Comparative Study of Effect of Etomidate Versus Propofol plus Ketamine on Haemodynamic Response to Laryngoscopy and Endotracheal Intubation

Author(s): Saraswathi Ramakrishna1, Langpoklakpam Chaoba Singh2, Bijaya Chingtham3, Rahul Jain4

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.
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 pressure-
SBP, 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.
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 %.
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.