Propofol is widely used as an induction agent during general anesthesia. The prevalent induction dose may be associated with unacceptable cardiovascular instability, especially in elderly patients.The combination of ketamine and propofol has been shown to balance the cardiodepressant effects. Esketamine is dextrorotatory structure of ketamine but with stronger analgesic effects and fewer adverse events.However, there have been no previous published reports on the use of esketamine combined with propofol during induction. The main aim of this study was to investigate the haemodynamic effects of esketamine with propofol for the elderly during induction with LMA( laryngeal mask airway) insertion.
Propofol is widely used as an induction agent during general anesthesia. The prevalent induction dose may be associated with unacceptable cardiovascular instability, especially in elderly patients. 1.7(0.6) mg.kg-1 adjusted dosed propofol demonstrated by a large multicenter cohort is suitable to advanced patients over aged 65. Ketamine increases heart rate and arterial blood pressure by its activation of the sympathetic nervous system. When it is used with propofol for induction of general anesthesia, the cardiostimulating effects of ketamine balance the cardiodepressant effects of propofol. Esketamine is dextrorotatory structure of ketamine but with stronger analgesic effects and fewer adverse events. A previous study has shown that the use of ketamine before induction with propofol preserves haemodynamic stability during LMA insertion. However, there have been no previous published reports on the use of esketamine combined with propofol in elderly patients for induction. The main aim of this study was to investigate the haemodynamic effects of esketamine with propofol during induction with LMA insertion. The secondary aim was to investigate whether the administration of esketamine in induction would delay the emergence of anesthesia.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
120
1mg•kg-1propofol and 0.5 mg•kg-1esketamine for general anesthesia induction.
1mg•kg-1propofol and 0.75 mg•kg-1esketamine for general anesthesia induction.
2mg•kg-1propofol for general anesthesia induction.
Anesthesiology Department of Affiliated Eye and ENT Hospital, Fudan University
Shanghai, Shanghai Municipality, China
RECRUITINGsystolic blood pressure (T0)
systolic blood pressure (SBP)
Time frame: before induction of anesthesia (T0; baseline)
systolic blood pressure (T1)
systolic blood pressure (SBP)
Time frame: at the end of anaesthesia induction (T1)
systolic blood pressure (T2)
systolic blood pressure (SBP)
Time frame: at the time before LMA insertion (T2)
systolic blood pressure (T3)
systolic blood pressure (SBP)
Time frame: at the end of LMA insertion (T3)
systolic blood pressure (T4)
systolic blood pressure (SBP)
Time frame: 5min after LMA insertion (T4)
systolic blood pressure (T5)
systolic blood pressure (SBP)
Time frame: 10min after LMA insertion (T5)
diastolic blood pressure (T0)
diastolic blood pressure (DBP)
Time frame: before induction of anesthesia (T0; baseline)
diastolic blood pressure (T1)
diastolic blood pressure (DBP)
Time frame: at the end of anaesthesia induction (T1)
diastolic blood pressure (T2)
diastolic blood pressure (DBP)
Time frame: at the time before LMA insertion (T2)
diastolic blood pressure (T3)
diastolic blood pressure (DBP)
Time frame: at the end of LMA insertion (T3)
diastolic blood pressure (T4)
diastolic blood pressure (DBP)
Time frame: 5min after LMA insertion (T4)
diastolic blood pressure (T5)
diastolic blood pressure (DBP)
Time frame: 10min after LMA insertion (T5)
mean arterial pressure (T0)
mean arterial pressure (MAP)
Time frame: before induction of anesthesia (T0; baseline)
mean arterial pressure (T1)
mean arterial pressure (MAP)
Time frame: at the end of anaesthesia induction (T1)
mean arterial pressure (T2)
mean arterial pressure (MAP)
Time frame: at the time before LMA insertion (T2)
mean arterial pressure (T3)
mean arterial pressure (MAP)
Time frame: at the end of LMA insertion (T3)
mean arterial pressure (T4)
mean arterial pressure (MAP)
Time frame: 5min after LMA insertion(T4)
mean arterial pressure (T5)
mean arterial pressure (MAP)
Time frame: 10min after LMA insertion(T5)
heart rate (T0)
heart rate (HR))
Time frame: before induction of anesthesia (T0; baseline)
heart rate (T1)
heart rate (HR))
Time frame: at the end of anesthesia induction (T1)
heart rate (T2)
heart rate (HR))
Time frame: at the time before LMA insertion (T2)
heart rate (T3)
heart rate (HR))
Time frame: at the end of LMA insertion (T3)
heart rate (T4)
heart rate (HR))
Time frame: 5min after LMA insertion(T4)
heart rate (T5)
heart rate (HR))
Time frame: 10min after LMA insertion(T5)
the occurrence of hypotension
hypotension is defined as systolic blood pressure decreased above 30% preanesthesia level or mean blood pressure\<65 mmHg.
Time frame: during general anesthesia, about 15 min.
Recovery time
Recovery time was the time patients are extubated and acquire 10 scores by assessed with Modified Aldrete Score.
Time frame: from the time of completion of the procedure to the time of returning to the guard
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