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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1804530
Original Article

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

Siddharth Chakraborty
1   Department of Neuroanesthesia and Critical Care, Kalinga Institute of Medical Sciences, Bhuvneshwar, Orissa, India
,
Priyanka Gupta
2   Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Sharmishtha Pathak
3   Department of Anesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
,
Ashutosh Kaushal 
4   Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Shivam Shekhar
2   Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Aditya R. Yadav
2   Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
› Institutsangaben Funding None.
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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 (rSO2%) 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. rSO2 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.

Keywords

ketofol - etomidate - cerebral blood flow velocity - regional cerebral oxygenation - craniotomy

Authors' Contributions

S.C. contributed to acquisition, analysis, and interpretation of data and drafting of the manuscript. P.G. contributed to conception of the study design, interpretation of data, drafting of the manuscript, critical analysis, and final approval of the manuscript. S.P. contributed to drafting and editing of the manuscript. A.K. contributed to conception of the study design. S.S. contributed to drafting of the manuscript. A.R.Y. contributed to drafting of the manuscript.




Publikationsverlauf

Artikel online veröffentlicht:
20. Februar 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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