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Hemodynamic Responses to Two Different Anesthesia Regimens in Compromised Left Ventricular Function Patients Undergoing Coronary Artery Bypass Graft Surgery: Etomidate-Midazolam Versus Propofol-Ketamine.

Aghdaii N, Ziyaeifard M, Faritus SZ, Azarfarin R - Anesth Pain Med (2015)

Bottom Line: The current study evaluated hemodynamic effects of propofol-ketamine mixture in comparison to etomidate-midazolam mixture during anesthesia induction.Two groups were compared for pain on injection and myoclonus, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Cardiac Index (CI) and Systemic Vascular Resistance (SVR), before and one minute after induction of anesthesia, and one, three and five minutes after intubation.The hemodynamic response was similar in the two groups for all variables over the time interval, except for CI at one and three minutes after intubation (P = 0.024 and P = 0.048, respectively), and SVR in five minutes after intubation (P = 0.009), with differences being statistically significant.

View Article: PubMed Central - PubMed

Affiliation: Rajaie Cardiovascular Medical Research Center, Iran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Various methods have been suggested to prevent hemodynamic instability caused by propofol and adverse effects caused by etomidate induction. The current study evaluated hemodynamic effects of propofol-ketamine mixture in comparison to etomidate-midazolam mixture during anesthesia induction.

Objectives: The aim of this study was to evaluate the hemodynamic effects of etomidate-midazolam by comparing it with propofol-ketamine for the induction of anesthesia in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery.

Patients and methods: One-hundred patients aged between 40 and 65 with coronary artery disease and low ejection fraction scheduled for elective coronary artery bypass surgery participated in this study. The patients were randomly allotted to one of the two groups to receive either propofol-ketamine or etomidate-midazolam combination. Two groups were compared for pain on injection and myoclonus, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Cardiac Index (CI) and Systemic Vascular Resistance (SVR), before and one minute after induction of anesthesia, and one, three and five minutes after intubation.

Results: Incidence of pain on injection (2 - 4%) and myoclonus (10%) was less in both groups. The hemodynamic response was similar in the two groups for all variables over the time interval, except for CI at one and three minutes after intubation (P = 0.024 and P = 0.048, respectively), and SVR in five minutes after intubation (P = 0.009), with differences being statistically significant.

Conclusions: Both anesthetic regimens were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction undergoing coronary artery bypass graft surgery.

No MeSH data available.


Related in: MedlinePlus

Systemic Vascular Resistance at Various Time Intervals in the Etomidate-Midazolam and Propofol-Ketamine GroupAbbreviations: Group EM, Etomidate-Midazolam group; Group PK, Propofol-Ketamine group; SVR, systemic vascular resistance; T0, before induction of anesthesia (baseline); T1, one minute after induction; T2, one minute after intubation; T3, three minutes after intubation; and T4, five minutes after intubation.
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fig20210: Systemic Vascular Resistance at Various Time Intervals in the Etomidate-Midazolam and Propofol-Ketamine GroupAbbreviations: Group EM, Etomidate-Midazolam group; Group PK, Propofol-Ketamine group; SVR, systemic vascular resistance; T0, before induction of anesthesia (baseline); T1, one minute after induction; T2, one minute after intubation; T3, three minutes after intubation; and T4, five minutes after intubation.

Mentions: Changes in HR, SBP, MAP and DBP were not statistically significant at different time intervals between the two groups. There was a significant decrease from the baseline in heart rate (P = 0.001 in each group), systolic, diastolic and mean arterial pressure (P = 0.001 in each group), after induction in the two groups. All of these variables increased near baseline one minute after intubation, while heart rate increased above baseline one minute after intubation. However, intergroup comparison revealed no changes in these variables during this period (Table 2, Figure 1). We were able to measure CI and SVR in 17 patients from each group. There was a significant decrease in CI from baseline (P = 0.001 in each group) after induction and then a significant increase after intubation (P = 0.001 in each group) to above baseline, which was more prominent in the PK group (Table 3) (Figure 2). Increases in CI were significantly different at one and three minutes after intubation (T2, T3) between the two groups (P = 0.024 for T2 and P = 0.048 for T3). There was a significant decrease from baseline in SVR at different time intervals in both groups (P = 0.001 in each group). Intragroup comparison revealed that there was no significant change in SVR during induction and one and three minutes after intubation, however there was a significant decrease in SVR five minutes after intubation (P = 0.009) (Table 3, Figure 3).


