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Effect of Etomidate Versus Combination of Propofol-Ketamine and Thiopental-Ketamine on Hemodynamic Response to Laryngoscopy and Intubation: A Randomized Double Blind Clinical Trial.

Gholipour Baradari A, Firouzian A, Zamani Kiasari A, Aarabi M, Emadi SA, Davanlou A, Motamed N, Yousefi Abdolmaleki E - Anesth Pain Med (2016)

Bottom Line: In addition, the main effect of MAP and HR were statistically significant during the course of study (P < 0.05).Combination of propofol-ketamine had superior hemodynamic stability compared to other induction agents.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.

ABSTRACT

Background: Laryngoscopy and intubation frequently used for airway management during general anesthesia, is frequently associated with undesirable hemodynamic disturbances.

Objectives: 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.

Patients and 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.

No MeSH data available.


Related in: MedlinePlus

MAP and HR Changes During the Study in the Three Treatment Groups (Mean and 95% CI)
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fig26029: MAP and HR Changes During the Study in the Three Treatment Groups (Mean and 95% CI)

Mentions: Figures 2 and 3 show changes in SBP, DBP and MAP as well as HR during the study period in different treatment groups. A repeated measurement ANOVA with a Huynh-Feldt correction test showed significant changes in mean SBP and DBP between the time points, (F (2.541, 297.354) = 15.228, P-value < 0.0001) and (F (2.539, 297.054) = 27.654, P-value < 0.0005), respectively. In addition, the main effect of MAP and HR, corrected by Huynh-Feldt, were statistically significant during the course of study, (F (2.586, 302.611) = 27.894, P-value < 0.0005) and (F (2.770, 324.069) = 7.36, P-value < 0.0005), respectively. Furthermore, after induction of anesthesia, the three study groups had significant different SBP, DBP and MAP changes overtime, (F (5.083, 297.354) = 12.085, P-value < 0.0005), (F (5.078, 297.054) = 5.413, P-value < 0.0005) and (F (5.173, 302.611) = 9.057, P-value < 0.0005), respectively. However, HR changes overtime were not statistically significant (F (5.540, 324.069) = 21.13, P-value = 0.065).


Effect of Etomidate Versus Combination of Propofol-Ketamine and Thiopental-Ketamine on Hemodynamic Response to Laryngoscopy and Intubation: A Randomized Double Blind Clinical Trial.

Gholipour Baradari A, Firouzian A, Zamani Kiasari A, Aarabi M, Emadi SA, Davanlou A, Motamed N, Yousefi Abdolmaleki E - Anesth Pain Med (2016)

MAP and HR Changes During the Study in the Three Treatment Groups (Mean and 95% CI)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834424&req=5

fig26029: MAP and HR Changes During the Study in the Three Treatment Groups (Mean and 95% CI)
Mentions: Figures 2 and 3 show changes in SBP, DBP and MAP as well as HR during the study period in different treatment groups. A repeated measurement ANOVA with a Huynh-Feldt correction test showed significant changes in mean SBP and DBP between the time points, (F (2.541, 297.354) = 15.228, P-value < 0.0001) and (F (2.539, 297.054) = 27.654, P-value < 0.0005), respectively. In addition, the main effect of MAP and HR, corrected by Huynh-Feldt, were statistically significant during the course of study, (F (2.586, 302.611) = 27.894, P-value < 0.0005) and (F (2.770, 324.069) = 7.36, P-value < 0.0005), respectively. Furthermore, after induction of anesthesia, the three study groups had significant different SBP, DBP and MAP changes overtime, (F (5.083, 297.354) = 12.085, P-value < 0.0005), (F (5.078, 297.054) = 5.413, P-value < 0.0005) and (F (5.173, 302.611) = 9.057, P-value < 0.0005), respectively. However, HR changes overtime were not statistically significant (F (5.540, 324.069) = 21.13, P-value = 0.065).

Bottom Line: In addition, the main effect of MAP and HR were statistically significant during the course of study (P < 0.05).Combination of propofol-ketamine had superior hemodynamic stability compared to other induction agents.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Faculty of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.

ABSTRACT

Background: Laryngoscopy and intubation frequently used for airway management during general anesthesia, is frequently associated with undesirable hemodynamic disturbances.

Objectives: 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.

Patients and 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.

No MeSH data available.


Related in: MedlinePlus