Reduction of Propofol Induction Dose Using Midazolam, Fentanyl, And Ketamine as Co-Induction Agents: A Randomized Double-Blind Clinical Study
Sajid Farooq
DOI: http://doi.org/10.63139/aqamc.v2i1.0021
Keywords: Co-induction; Propofol; Ketamine; Midazolam; Fentanyl; Hemodynamic stability
ABSTRACT
Introduction: Propofol is widely used for induction of general anesthesia because of its rapid onset and favorable recovery profile; however, it is frequently associated with dose-dependent hypotension and hemodynamic instability. The co-induction technique involves the administration of adjuvant agents to reduce the required induction dose of propofol while maintaining cardiovascular stability.
Objective: To compare the effects of ketamine, midazolam, and fentanyl as co-induction agents on the induction dose of propofol, hemodynamic responses, and adverse effects during induction of general anesthesia.
Methods: This randomized, double-blind, comparative clinical study was conducted at Bahawal Victoria Hospital, Bahawalpur. A total of 136 patients (ASA physical status I–II), aged 20–50 years, scheduled for elective surgery under general anesthesia were enrolled and randomly allocated into four equal groups (n=34). Group I received normal saline (control), Group II ketamine 0.4 mg/kg, Group III midazolam 0.04 mg/kg, and Group IV fentanyl 0.5 µg/kg as co-induction agents. Propofol was administered incrementally until loss of eyelash reflex or verbal response. Total propofol dose, heart rate, blood pressure, and pain on injection were recorded
Results: All co-induction agents significantly reduced the propofol induction dose compared with the control group (p<0.001). The greatest reduction was observed in the ketamine group. Hemodynamic parameters showed significantly better stability in the ketamine group, with less reduction in heart rate and mean arterial pressure compared to midazolam and fentanyl groups. Pain on propofol injection was least frequent in the ketamine group and highest in the control group.
Conclusion: Ketamine, when used as a co-induction agent with propofol, provides superior reduction in induction dose and better hemodynamic stability compared to midazolam and fentanyl. Ketamine may be considered a safer and more effective co-induction agent, particularly in patients at risk of hypotension.
Keywords: Co-induction; Propofol; Ketamine; Midazolam; Fentanyl; Hemodynamic stability