Hemodynamic Responses to Two Different Anesthesia Regimens in Compromised Left Ventricular Function Patients Undergoing Coronary Artery Bypass Graft Surgery: Etomidate-Midazolam Versus Propofol-Ketamine.

Aghdaii N, Ziyaeifard M, Faritus SZ, Azarfarin R - Anesth Pain Med (2015)

Systemic Vascular Resistance at Various Time Intervals in the Etomidate-Midazolam and Propofol-Ketamine GroupAbbreviations: Group EM, Etomidate-Midazolam group; Group PK, Propofol-Ketamine group; SVR, systemic vascular resistance; T0, before induction of anesthesia (baseline); T1, one minute after induction; T2, one minute after intubation; T3, three minutes after intubation; and T4, five minutes after intubation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493732&req=5

fig20210: Systemic Vascular Resistance at Various Time Intervals in the Etomidate-Midazolam and Propofol-Ketamine GroupAbbreviations: Group EM, Etomidate-Midazolam group; Group PK, Propofol-Ketamine group; SVR, systemic vascular resistance; T0, before induction of anesthesia (baseline); T1, one minute after induction; T2, one minute after intubation; T3, three minutes after intubation; and T4, five minutes after intubation.
Mentions: Changes in HR, SBP, MAP and DBP were not statistically significant at different time intervals between the two groups. There was a significant decrease from the baseline in heart rate (P = 0.001 in each group), systolic, diastolic and mean arterial pressure (P = 0.001 in each group), after induction in the two groups. All of these variables increased near baseline one minute after intubation, while heart rate increased above baseline one minute after intubation. However, intergroup comparison revealed no changes in these variables during this period (Table 2, Figure 1). We were able to measure CI and SVR in 17 patients from each group. There was a significant decrease in CI from baseline (P = 0.001 in each group) after induction and then a significant increase after intubation (P = 0.001 in each group) to above baseline, which was more prominent in the PK group (Table 3) (Figure 2). Increases in CI were significantly different at one and three minutes after intubation (T2, T3) between the two groups (P = 0.024 for T2 and P = 0.048 for T3). There was a significant decrease from baseline in SVR at different time intervals in both groups (P = 0.001 in each group). Intragroup comparison revealed that there was no significant change in SVR during induction and one and three minutes after intubation, however there was a significant decrease in SVR five minutes after intubation (P = 0.009) (Table 3, Figure 3).

Bottom Line: The current study evaluated hemodynamic effects of propofol-ketamine mixture in comparison to etomidate-midazolam mixture during anesthesia induction.Two groups were compared for pain on injection and myoclonus, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Cardiac Index (CI) and Systemic Vascular Resistance (SVR), before and one minute after induction of anesthesia, and one, three and five minutes after intubation.The hemodynamic response was similar in the two groups for all variables over the time interval, except for CI at one and three minutes after intubation (P = 0.024 and P = 0.048, respectively), and SVR in five minutes after intubation (P = 0.009), with differences being statistically significant.

View Article: PubMed Central - PubMed

Affiliation: Rajaie Cardiovascular Medical Research Center, Iran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Various methods have been suggested to prevent hemodynamic instability caused by propofol and adverse effects caused by etomidate induction. The current study evaluated hemodynamic effects of propofol-ketamine mixture in comparison to etomidate-midazolam mixture during anesthesia induction.

Objectives: The aim of this study was to evaluate the hemodynamic effects of etomidate-midazolam by comparing it with propofol-ketamine for the induction of anesthesia in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery.

Patients and methods: One-hundred patients aged between 40 and 65 with coronary artery disease and low ejection fraction scheduled for elective coronary artery bypass surgery participated in this study. The patients were randomly allotted to one of the two groups to receive either propofol-ketamine or etomidate-midazolam combination. Two groups were compared for pain on injection and myoclonus, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Cardiac Index (CI) and Systemic Vascular Resistance (SVR), before and one minute after induction of anesthesia, and one, three and five minutes after intubation.

Results: Incidence of pain on injection (2 - 4%) and myoclonus (10%) was less in both groups. The hemodynamic response was similar in the two groups for all variables over the time interval, except for CI at one and three minutes after intubation (P = 0.024 and P = 0.048, respectively), and SVR in five minutes after intubation (P = 0.009), with differences being statistically significant.

Conclusions: Both anesthetic regimens were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction undergoing coronary artery bypass graft surgery.

No MeSH data available.


Related in: MedlinePlus