The effects of propofol-midazolam-ketamine co-induction on hemodynamic changes and catecholamine response

被引:12
|
作者
Abbasivash, Rahman [1 ]
Aghdashi, Mir Moosa [1 ]
Sinaei, Behzad [1 ]
Kheradmand, Fatemeh [2 ]
机构
[1] Urmia Univ Med Sci, Imam Khomeini Hosp, Dept Anesthesiol, Orumiyeh, Iran
[2] Urmia Univ Med Sci, Fac Med, Dept Biochem, Ctr Cellular & Mol Res, Orumiyeh, Iran
关键词
Etomidate hemodynamics; Ketamine hemodynamics; Midazolam; Propofol; EMERGENCY-DEPARTMENT; PROCEDURAL SEDATION; KETOFOL; INTUBATION; PARAMETERS; ANESTHESIA; ANALGESIA; INSERTION; TRIAL;
D O I
10.1016/j.jclinane.2014.05.014
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
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. (C) 2014 Elsevier Inc. All rights reserved.
引用
收藏
页码:628 / 633
页数:6
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