Haemodynamic stability and ketamine-alfentanil anaesthetic induction

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Ketamine is frequently used for anesthesia induction.
• Ketamine administration can commonly lead to hemodynamic instability, including increased heart rate and mean arterial pressure.
• Managing these hemodynamic changes is crucial for patient safety during anesthesia.

Purpose of the Study:

• To investigate the potential of alfentanil to obtund ketamine-induced hemodynamic instability.
• To evaluate the effect of varying alfentanil doses on cardiovascular responses during ketamine anesthesia.

Main Methods:

• A randomized study involving five groups of ASA I and II patients.
• Patients received ketamine 1 mg/kg intravenously, preceded by saline or alfentanil (10, 20, 30, or 40 mcg/kg).
• Heart rate, mean arterial pressure, and postoperative patient complaints were monitored.

Main Results:

• All groups exhibited increased heart rate and mean arterial pressure after ketamine administration.
• These increases were progressively attenuated with higher doses of alfentanil.
• Significant obtundation of heart rate and mean arterial pressure increases post-intubation was observed in groups receiving 20-40 mcg/kg of alfentanil compared to the saline group.

Conclusions:

• Ketamine at 1 mg/kg combined with alfentanil at 20-40 mcg/kg significantly mitigates hemodynamic instability.
• Alfentanil effectively obtunds the common cardiovascular responses to ketamine anesthesia.
• No significant postoperative patient dissatisfaction or dysphoria was reported with this combination.