Ketamine as an alternative to midazolam co-induction to propofol: a comparative study
Keywords:
Combined anesthetic, Ketamine, Midazolam, PropofolAbstract
Background: Induction of anesthesia with propofol is known to produce systemic hypotension. Co-induction adds a small dose of other anesthetics to reduce the dose of induction agent to decrease hemodynamic disturbances. The aim of the study was to compare hemodynamic changes associated with Midazolam and ketamine as a co-induction agent with Propofol and to compare induction dose of Propofol following the co-induction.
Methods: Fifty adult patients undergoing elective surgery to be performed under general anesthesia were randomized to receive 0.3 mg/kg of Ketamine or 0.03 mg/kg of Midazolam intravenously as co-induction agent. A minute after administration of co-induction agent, anesthesia was induced with Propofol 40 mg bolus then 10 mg every 10 seconds until the loss of verbal response. The hemodynamic response at 0, 1, 2, 5 minutes respectively and the induction dose of Propofol were noted.
Results: The mean arterial pressure heart rates were significantly lower at 1, 2 and 5 minutes in midazolam group. However, mean arterial pressure and heart were within the physiological range in both the groups. Propofol dose requirement for induction between the two groups was similar (p>0.05) but co-induction significantly decreased the induction dose of Propofol as compared to standard recommended dose for induction.
Conclusion: Our study showed that hemodynamic variables were maintained within the physiological range with midazolam and ketamine co-induction. However, lesser degree of decrease in mean arterial pressure was seen with ketamine but the heart rate was higher. A similar reduction of induction dose of propofol was achieved with both the drugs.
References
2. Bryson HM, Fulton BR, Faulds D. Propofol: An update of its use in anesthesia and conscious sedation. Drugs 1995;50:513-59.
3. Cressy DM, Claydon P, Bhaskaran NC, Reilly CS. Effect of Midazolam pretreatment on induction dose requirement of Propofol in combination with Fentanyl in younger and older adults. Anesth 2001;56:108-13.
4. Tweed WA, Minuck MS, Mymin D. Circulatory response to Ketamine anesthesia. Anesthesiology 1972;37:613-9.
5. Collins LM, Conney CM, Fitzpatrick G. Propofol induction characteristics after Fentanyl or Midazolam and Fentanyl. Br J Anesth 1997;79:676-7.
6. Srivastava U, Sharma N, Kumar A, Saxena S. Small dose of Propofol or Ketamine as an alternative to Midazolam co induction to Propofol. Indian J Anaesth 2006;50:112-4.
7. Ong EL, Osborne GA. Ketamine for co-induction of anaesthesia in oral surgery. Ambulatory Surg 2001;9:131-5.
8. Asida SM. Midazolam co-induction in the elderly. El-Minia Med Bull 2004;15:300-7.
9. Hui TW, Short TG, Hong W, Suen T, Gin T, Plummer J. Additive interactions between Propofol and Ketamine when used for Anaesthesia induction in female patients. Anesthisology 1995;82:641-48.
10. Adachi YU, Uchihashi Y, Wetanab K, Satoh T. Small dose Midazolam or Droperidol reduces the hypnotic dose of Propofol at the induction of Anaesthesia. Euro J Anaesthesiol 2000;17:126-31.
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
