Hemodynamic Stability during the Induction of Anesthesia with Propofol Plus Fentanyl, Ketamine and Fentanyl-Ketamine

Background: This study was conducted to investigate hemodynamic stability during anesthesia induction and tracheal intubation, using propofol plus fentanyl, propofol plus ketamine, and propofol plus fentanyl and ketamine. Methods: Sixty adult patients were randomly allocated to one of three groups according to the agents used for induction:propofol (2 mg/kg) plus fentanyl (2 mcg/kg) (PF), propofol (2 mg/kg) plus ketamine (0.1 mg/kg) (PK), propofol (2 mg/kg) plus fentanyl (2 mcg/kg) and ketamine (0.1 mg/kg) (PFK). Hemodynamic responses were assessed by measuring changes in mean arterial pressure (MAP), heart rate (HR), and rate-pressure product (RPP). Results: MAP, HR and RPP changes during the induction of anesthesia tended to be greater in the PK group than in the PF and PFK groups. After the injection of propofol, MAP, HR, and RPP fell significantly below baseline values in the all groups, but remained relatively stable in the PK groups. After tracheal intubation, MAP, HR and RPP increased significantly compared with the pre-intubation values in the all groups, but reached a level significantly above baseline only in the PK group. Conclusions: A combination of propofol plus fentanyl and ketamine reduces fluctuations in the hemodynamic variables associated with the induction of anesthesia and tracheal intubation than combinations of propofol plus fentanyl or propofol plus ketamine.