Background: Most of the time propofol and ketamine have been used as an induction agent in adult surgical patients but propofol may cause cardiorespiratory depression while ketamine increases heart rate and arterial blood pressure. On the other hand, the clinical effects of propofol and ketamine seem to be complementary. Ketofol is most commonly used for procedural sedation hence exploring its effectiveness for induction will be paramount for the clinical care of surgical patients. Objective: This study aims to compare the hemodynamic changes between ketofol and propofol within 30 min after induction of general anesthesia for elective surgical patients. Methodology: A Double-blind Randomized Controlled Trial was done on 62 patients aged between 18 and 65 years and the American Society of Anesthesiologist class I & II those have been allocated randomly into ketofol and propofol groups. A change in systolic blood pressure, mean arterial pressure, and heart rate within 30mins was followed for both groups. After the normal distribution of data was tested analytic statistics were calculated for variables in the study using Mixed ANOVA, Independent samples T-test, and Mann Whitney U test as appropriate, and for categorical data Chi-square test or fisher's exact test was used for analysis. P-value < 0.05 is considered statistically significant with a power of 90%. Results: Both the mean systolic blood pressure and mean arterial pressure were significantly decreased in the propofol group immediately after induction, at 5th minute, 10th minute, and 15th minute compared to the baseline value with a statistically significant value of (p < 0.05). There was a significant increase in mean heart rate in the ketofol group immediately after induction and on the 5th minute after induction compared to the baseline value (p = 0.001 and p = 0.022 respectively). Conclusion and recommendations: We conclude the administration of ketofol (0.75 mg/kg of ketamine and 1.5 mg/kg of propofol) for induction of general anesthesia has better hemodynamic stability than propofol during the first 30 min after induction. We recommend to researchers to do further randomize controlled trials, with invasive blood pressure measurement and multicenter study. Highlights
Patients with congestive heart failure have a high risk of perioperative major adverse cardiac events and death. The major perioperative goal of management in patients with low ejection fraction is maintaining hemodynamic stability. Evidence is scarce on the safety of a certain anesthetic technique for patients with heart failure. In this report, we present a 48-year-old man with ischemic dilated cardiomyopathy and low-output congestive heart failure (estimated ejection fraction of 27%) who underwent emergent below-knee amputation under selective spinal anesthesia without any apparent complications. We believe that selective spinal anesthesia can be a useful alternative anesthetic technique in patients with low ejection fraction undergoing emergent lower limb surgery. We showed evidencebased and customized anesthetic management of a high-risk patient with the available equipment and resources. This report will hopefully show the contextual challenges of the perioperative care of critically ill patients in resource-constrained settings.
Background Due to their advanced age and the prevalence of numerous co-morbid conditions, elderly patients scheduled for surgery are at risk for preoperative ECG abnormalities. Although preoperative ECG is frequently used to identify cardiovascular diseases and reduce intraoperative morbidity and mortality, its impact in predicting perioperative cardiovascular complications is under debate. Objective The aim of this study was to determine the impact of preoperative abnormal ECG on anesthesia management among older surgical patients in southern Ethiopia, 2022. Method ology: A multicenter prospective observational study on 246 elderly surgical patients recruited consecutively was conducted at three teaching hospitals in southern Ethiopia. Data were entered into Epidata version 4.6, then exported and analyzed in STATA version 16. The data was presented in the appropriate manner, using numbers, frequencies, tables, charts, and figures. To test categorical variables, the Chi-square test was used. P-values of 0.05 were considered statistically significant. Result In this study, 120 (48.78%) of older surgical patients had abnormal preoperative ECGs. In terms of severity, 55.3% were classified as minor, while 44.16% were major ECG abnormalities. 26 (21.66%) of patients with abnormal ECG were decided as unfit for anesthesia and reasons for the decision were the need for further investigation, consultation, and optimization. In addition, 7.31% of patients were delayed due to an abnormal ECG with a mean operative delay of 4.23 days. Preoperative abnormal ECG influenced the decision of anesthesia plan in four (1.62%) of the cases. Patients with an abnormal ECG prior to surgery were more likely to experience an intraoperative arrhythmia (p-value = 0.001). Conclusion and recommendation: Almost half (48.78%) of elderly patients presenting for surgery have an abnormal ECG, which impacts patients by postponing surgery and necessitating further investigation. Preoperative ECG is recommended prior to any elective surgery as early as 50 years, especially for those with risk factors. Highlights
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