Research Article

Comparison of Hemodynamic Responses to Ketofol versus Etomidate During Anesthesia Induction in Elderly Patients

Abstract

Background: Nausea While elderly patients are at an increased risk of perioperative morbidity and mortality; old age alone is not a contraindication for surgery. General factors that should be considered in preoperative risk assessments include age, functional status, cognition, nutritional status, and comorbidities, such as cardiac, pulmonary, renal, and endocrine disorders. Induction of anesthesia is a critical step in surgery, particularly for elderly patients and those with a high physical status. Commonly used drugs for this purpose include etomidate and propofol. Therefore, this study aimed to compare the impact of Ketofol versus etomidate alone on the hemodynamic status of patients who fall under the ASA class II or higher.
Methods: The study was a prospective randomized double-blind clinical trial, with a study population of age of ≥65 years, ASA physical status class II or higher, that were randomized into two groups. Ketofol (n=45) and, Etomidate (n=45) groups. Patients followed for clinical outcomes including their hemodynamic status during the induction period.
Results: The present study showed that, the examination of hemodynamic parameters up to 10 minute after laryngoscopy showed that none of these parameters were significantly different between the two groups, while immediately after anesthesia induction, heart rate and blood pressure were found to be significantly different. However, there was no significant difference in terms of SPO2 among the two groups in any given interval.
Conclusion: The results of the present study revealed that Ketofol resulted in better regulation and stability of blood pressure and heart rate in patients undergoing endotracheal intubation, compared to etomidate alone.

[1] Aubrun F. Management of postoperative analgesia in elderly patients. Reg Anesth Pain Med. 2005; 30(4):363-79.
[2] Naghibi K., Nazemroaya B., Sargaran A. A Comparison of the Effect of Intravenous Dexamethasone and Lidocaine on Prevention of Postoperative Cognitive Disorders in Cataract Surgery in Elderly Patients. Journal of Isfahan Medical School, 2018; 36(484): 666-672.
[3] Poulose N, Raju R. Aging and injury: alterations in cellular energetics and organ function. Aging Dis. 2014; 5(2):101-8.
[4] Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006; 203(6):865-77.
[5] Sung VW, Weitzen S, Sokol ER, Rardin CR, Myers DL. Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol. 2006; 194(5):1411-7.
[6] Kanonidou Z, Karystianou G. Anesthesia for the elderly. Hippokratia. 2007; 11(4):175.
[7] Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. New England Journal of Medicine. 2002 Apr 11;346(15):1128-37.
[8] Barber EL, Rutstein SE, Miller WC, Gehrig PA. A preoperative personalized risk assessment calculator for elderly ovarian cancer patients undergoing primary cytoreductive surgery. Gynecol Oncol. 2015; 139(3):401-6.
[9] Lin C, Darling C, Tsui BC. Practical regional anesthesia guide for elderly patients. Drugs Aging. 2019; 36(3):213-34.
[10] Katona PG, Lipson DA, Dauchot PJ. Opposing central and peripheral effects of atropine on parasympathetic cardiac control. Am J Physiol. 1977; 232(2):H146-51.
[11] Short CE, Bufalari A. Propofol anesthesia. Vet Clin North Am Small Anim Pract. 1999; 29(3):747-78.
[12] Murphy M, Bruno MA, Riedner BA, Boveroux P, Noirhomme Q, Landsness EC, et al. Propofol anesthesia and sleep: a high-density EEG study. Sleep. 2011; 34(3):283-91.
[13] Ebert TJ, Muzi M, Berens R, Goff D, Kampine JP. Sympathetic responses to induction of anesthesia in humans with propofol or etomidate. Anesthesiology. 1992; 76(5):725-33.
[14] Atkins JP Jr, Keane WM, Young KA, Rowe LD. Value of panendoscopy in determination of second primary cancer. A study of 451 cases of head and neck cancer. Arch Otolaryngol. 1984; 110(8): 533-4.
[15] Wenig BL, Raphael N, Stern JR, Shikowitz MJ, Abramson AL. Cardiac complications of suspension laryngoscopy. Fact or fiction? Arch Otolaryngol Head Neck Surg. 1986; 112(8): 860-2.
[16] Khil JY, Choi YJ, Choi SU, Shin HW, Lee HW, Lim HJ, et al. Comparison of propofolremifentanil andsevoflurane-remifentanil anesthesia for suspension laryngoscopic surgery. Anesth Pain Med. 2008; 3(1): 12-6.
[17] Nazemroaya B, Majedi MA, Shetabi H, Salmani S. Comparison of Propofol and Ketamine Combination (Ketofol) and Propofol and Fentanyl Combination (Fenofol) on Quality of Sedation and Analgesia in the Lumpectomy: A Randomized Clinical Trial. Adv Biomed Res. 2018; 7:134.
[18] Altintas F, Bozkurt P, Kaya G, Akkan G. Lidocaine 10% in the endotracheal tube cuff: blood concentrations, haemodynamic and clinical effects. Eur J Anaesthesiol. 2000; 17(7): 436-42.
[19] Agosti L. Anaesthetic technique for microsurgery of the larynx. Anaesthesia. 1977; 32(4): 362-5
[20] Sieber F, Neufeld KJ, Gottschalk A, Bigelow GE, Oh ES, Rosenberg PB, et al. Depth of sedation as an interventional target to reduce postoperative delirium: mortality and functional outcomes of the Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients randomised clinical trial. Br J Anaesth. 2019; 122(4):480-9.
[21] Sergi G, Veronese N, Fontana L, De Rui M, Bolzetta F, Zambon S, et al. Pre-frailty and risk of cardiovascular disease in elderly men and women: the Pro. VA study J Am Coll Cardiol. 2015; 65(10):976-83.
[22] Pathanon P, Jangprajak N, Chansing S, Jaidee A, Tubtimhin S. Efficacy of Sedation for Colonoscopy, A Comparison between Propofol and Ketamine Combination (Ketofol) Versus Propofol and Fentanyl Combination (Fenofol). Journal of The Department of Medical Services. 2021; 46(1): 37–44.
[23] Baradari AG, Alipour A, Habibi MR, Rashidaei S, Zeydi AE. A randomized clinical trial comparing hemodynamic responses to ketamine-propofol combination (ketofol) versus etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery. Arch Med Sci. 2017; 13(5):1102-10.
[24] Sanri E, Karacabey S, Akoglu H, Kaya B, Guneysel O. Comparison of ketamine/propofol (ketofol) and etomidate/fentanyl (etofen) combinations for procedural sedation and analgesia in the emergency department: An observational study. Turkish journal of emergency medicine. 2017; 17(3):89-94.
[25] Hosseinzadeh H, Eidy M, Golzari SE, Vasebi M. Hemodynamic stability during induction of anesthesia in elderlyPatients: propofol+ ketamine versus propofol+ etomidate. J Cardiovasc Thorac Res. 2013; 5(2):51-4.
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Keywords
Etomidate Hemodynamic Endotracheal intubation Ketamine Peripheral oxygen saturation

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Khalili G, Soheilipoor M. Comparison of Hemodynamic Responses to Ketofol versus Etomidate During Anesthesia Induction in Elderly Patients. Arch Anesth & Crit Care. 2024;.