R
authors.lastname: Abbasivash
authors.affiliation: Department of Anesthesiology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Mir Moosa
authors.initials: MM
authors.lastname: Aghdashi
authors.affiliation: Department of Anesthesiology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Behzad
authors.initials: B
authors.lastname: Sinaei
authors.affiliation: Department of Biochemistry, Center for Cellular and Molecular Research, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Electronic address: f_kheradmand@umsu.ac.ir.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Kheradmand
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D018681:Anesthetics, General / Q000008:administration & dosage / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004837:Epinephrine / Q000097:blood; D005045:Etomidate / Q000008:administration & dosage* / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006785:Hospitals, University; D006801:Humans; D007442:Intubation, Intratracheal; D007649:Ketamine / Q000008:administration & dosage* / Q000494:pharmacology; D008874:Midazolam / Q000008:administration & dosage* / Q000494:pharmacology; D009638:Norepinephrine / Q000097:blood; D015742:Propofol / Q000008:administration & dosage* / Q000494:pharmacology; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D018681:Anesthetics, General; D007649:Ketamine; D008874:Midazolam; D009638:Norepinephrine; D015742:Propofol; D004837:Epinephrine; D005045:Etomidate
keywords: Etomidate hemodynamics; Ketamine hemodynamics; Midazolam; Propofol