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; Priyanka Gupta; Sharmishtha Pathak; Ashutosh Kaushal; Shivam Shekhar; Aditya R. Yadav

doi:10.1055/s-0045-1804530

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(02): 314-321
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

Authors

Siddharth Chakraborty

¹Department of Neuroanesthesia and Critical Care, Kalinga Institute of Medical Sciences, Bhuvneshwar, Orissa, India
Priyanka Gupta

²Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Sharmishtha Pathak

³Department of Anesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
Ashutosh Kaushal

⁴Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
Shivam Shekhar

²Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Aditya R. Yadav

²Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

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

Volltext

Referenzen

References
1 Bruder NJ, Ravussin P, Schoettker P. Supratentorial masses: anesthetic considerations. In: Cottrell JE, Patel P. eds. Cottrell and Patel's Neuroanesthesia. 6th ed.. Philadelphia, PA: Elsevier; 2017: 189-208
2 Sharma D, Bithal PK, Dash HH, Chouhan RS, Sookplung P, Vavilala MS. Cerebral autoregulation and CO₂ reactivity before and after elective supratentorial tumor resection. J Neurosurg Anesthesiol 2010; 22 (02) 132-137
3 Dong J, Zeng M, Ji N. et al. Impact of anesthesia on long-term outcomes in patients with supratentorial high-grade glioma undergoing tumor resection: a retrospective cohort study. J Neurosurg Anesthesiol 2020; 32 (03) 227-233
4 Gruenbaum SE, Meng L, Bilotta F. Recent trends in the anesthetic management of craniotomy for supratentorial tumor resection. Curr Opin Anaesthesiol 2016; 29 (05) 552-557
5 Matsumoto M, Sakabe T. Effects of anesthetic agents and other drugs on cerebral blood flow, metabolism, and intracranial pressure. In: Cottrell JE, Patel P. eds. Cottrell and Patel's Neuroanesthesia. 6th ed.. Philadelphia, PA: Elsevier; 2017: 74-90
6 Slupe AM, Kirsch JR. Effects of anesthesia on cerebral blood flow, metabolism, and neuroprotection. J Cereb Blood Flow Metab 2018; 38 (12) 2192-2208
7 Sorond FA, Hollenberg NK, Panych LP, Fisher ND. Brain blood flow and velocity: correlations between magnetic resonance imaging and transcranial Doppler sonography. J Ultrasound Med 2010; 29 (07) 1017-1022
8 Owen-Reece H, Elwell CE, Goldstone J, Smith M, Delpy DT, Wyatt JS. Investigation of the effects of hypocapnia upon cerebral haemodynamics in normal volunteers and anaesthetised subjects by near infrared spectroscopy (NIRS). Adv Exp Med Biol 1994; 361: 475-482
9 Kim MB, Ward DS, Cartwright CR, Kolano J, Chlebowski S, Henson LC. Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia. J Clin Monit Comput 2000; 16 (03) 191-199
10 Yan S, Li Q, He K. The effect of esketamine combined with propofol-induced general anesthesia on cerebral blood flow velocity: a randomized clinical trial. BMC Anesthesiol 2024; 24 (01) 66
11 Mayberg TS, Lam AM, Matta BF, Domino KB, Winn HR. Ketamine does not increase cerebral blood flow velocity or intracranial pressure during isoflurane/nitrous oxide anesthesia in patients undergoing craniotomy. Anesth Analg 1995; 81 (01) 84-89
12 Thiel A, Zickmann B, Roth H, Hempelmann G. Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia. J Clin Monit 1995; 11 (02) 92-98
13 Dash R, Dubey RK, Mishra LD. The effect of propofol versus etomidate induction on middle cerebral artery flow velocities and its derived parameters using transcranial doppler ultrasonography. J Clin Anesth Manage 2017; 2 (01) 1-6
14 Duran H, Koksal E, Ustun Y, Bilgin S, Özkan F. The effects of anaesthesia induction with propofol or ketofol on cerebral oxygenation in patients above 60 years of age. Medicine (Baltimore) 2020; 9 (01) 21-25
15 Bhaire VS, Panda N, Luthra A, Chauhan R, Rajappa D, Bhagat H. Effect of combination of ketamine and propofol (ketofol) on cerebral oxygenation in neurosurgical patients: a randomized double-blinded controlled trial. Anesth Essays Res 2019; 13 (04) 643-648
16 Smischney NJ, Seisa MO, Morrow AS. et al. Effect of ketamine/propofol admixture on peri-induction hemodynamics: a systematic review and meta-analysis. Anesthesiol Res Pract 2020; 2020: 9637412
17 Khalili G, Soheilipoor M. Comparison of hemodynamic responses to ketofol versus etomidate during anesthesia induction in elderly patients. Arch Anesth & Crit Care. 2024; 10 (Suppl. 01) 474-481
18 Baradari AG, Alipour A, Habibi MR, Rashidaei S, Emami Zeydi A. A randomized clinical trial comparing hemodynamic responses to ketamine-propofol combination (ketofol) versus etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery. Arch Med Sci 2017; 13 (05) 1102-1110