Hemodynamic Responses to Two Different Anesthesia Regimens in Compromised Left Ventricular Function Patients Undergoing Coronary Artery Bypass Graft Surgery: Etomidate-Midazolam Versus Propofol-Ketamine

Nahid Aghdaii, Mohsen Ziyaeifard, Seyedeh Zahra Faritus, Rasoul Azarfarin, Nahid Aghdaii, Mohsen Ziyaeifard, Seyedeh Zahra Faritus, Rasoul Azarfarin

Abstract

Background: Various methods have been suggested to prevent hemodynamic instability caused by propofol and adverse effects caused by etomidate induction. The current study evaluated hemodynamic effects of propofol-ketamine mixture in comparison to etomidate-midazolam mixture during anesthesia induction.

Objectives: The aim of this study was to evaluate the hemodynamic effects of etomidate-midazolam by comparing it with propofol-ketamine for the induction of anesthesia in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery.

Patients and methods: One-hundred patients aged between 40 and 65 with coronary artery disease and low ejection fraction scheduled for elective coronary artery bypass surgery participated in this study. The patients were randomly allotted to one of the two groups to receive either propofol-ketamine or etomidate-midazolam combination. Two groups were compared for pain on injection and myoclonus, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Cardiac Index (CI) and Systemic Vascular Resistance (SVR), before and one minute after induction of anesthesia, and one, three and five minutes after intubation.

Results: Incidence of pain on injection (2 - 4%) and myoclonus (10%) was less in both groups. The hemodynamic response was similar in the two groups for all variables over the time interval, except for CI at one and three minutes after intubation (P = 0.024 and P = 0.048, respectively), and SVR in five minutes after intubation (P = 0.009), with differences being statistically significant.

Conclusions: Both anesthetic regimens were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction undergoing coronary artery bypass graft surgery.

Keywords: Combined-Anesthetics; Coronary Artery Bypass; Hemodynamics; Left Ventricular Dysfunction.

Figures

Figure 1.. Hemodynamic Parameters at Various Time…
Figure 1.. Hemodynamic Parameters at Various Time Intervals in the Etomidate-Midazolam and Propofol-Ketamine Group
Abbreviations: DBP, diastolic blood pressure; Group EM, Etomidate-Midazolam group; Group PK, Propofol-Ketamine group; SBP, systolic blood pressure; T0, before induction of anesthesia (baseline); T1, one minute after induction; T2, 1 minutes after intubation; T3, three minutes after intubation; and T4, five minutes after intubation.
Figure 2.. Cardiac Index at Various Time…
Figure 2.. Cardiac Index at Various Time Intervals in the Etomidate-Midazolam and Propofol-Ketamine Group
Abbreviations: CI, cardiac index; Group EM, etomidate-midazolam group; Group PK, Propofol-Ketamine group; T0, before induction of anesthesia (baseline); T1, one minute after induction; T2, one minute after intubation; T3, three minutes after intubation; and T4, five minutes after intubation.
Figure 3.. Systemic Vascular Resistance at Various…
Figure 3.. Systemic Vascular Resistance at Various Time Intervals in the Etomidate-Midazolam and Propofol-Ketamine Group
Abbreviations: Group EM, Etomidate-Midazolam group; Group PK, Propofol-Ketamine group; SVR, systemic vascular resistance; T0, before induction of anesthesia (baseline); T1, one minute after induction; T2, one minute after intubation; T3, three minutes after intubation; and T4, five minutes after intubation.

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Source: PubMed

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