Comparison of a ketamine-propofol combination and etomidate for anaesthesia induction on haemodynamic parameters in patients undergoing coronary artery bypass grafting

Abstract

Objective: To compare the haemodynamic response of both a ketamine-propofol (ketofol) combination and etomidate for anaesthesia induction in patients undergoing coronary artery bypass grafting (CABG).
Methods: This randomised study was conducted in 120 patients (n = 60 for each group) who were scheduled for elective CABG surgery. Patients in group K received ketofol (a ketamine and propofol combination [1:1]) and group E received etomidate, until loss of verbal response. Baseline haemodynamic variables including heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI) and systemic vascular resistance (SVR) were measured for all patients at 1, 2 and 3 minutes post induction. Serum cortisol and blood sugar levels were also compared before induction, after cardiopulmonary bypass (CPB) and at 24 hours postoperatively.
Results: Statistically significant reduction occurred in HR, SAP, DAP and MAP from baseline until 3 minutes post induction in both groups (p < 0.001), but intergroup comparison was comparable. Maximum fall in CO and CI from baseline at 3 minutes were greater in group E than in group K (38.18% and 22.36%, and 34.16% and 19.86%, respectively). Maximum fall in SVR at 3 minutes post induction was greater in group K than in group E and was statistically significant (p < 0.05). Significant increase in cortisol levels occurred within group K from baseline until 24 hours postoperatively. Significant fall in serum cortisol levels occurred after weaning off CPB within group E, which returned to almost baseline at 24 hours. Blood glucose levels rose from baseline until 24 hours postoperatively in both groups, but peaked more in group K after weaning from CPB than in group E (p < 0.05).
Conclusion: We concluded that both ketofol and etomidate produced stable haemodynamics in patients undergoing CABG.