Hemodynamic Stability during Induction of Anesthesia in Elderly Patients: Propofol + Ketamine versus Propofol + Etomidate

Abstract

Introduction: Various methods have been recommended to prevent hemodynamic instability caused by propofol induction. Current study evaluates hemodynamic effects of ketamine and propofol in comparison to etomidate and propofol during anesthesia induction. Methods: Sixty-two patients over 50 years old undergoing elective surgeries were randomly assigned to ketamine + propofol (ketofol) (n=30) and etomidate + propofol (etofol) (n=32) groups. Patients in ketofol group were induced with ketamine 0.75 mg/kg and propofol 1 mg/kg. In etofol group, induction was performed with etomidate 0.2 mg/kg and propofol 1 mg/kg. Hemodynamic states before and after induction, first, third and sixth minutes after intubation were measured and compared between groups. Results: There was no difference between groups in systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SaO2). There was significant decrease in SAP, DAP and MAP after induction and 6 minutes after intubation and in HR after induction than values before induction. There was significant increase in SaO2 in all evaluated periods than before induction in etofol group; however, the difference in ketofol group was not significant. Conclusion: Both methods of induction -ketamine + propofol and etomidate + propofol- are effective in maintaining hemodynamic stability and preventing hemodynamic changes due to propofol administration.

Keywords: Ketamine, Etomidate, Intubation, Hemodynamic