Comparison of Hemodynamic Profile of Ketamine and Propofol (Ketofol) with Propofol in Traumatic Brain Injury Patients Undergoing General Anesthesia

Background: Comparison of MAP, brain relaxation, plasma level of glial fibrillary acidic protein (GFAP) in intraoperative and extended Glasgow outcome scale (GOSE) at 3 months of postoperative period in patients receiving “ ketofol” (ketamine and propofol = 1:5) or propofol for induction and maintenance of anesthesia in TBI patients undergoing surgery.

Materials and Methods: A prospective randomized controlled trial was done on 50 TBI patients undergoing surgery after approval of Institute Ethics Committee and written informed consent from patients’ kin. Patients in group P (n = 25) received propofol, while patients in group KP (n = 25) received combination of ketamine and propofol (1:5) for induction and maintenance of anesthesia. Invasive MAP was recorded continuously. Rescue measure to maintain MAP were recorded. Brain relaxation, ONSD, plasma biomarker GFAP, and GOSE (at 3 months) were observed.

Results: Throughout the drug infusion period MAP was better maintained and hemodynamic fluctuations were less in patients receiving ketofol compared with those receiving propofol (p < 0.05). There was decreased requirement of phenylephrine in ketofol group (p = 0.02). There is no statistically significant difference in quality of brain relaxation, ONSD, GFAP values, number of ventilator days, and GOSE score at 3 months in either group.

Conclusions: Ketofol (ketamine and propofol in the ratio 1:5) is preferred over propofol as induction and maintenance anesthetic agent in patients undergoing surgery for TBI as it provides more hemodynamic stability compared with propofol alone with no significant adverse effects.

Publication History

Article published online:
25 March 2020