Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine

Abstract

OBJECTIVEThe aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.INTRODUCTIONAnesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting surgery is both the attenuation of sympathetic responses to noxious stimuli and the prevention of hypotension.METHODSThirty patients undergoing coronary artery bypass grafting surgery were randomized to receive either ketamine 2 mg.kg−1 (Group K) or propofol 0.5 mg.kg−1 (Group P) during induction of anesthesia. Patients also received standardized doses of midazolam, fentanyl, and rocuronium in the induction sequence. The duration of anesthesia from induction to skin incision and sternotomy, as well as the supplemental doses of fentanyl and sevoflurane, were recorded. Heart rate, mean arterial pressure, central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index, systemic and pulmonary vascular resistance indices, stroke work index, and left and right ventricular stroke work indices were obtained before induction of anesthesia; one minute after induction; one, three, five, and ten minutes after intubation; one minute after skin incision; and at one minute after sternotomy.RESULTSThere were significant changes in the measured and calculated hemodynamic variables when compared to their values before induction. One minute after induction, mean arterial pressure and the systemic vascular resistance index decreased significantly in group P (p<0.01).CONCLUSIONThere were no differences between groups in the consumption of sevoflurane or in the use of additional fentanyl. The combination of ketamine, midazolam, and fentanyl for the induction of anesthesia provided better hemodynamic stability during induction and until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.

Cardiology in Brazilian scientific journals: an overview

“…Anesthesiology for thoracic surgery contributes 3 original research themes: Basagan-Mogol et al [57] evaluated the hemodynamic and analgesic effects of ketamine by prospectively comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in 30 patients undergoing coronary artery bypass grafting surgery. There were no differences between groups in the consumption of sevoflurane or in the use of additional fentanyl.…”

Hemodynamic Responses to Etomidate Versus Ketamine-Thiopental Sodium Combination for Anesthetic Induction in Coronary Artery Bypass Graft Surgery Patients with Low Ejection Fraction: A Double-Blind, Randomized, Clinical Trial

“…on the changes of hemodynamic variables. Basagan-Mogol et al, [5] in a study with aim to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing CABG surgery have been shown that in these patients, there were significant changes in the measured and calculated hemodynamic variables when compared to their values before induction. One minute after induction, MAP and the systemic vascular resistance (SVR) index decreased significantly in patients who received propofol and the combination of ketamine, midazolam and fentanyl for the induction of anesthesia provided better hemodynamic stability during induction and until the end of sternotomy.…”

Administration of ketamine to children with pulmonary hypertension is safe: pro‐con debate

“…Second, although some have argued that studies carried out utilizing the natural airway and spontaneous ventilation are flawed due to hypoventilation, this argument cannot be consistently supported. Elevations of PAP and PVR have been observed in subjects with spontaneous ventilation of room air through a natural airway with documented normal blood gases (15,16,21,24) as well as in those with supported ventilation and oxygen administration (18)(19)(20).…”

“…Published reviews of the anesthetic management of patients with PAH uniformly emphasize strategies that optimize cardiac function and reduce PVR but authors differ in their opinions whether ketamine helps attain those goals. Fischer et al (19) stated ketamine increases PVR in adults but was little changed in children. Two reviews considered ketamine administration controversial (7,20) and three others regarded it safe or an agent of choice (15,21,22).…”