J Dent Anesth Pain Med.  2015 Sep;15(3):129-134.

Comparison of the hemodynamic effects of propofol and ketamine as anesthetic induction agents during high-dose remifentanil administration: a single-center retrospective comparative study

• Sanuki T
• Mishima G
• Kurata S
• Watanabe T
• Kiriishi K
• Tachi M
• Ozaki Y
• Okayasu I
• Kawai M
• Matsushita Y
• Miura K
• Ayuse T

Abstract

BACKGROUND
We hypothesized that ketamine, when administered as the anesthetic induction agent, may prevent cardiovascular depression during high-dose remifentanil administration, unlike propofol. To test our hypothesis, we retrospectively compared the hemodynamic effects of ketamine, during high-dose remifentanil administration, with those of propofol.
METHODS
Thirty-eight patients who underwent oral surgery at the Nagasaki University Hospital between April 2014 and June 2015 were included in this study. Anesthesia was induced by the following procedure: First, high-dose remifentanil (0.3-0.5 µg/kg/min) was administered 2-3 min before anesthesia induction; next, the anesthetic induction agent, either propofol (Group P) or ketamine (Group K), was administered. Mean arterial pressure (MAP) and the heart rate were recorded by the automated anesthesia recording system at four time points: immediately before the administration of high-dose remifentanil (T1); immediately before the administration of propofol or ketamine (T2); 2.5 min (T3), and 5 min (T4) after the administration of the anesthetic induction agent.
RESULTS
In Group P, the MAP at T3 (75.7 ± 15.5 mmHg, P = 0.0015) and T4 (68.3 ± 12.5 mmHg, P < 0.001) were significantly lower than those at T1 (94.0 ± 12.4 mmHg). However, the MAP values in the K group were very similar (P = 0.133) at all time points. The heart rates in both Groups P (P = 0.254) and K (P = 0.859) remained unchanged over time.
CONCLUSIONS
We showed that ketamine, when administered as the anesthetic induction agent during high-dose remifentanil administration, prevents cardiovascular depression.

Keyword

Hemodynamic changes; High-dose remifentanil anesthesia; Ketamine; Propofol

MeSH Terms

Anesthesia
Arterial Pressure
Depression
Heart Rate
Hemodynamics*
Humans
Ketamine*
Propofol*
Retrospective Studies*
Surgery, Oral
Ketamine
Propofol

Figure

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  Fig. 1 Mean arterial pressure recorded in the propofol (P) and ketamine (K) groups at four time points: Immediately before the administration of high-dose remifentanil (T1); immediately before the administration of the anesthetic induction agent (T2); and 2.5 min (T3), and 5 min (T4) after the administration of the anesthetic induction agent. Data are expressed as mean ± standard deviation. *P < 0.01 compared with T1. †P < 0.01 compared with Group P.

• 

  Fig. 2 Mean heart rate recorded in the propofol (P) and ketamine (K) groups at four time points: Immediately before the administration of high-dose remifentanil (T1); immediately before the administration of the anesthetic induction agent (T2); and 2.5 min (T3), and 5 min (T4) after the administration of the anesthetic induction agent. Data are expressed as mean ± standard deviation.

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