• Rahman Abbasivash, Mir Moosa Aghdashi, Behzad Sinaei, and Fatemeh Kheradmand.
• Department of Anesthesiology, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
• J Clin Anesth. 2014 Dec 1; 26 (8): 628633628-33.

Study ObjectiveTo compare the clinical efficacy of co-induction with propofol-midazolam-ketamine with etomidate as the sole induction agent.DesignProspective, double-blinded, randomized controlled trial.SettingOperating room of a university hospital.Patients60 ASA physical status 1 and 2 patients scheduled for limited elective surgery requiring general anesthesia.InterventionsPatients were randomized to two groups to receive etomidate 0.3 mg/kg (single-drug group) or propofol 0.6 mg/kg + ketamine 0.8 mg/kg + midazolam 0.06 mg/kg (three-drug group).MeasurementsHemodynamic responses (systolic and diastolic blood pressure, and mean arterial pressure) were examined at baseline and at one, three, and 5 minutes after tracheal intubation. Plasma catecholamine levels were measured at baseline, one, and 5 minutes after tracheal intubation.Main ResultsHeart rate (HR) changes differed significantly between the two groups at three minutes (P = 0.01) and 5 minutes (P = 0.00) after tracheal intubation. However, the HR increase in the three-drug group was in the acceptable range. Percentage changes of epinephrine level differed between the two groups at 5 minutes after tracheal intubation (P = 0.03).ConclusionsThe higher norepinephrine/epinephrine ratio noted in the single-drug group may be implicated in lower adrenal sympathetic activity. Propofol-midazolam-ketamine co-induction may be used instead of etomidate for anesthesia induction in patients with hemodynamic instability.Copyright © 2014 Elsevier Inc. All rights reserved.

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