The effects of propofol-midazolam-ketamine co-induction on hemodynamic changes and catecholamine response
Rahman Abbasivash1, Mir Moosa Aghdashi1, Behzad Sinaei1
1Department of Anesthesiology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
Study Objective:
To compare the clinical efficacy of co-induction with propofol-midazolam-ketamine with etomidate as the sole induction agent.
Design:
Prospective, double-blinded, randomized controlled trial.
Setting:
Operating room of a university hospital.
Patients:
60 ASA physical status 1 and 2 patients scheduled for limited elective surgery requiring general anesthesia.
Interventions:
Patients were randomized to two groups to receive etomidate 0.3 mg/kg (single-drug group) or propofol 0.6 mg/kg + ketamine 0.8 mg/kg + midazolam 0.06 mg/kg (three-drug group).
Measurements:
Hemodynamic responses (systolic and diastolic blood pressure, and mean arterial pressure) were examined at baseline and at one, three, and 5 minutes after tracheal intubation. Plasma catecholamine levels were measured at baseline, one, and 5 minutes after tracheal intubation.
Main Results:
Heart rate (HR) changes differed significantly between the two groups at three minutes (P = 0.01) and 5 minutes (P = 0.00) after tracheal intubation. However, the HR increase in the three-drug group was in the acceptable range. Percentage changes of epinephrine level differed between the two groups at 5 minutes after tracheal intubation (P = 0.03).
Conclusions:
The higher norepinephrine/epinephrine ratio noted in the single-drug group may be implicated in lower adrenal sympathetic activity. Propofol-midazolam-ketamine co-induction may be used instead of etomidate for anesthesia induction in patients with hemodynamic instability.
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