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.

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.

Study at a glance

Abstract

Objectives During anesthesia induction, fluctuations in systemic hemodynamic may also alter cerebral hemodynamic, especially in patients with intracranial tumors, as these patients might have impaired cerebral autoregulation. This study compared the effects of ketofol (a mixture of ketamine and propofol) and etomidate on cerebral blood flow, oxygenation, and systemic hemodynamics during anesthesia induction for craniotomy in patients with supratentorial tumors. Materials and Methods This prospective, randomized, double-blind study included 50 patients aged 18 to 65 years, American Society of Anesthesiologists (ASA) classes I to II, undergoing elective craniotomy. Patients were assigned to receive either ketofol or etomidate for induction. Middle cerebral artery (right and left side) mean flow velocity (mFV) and pulsatility index (PI) were measured using transcranial Doppler, and cerebral oxygenation (rSO 2 %) of both hemispheres was measured using near-infrared spectroscopy (NIRS) during the first 10 minutes (1, 3, 5, and 10 minutes) following anesthesia induction. Statistics An independent sample " t " test and one-way analysis of variance was used for continuous data. Chi-squared test was used for categorical data. Linear correlation between two continuous variables was explored using Pearson's correlation (normally distributed data) and Spearman's correlation (non-normally distributed data). A p -value of less than 0.05 was considered statistically significant. Results Both groups showed a fall in mFV (cm/s) following induction, with a greater fall in the etomidate group (38.32 ± 2.54 vs. 28.88 ± 3.07; p = 0.001). In the etomidate group, mFV returned to baseline within 3 minutes and rose after laryngoscopy, while it remained below baseline in the ketofol group. rSO 2 decreased immediately postinduction but was better preserved in the ketofol group. Mean arterial pressure and heart rate significantly increased during laryngoscopy in the etomidate group ( p < 0.001). Conclusion Ketofol provided more stable cerebral hemodynamics, cerebral oxygenation, and systemic parameters compared with etomidate during anesthesia induction in patients undergoing craniotomy for supratentorial tumors.