Comparing the Combination Effect of Propofol- Ketamine and Propofol-Alfentanil on Hemodynamic Stability during Induction of General Anesthesia in the Elderly

Background: Propofol (Diprivan), a modern intravenous hypnotic drug, produces a reduction in both cardiac index (CI) and mean arterial pressure (MAP) due to its sympatholytic activity. S-Ketamine (Ketanest), a potent analgesic, in contrast, causes an increase in both CI and MAP due to its sympathomimetic activity. This study was performed to compare the combination effects of propofol-ketamine and propofol-alfentanil on hemodynamic stability during induction of general anesthesia. Methods: In a prospective study, 100 patients over 60 (ASA I, II) scheduled for elective lower abdominal interventions were randomly divided into two groups. For induction of general anesthesia, after injection of midazolam, the first group (A) received alfentanil and propofol and the second group (B) received S-ketamine and propofol. Each group received atracurium as muscle relaxant. Blood pressure (BP) and heart rate (HR) were measured before and 1 and 5 minutes after induction of anesthesia. Results: The increase in HR and decrease in MAP were statistically significant in both groups 1 and 5 minutes after general anesthesia. The increase in HR and decrease in MAP were significantly more in Group A, 1 and 5 minutes after general anesthesia. Conclusion: The dose of S-ketamine administered during induction of general anesthesia may not be enough to neutralize the cardio-depressant effect of propofol. A better hemodynamic activity was observed in Group B compared to Group A due to partial neutralization of the opposing action.