Effectiveness of ketofol versus propofol induction on hemodynamic profiles in adult elective surgical patients: A Randomized Controlled Trial

Abstract

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

Ketofol as induction agent in diabetic patients.

“…Ketofol in ratio 1:1, 1:2 has been used in some studies as induction agent in patients undergoing laparotomy or laproscopic surgery and better hemodynamic stability was observed in the group receiving combination of drug. 11,12,13 Smichney NJ et al performed a study in critically ill pts requiring intubation and they compared propofol and ketofol as induction agent in these pts the results were similar to our study i.e. hemodynamic stability in ketofol group while hypotension and bradycardia in propofol group.…”

Comparison of Hemodynamic Effect of Propofol and Ketofol during Induction of Anaesthesia in General Surgery Patients

“…4 However, the Hemodynamic instability poses a significant challenge during anesthesia and surgery, often arising from the stresses of intubation, surgical incisions, and the administration of anesthetic drugs. 5 This issue is especially common among patients with heart conditions and older adults. 5,6 Hemodynamic disturbances are frequently seen during the start and end of anesthesia.…”

“…5 This issue is especially common among patients with heart conditions and older adults. 5,6 Hemodynamic disturbances are frequently seen during the start and end of anesthesia. Low blood pressure is a common occurrence when propofol is used for anesthesia induction, leading to a notable drop in blood pressure, particularly in patients with high blood pressure.…”

ACVIM Consensus Statement on the management of status epilepticus and cluster seizures in dogs and cats

“…This effect was further supported in clinical studies in humans when ketamine was administered concurrently with propofol (a combination known as ketofol). Ketofol can lead to improved hemodynamics and respiratory function compared to propofol alone 155‐157 . In a clinical study in humans with refractory SE, ketofol was successful in terminating seizure activity.…”

“…Ketofol can lead to improved hemodynamics and respiratory function compared to propofol alone. 155 , 156 , 157 In a clinical study in humans with refractory SE, ketofol was successful in terminating seizure activity. In the same study, it was reported that the short‐term or prolonged infusion of ketamine, with or without propofol infusion, was also effective in controlling super‐refractory SE.…”