Critically ill patients may require emergent intubations, and the use of some induction agents can lead to undesirable effects on hemodynamics. The use of “ketofol” (ketamine/propofol admixture) may allow for improved hemodynamic control. The primary aim of this study was to assess the hemodynamic effects of “ketofol” in a fixed-dose combination during induction of general anesthesia in a controlled environment.
This was a randomized, double-blinded, placebo-controlled trial conducted at the Dartmouth Hitchcock Medical Center. American Society of Anesthesiology physical status I and II patients undergoing general anesthesia were randomly assigned to standardized induction with propofol alone or with “ketofol.” Baseline noninvasive hemodynamic measurements were obtained and continuously monitored throughout the study period. Our hypothesis assumed that “ketofol” as an induction alternative would produce stable hemodynamics as referenced from baseline compared with propofol alone. The primary outcome was a systematic randomized assessment of changes in systolic blood pressure from baseline measurements for 30 minutes after induction. The primary comparisons were the frequency of a 20% change in systolic blood pressure at 5 minutes, 10 minutes, and 30 minutes after induction.
Baseline patient demographics and intraoperative characteristics were equivalent in both groups. Propofol was more likely to generate a 20% reduction in systolic blood pressure from baseline at 5 minutes (48.8% vs. 12%, odds ratio: 6.87, 95% confidence interval: 2.07–26.15, p = < 0.001) and 10 minutes (67.4% vs. 39%, odds ratio: 3.24, 95% confidence interval: 1.21–8.75, p = < 0.01) as compared with “ketofol.” This difference remained significant after adjustment for potentially confounding variables.
“Ketofol” is associated with improved hemodynamic stability during the first 10 minutes after induction. Further study is needed to assess the efficacy of “ketofol” in critically ill patients and those with significant comorbidities. This combination has the potential to be used as an alternative agent for emergency induction during which time stable hemodynamics are desirable. (J Trauma Acute Care Surg. 2012;73: 94–101. Copyright © 2012 by Lippincott Williams & Wilkins)
LEVEL OF EVIDENCE
Therapeutic study, level I.