Exploring the Effects of Ketofol and Etomidate on Cerebral Blood Flow and Oxygenation during Anesthesia Induction in Supratentorial Tumor Patients: A Randomized Double-Blind Study.
Asian journal of neurosurgery June 1, 2025 Siddharth Chakraborty, Priyanka Gupta, Sharmishtha Pathak et al.
During anesthesia induction for brain tumor surgery, a mixture of ketamine and propofol (ketofol) maintained more stable cerebral blood flow and oxygenation than etomidate. In a randomized trial of 50 adults undergoing craniotomy, both drugs initially reduced middle cerebral artery blood flow velocity, but the drop was larger with etomidate (38.32 vs. 28.88 cm/s). Etomidate's flow returned to baseline within 3 minutes and rose sharply during laryngoscopy, while ketofol kept flow below baseline. Brain oxygenation was better preserved with ketofol. Etomidate also caused larger increases in blood pressure and heart rate during laryngoscopy. Ketofol appears to offer steadier brain perfusion and systemic stability for these patients.