Efficacy comparison of ketofol and etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery

Abstract

Introduction: Anesthesia induction is a critical phase characterized by hemodynamic changes that disrupt the delicate balance between myocardial oxygen demand and supply, resulting in myocardial ischemia in patients with underlying coronary artery disease and impaired left ventricular systolic function. Consequently, maintaining stable hemodynamics during the induction process holds paramount importance. This study aims to compare the hemodynamic changes and evaluate the quality of endotracheal intubation between ketofol and etomidate during anesthesia induction for patients undergoing coronary artery bypass graft (CABG) surgery with diminished left ventricular function.
 Methods: A total of 159 adult patients undergoing CABG with extracorporeal circulation were enrolled from the Department of Anesthesiology and Intensive Care, Hanoi Heart Hospital. The patients were divided into two groups: The ketofol group (83 patients) receiving intravenous infusion of Ketofol (ketamin 0,75mg/kg + 1,5mg/kg propofol) and etomidate group (76 patients) receiving intravenous infusion of 0,2mg/kg etomidate. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and heart rate (HR) were recorded at various time points, including pre-induction, post-endotracheal intubation, and assessment of endotracheal intubation quality.
 Results: The most substantial decrease in blood pressure was observed from the pre-induction period to just prior to endotracheal intubation. Subsequently, stable levels were maintained at 1, 2, and 3 minutes post-intubation in both study groups (p>0.05). In the ketofol group, heart rate did not increase during the induction process, but rather exhibited a decreasing trend (5±8%), with no statistically significant difference compared to the etomidate group (p=0.283). The quality of endotracheal tube placement was comparable between the ketofol group (excellent: 51.8%, good: 48.2%) and the etomidate group (excellent: 52.6%, good: 47.4%).
 Conclusion: Utilizing ketofol and etomidate for anesthesia induction demonstrated equivalent maintenance of hemodynamic stability and quality of endotracheal intubation in patients with impaired left ventricular function undergoing CABG surgery.