Effect of Etomidate Versus Combination of Propofol-Ketamine and Thiopental-Ketamine on Hemodynamic Response to Laryngoscopy and Intubation: A Randomized Double Blind Clinical Trial.
BACKGROUND
Laryngoscopy and intubation frequently used for airway management during general anesthesia, is frequently associated with undesirable hemodynamic disturbances.


OBJECTIVE
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.


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.
Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
Afshin
A
Gholipour Baradari
Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
Abolfazl
A
Firouzian
Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
Alieh
A
Zamani Kiasari
Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Mohsen
M
Aarabi
Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
Seyed Abdollah
SA
Emadi
Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
Ali
A
Davanlou
Department of Community Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
Nima
N
Motamed
Faculty of Medicine, Ghaemshahr Razi Haspital, Mazandaran University of Medical Sciences, Sari, Iran.
Ensieh
E
Yousefi Abdolmaleki
Etomidate; Hemodynamics; Ketamine; Laryngoscopy; Propofol; Thiopental