June 7, 2015Anesthesiology and Pain MedicineOpen Access

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

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Coronary artery disease with left ventricular dysfunction (n=100). Intervention: Propofol-ketamine vs. Etomidate-midazolam (0.2 mg/kg etomidate and 0.06 mg/kg midazolam). Primary outcome: Hemodynamic responses (HR, SBP, DBP, MAP, CI, SVR) during anesthesia induction and intubation.

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Key result

Propofol-ketamine and etomidate-midazolam provided similar and acceptable hemodynamic stability during anesthesia induction in patients with left ventricular dysfunction undergoing CABG, with only minor differences in cardiac index and systemic vascular resistance.

Why the study?

Does a propofol-ketamine induction regimen improve hemodynamic stability compared to an etomidate-midazolam regimen in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery?

Population

100 adults with coronary artery disease and left ventricular dysfunction scheduled for elective coronary…

Comparison

Propofol 1 mg/kg and ketamine 1 mg/kg… vs Midazolam 0.06 mg/kg intravenously over 90…

Design

RCT, Randomly divided to two groups of 50 each, by computer generated random…

Follow-up

5 minutes after intubation

Authors

NANahid AghdaiiSarem Cell Research Center MZMohsen ZiyaeifardShaheed Rajaei Cardiovascular Medical and Research Center SFSeyedeh Zahra FaritusIran University of Medical Sciences

Discussion

Member takes

Implication

Both regimens offer acceptable hemodynamic stability for induction in LV dysfunction CABG patients; confirms equivalence and supports individualized choice.

Study Design

Type

RCT (n=100)

Blinding

Single-blind

Randomization

Computer generated random numbers

Multicenter

Structured PICO

Population

100 adults aged 40-65 with coronary artery disease and left ventricular dysfunction (ejection fraction < 45%) undergoing elective coronary artery bypass graft surgery.

Intervention

Propofol 1 mg/kg and ketamine 1 mg/kg administered intravenously over 30-60 seconds for anesthesia induction.

Comparator

Midazolam 0.06 mg/kg intravenously over 90 seconds followed by etomidate 0.2 mg/kg intravenously for anesthesia induction. Both groups received background therapy of sufentanil 2.5 µg/kg and cisatracurium 0.2 mg/kg.

Outcome

Hemodynamic parameters including Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Cardiac Index (CI), and Systemic Vascular Resistance (SVR) measured before induction, 1 minute after induction, and 1, 3, and 5 minutes after intubation.surrogate

Both propofol-ketamine and etomidate-midazolam combinations provide stable hemodynamics and are safe for anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery.

Limitations

Small sample size (n=17 per group) for the specific investigation of cardiac index and systemic vascular resistance.
Small sample size (n=17) for the investigation of cardiac index and systemic vascular resistance

Cite This Study

Aghdaii et al. (2015) conducted an RCT in Coronary artery disease with left ventricular dysfunction (n=100). Propofol-ketamine vs. Etomidate-midazolam (0.2 mg/kg etomidate and 0.06 mg/kg midazolam) was evaluated on Hemodynamic responses (HR, SBP, DBP, MAP, CI, SVR) during anesthesia induction and intubation. Propofol-ketamine and etomidate-midazolam provided similar and acceptable hemodynamic stability during anesthesia induction in patients with left ventricular dysfunction undergoing CABG, with only minor differences in cardiac index and systemic vascular resistance.

synapsesocial.com/papers/6a986e864e6c8dba1244e241 https://doi.org/10.5812/aapm.27966v2

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Implication

Both regimens offer acceptable hemodynamic stability for induction in LV dysfunction CABG patients; confirms equivalence and supports individualized choice.

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

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

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

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider