Abstract
BACKGROUND Laryngoscopy and endotracheal intubation, a painful procedure, frequently used in airway management is commonly associated with undesired haemodynamic changes like hypertension, tachycardia and arrythmias. Thus, this study was designed to compare haemodynamic stability to laryngoscopy and intubation using single drug induction with etomidate and combined drug induction with propofol and ketamine. METHODS This was a double blind randomised controlled trial, a total of 90 patients of both sexes, aged between 18 - 60 years, who were scheduled for elective surgeries under general anaesthesia in regional institute of medical sciences (RIMS) operation theatre (OT) were divided into two groups. Group PK received propofol (1.5 mg / kg) + ketamine (0.5 mg / kg) and Group E received etomidate (0.3 mg / kg) as induction agents. The haemodynamic parameters (systolic blood pressureSBP, diastolic blood pressure-DBP, mean arterial pressure-MAP, heart rate-HR) were recorded before induction, immediately after induction, 1, 3 and 5 mins after intubation. Side effects like myoclonus and post-operative nausea and vomiting were also noted. RESULTS SBP, DBP, MAP which were recorded, before induction considered as the baseline, and after induction, were comparable between the two groups. SBP, DBP and MAP compared at 1, 3 and 5 mins after intubation showed statistically significant difference between the two groups with propofol-ketamine group showing better haemodynamic stability. The HR between both the groups at various time intervals were comparable and not considered statistically significant. The side effect associated after induction was myoclonus in 14 patients in Group E i.e. 31 % and post-operative nausea vomiting was observed in 8 patients in Group E i.e. 18 %. CONCLUSIONS Thus, in view of haemodynamic stability during laryngoscopy, intubation and side effect profile; propofol and ketamine combination proves to be a better alternative compared to etomidate according to our study. KEYWORDS Propofol, Ketamine, Etomidate, Haemodynamic Stability
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