Comparison of the Effect of Two Drug Combinations: Ketamine-Midazolam -Sufentanil with Etomidate-Sufentanil on Changes in Heart Rate and Blood Pressure After Laryngoscopy and Endotracheal Intubation

Azim Honarmand; Kimia Karimian; Mohammadreza Safavi; Hamidreza Shetabi; Alireza Yazdani

doi:10.18502/jzms.v6i3.14795

Azim Honarmand Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Kimia Karimian Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Mohammadreza Safavi Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Hamidreza Shetabi Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Alireza Yazdani Fellowship of Cardiothoracic Anesthesiology, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

DOI: https://doi.org/10.18502/jzms.v6i3.14795

Keywords: Laryngoscopy; Endotracheal intubation; General anesthesia; Ketamine; Sufentanil; Etomidate; Midazolam; Hemodynamic changes

Abstract

Background: Due to the high prevalence of complications during and after laryngoscopy, especially hemodynamic disturbances, and the absence of a suitable solution for preventing these complications, this study was conducted to compare the effect of “Ketamine-Midazolam-Sufentanil” with “Etomidate-Sufentanil” combinations on changes in heart rate and blood pressure after laryngoscopy and endotracheal intubation.

Methods: In this controlled, triple-blind randomized clinical trial, 96 laryngoscopy candidate patients were divided into three groups of 32 members and were given “Ketamine-Midazolam-Sufentanil” (KMS), “Etomidate-Sufentanil” (ES) and” Etomidate- Normal Saline” (NS) respectively before laryngoscopy. Hemodynamic parameter changes at baseline and 1,3,5 and 10 minutes after laryngoscopy, were measured and compared between the 3 groups.

Results: During the study, the 3 groups KMS, ES, and NS had 0%, 15.6% and, 3.1% bradycardia respectively (p value = 0.024). Changes in systolic blood pressure were significantly different in the 3 groups (p value = 0.043). However, the incidence of tachycardia, hypertension, and hypotension were not significantly different among the 3 groups.

Conclusion: Results of this study showed that using the “Ketamine-Midazolam-Sufentanil” combination before laryngoscopy can reduce hemodynamic disturbances during and after laryngoscopy. Patients who receive this drug combination seem to have more desirable hemodynamic stability during and after laryngoscopy.