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  • Title: The effects of propofol-midazolam-ketamine co-induction on hemodynamic changes and catecholamine response.
    Author: Abbasivash R, Aghdashi MM, Sinaei B, Kheradmand F.
    Journal: J Clin Anesth; 2014 Dec; 26(8):628-33. PubMed ID: 25439407.
    Abstract:
    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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