Document Detail


Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine.
MedLine Citation:
PMID:  20186295     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.
INTRODUCTION: Anesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting surgery is both the attenuation of sympathetic responses to noxious stimuli and the prevention of hypotension.
METHODS: Thirty patients undergoing coronary artery bypass grafting surgery were randomized to receive either ketamine 2 mg.kg(-1) (Group K) or propofol 0.5 mg.kg(-1) (Group P) during induction of anesthesia. Patients also received standardized doses of midazolam, fentanyl, and rocuronium in the induction sequence. The duration of anesthesia from induction to skin incision and sternotomy, as well as the supplemental doses of fentanyl and sevoflurane, were recorded. Heart rate, mean arterial pressure, central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index, systemic and pulmonary vascular resistance indices, stroke work index, and left and right ventricular stroke work indices were obtained before induction of anesthesia; one minute after induction; one, three, five, and ten minutes after intubation; one minute after skin incision; and at one minute after sternotomy.
RESULTS: There were significant changes in the measured and calculated hemodynamic variables when compared to their values before induction. One minute after induction, mean arterial pressure and the systemic vascular resistance index decreased significantly in group P (p<0.01).
CONCLUSION: There were no differences between groups in the consumption of sevoflurane or in the use of additional fentanyl. The combination of ketamine, midazolam, and fentanyl for the induction of anesthesia provided better hemodynamic stability during induction and until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.
Authors:
Elif Basagan-Mogol; Suna Goren; Gulsen Korfali; Gurkan Turker; Fatma Nur Kaya
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Clinics (São Paulo, Brazil)     Volume:  65     ISSN:  1980-5322     ISO Abbreviation:  Clinics (Sao Paulo)     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-26     Completed Date:  2010-12-03     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101244734     Medline TA:  Clinics (Sao Paulo)     Country:  Brazil    
Other Details:
Languages:  eng     Pagination:  133-8     Citation Subset:  IM    
Affiliation:
Uludag University School of Medicine, Department of Anesthesiology and Reanimation - Bursa, Turkey. basagan@uludag.edu.tr
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analgesics / administration & dosage*
Anesthetics, Intravenous / administration & dosage*
Coronary Artery Bypass / methods*
Coronary Artery Disease / surgery*
Female
Fentanyl / administration & dosage
Hemodynamics / drug effects*,  physiology
Humans
Ketamine / administration & dosage*
Male
Midazolam / administration & dosage
Middle Aged
Propofol / administration & dosage
Prospective Studies
Sternotomy
Chemical
Reg. No./Substance:
0/Analgesics; 0/Anesthetics, Intravenous; 2078-54-8/Propofol; 437-38-7/Fentanyl; 59467-70-8/Midazolam; 6740-88-1/Ketamine
Comments/Corrections

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