Abstract

Laryngoscopy and intubation, commonly employed for airway management during general anesthesia, often lead to undesirable hemodynamic changes. Objectives: This study aimed to compare the effects of etomidate, a combination of propofol-ketamine, and propofol-etomidate as induction agents on the hemodynamic response to laryngoscopy and intubation. Patients and Methods: In a double-blind, randomized clinical trial, 120 adult patients of both sexes, aged 18 to 45 years, scheduled for elective surgery under general anesthesia were randomly allocated into three equally sized groups. Group A received etomidate (0.3 mg/kg) plus normal saline as placebo. Groups B received propofol (1.5 mg/kg) plus ketamine (0.5 mg/kg) and Group C received the combination of 1mg/kg propofol plus 0.15mg/kg etomidate. respectively, for anesthesia induction. Hemodynamic values (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], and heart rate [HR]) were measured before laryngoscopy and tracheal intubation, immediately after, and one and three minutes after the procedures. Results: Repeated-measures ANOVA revealed significant changes in mean SBP and DBP between the time points (P < 0.05). Additionally, the main effects of MAP and HR were statistically significant during the study period (P < 0.05). Moreover, after anesthesia induction, the three study groups exhibited significantly different changes in SBP, DBP, and MAP over time (P < 0.05). However, changes in HR over time were not statistically significant (P > 0.05). The combination of propofol-ketamine demonstrated superior hemodynamic stability compared to other induction agents. Conclusions: The propofol-ketamine combination may be recommended as an effective and safe induction agent for attenuating hemodynamic responses to laryngoscopy and intubation with improved hemodynamic stability. Nevertheless, further well-designed randomized clinical trials are warranted to confirm the safety and efficacy of this combination, particularly in critically ill patients or those with cardiovascular disease

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