Baradari AG, et al. – This study compared patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery, in terms of hemodynamic responses to etomidate versus a combination of ketamine and propofol (ketofol). According to findings, the reported hemodynamic stability provided by etomidate was superior to that offered by ketofol in patients with left ventricular dysfunction undergoing CABG surgery under general anesthesia.

Methods

• Researchers performed a double-blind randomized clinical study, wherein, they randomly assigned a total of 84 patients with ischemic left ventricular dysfunction (EF < 40%) to two groups (A and B).
• Patients in group A received etomidate 0.2 mg/kg and a placebo (normal saline); group B received a combination of ketamine (1 mg/kg) and propofol (1.5 mg/kg) at the induction of anesthesia.
• Two minutes after induction, they measured hemodynamic variables, including systolic, diastolic, mean arterial pressure (SAP, DAP, MAP) and heart rate (HR), immediately before and after the laryngoscopy, and before intubation and post-intubation at 1, 2, and 3 min.

Results

• Findings demonstrated that the decrease in all hemodynamic parameters (SBP, DBP, MAP and HR) from induction time to laryngoscopy was greater in the ketofol group (group B) than in the etomidate group (group A) (p < 0.05).
• According to results, the ephedrine prescription rate due to hemodynamic changes was 24.4% (10 patients) and 5% (2 patients) in group B and group A, respectively (p = 0.03).