Comparing the combination effect of propofol-ketamine and propofol-alfentanil on hemodynamic stability during induction of general anesthesia in the elderly

ABSTRACT

Propofol [Diprivan], a modern intravenous hypnotic drug, produces a reduction in both cardiac index [CI] and mean arterial pressure [MAP] due to its sympatholytic activity. S-Ketamine [Ketanest], a potent analgesic, in contrast, causes an increase in both CI and MAP due to its sympathomimetic activity. This study was performed to compare the combination effects of propofol-ketamine and propofol-alfentanil on hemodynamic stability during induction of general anesthesia. In a prospective study, 100 patients over 60 [ASA I, II] scheduled for elective lower abdominal interventions were randomly divided into two groups. For induction of general anesthesia, after injection of midazolam, the first group [A] received alfentanil and propofol and the second group [B] received S-ketamine and propofol. Each group received atracurium as muscle relaxant. Blood pressure [BP] and heart rate [HR] were measured before and 1 and 5 minutes after induction of anesthesia. The increase in HR and decrease in MAP were statistically significant in both groups 1 and 5 minutes after general anesthesia. The increase in HR and decrease in MAP were significantly more in Group A, 1 and 5 minutes after general anesthesia. The dose of S-ketamine administered during induction of general anesthesia may not be enough to neutralize the cardio-depressant effect of propofol. A better hemodynamic activity was observed in Group B compared to Group A due to partial neutralization of the opposing action