Effect of adding ketamine to etomidate infusion on serum cortisol levels for anesthetic induction compared to etomidate infusion alone in elective surgical patients: a randomized controlled trial

The purpose of this study is to compare the effect of twodifferent anaesthetic regimen (Etomidate alone or Etomidate with Ketamine) thatwill be used to induce loss of consciousness in patients (in order to alleviatethe pain and agony during surgery) on the alteration of Serum Cortisol levels.2. Procedure/methods of the study. Cortisol is an hormone which is an essentialregulator of carbohydrate, protein and lipid metabolism, which is essential fornormal functioning of humans. In this study the patients will be alloted intoeither of the two groups (Group E and Group KE) with equal possibilities ofgetting into either of the group and both of these regimen can result in thedesired effect of loss of consciousness in patients while you undergo thesurgery. On reaching the operation theatre patients will be secured intravenouscannula which is the routine practice to administer drugs and fluids while youundergo surgery and two ml of blood will be taken for calculating baselinecortisol values. Vitals such as heart rate and blood pressure will be measuredevery 2 minutes . After this, patient will be administered with eitherEtomidate only or Ketamine and Etomidate depending upon the random group inwhich the patient is allotted (Group K or KE). Patient breathing will beassisted by an anaesthesiologist after they attain loss of consciousness. Once thepatient is completely anesthetized by the allocated anesthetic drug endotrachealtube will be inserted to maintain respiration during surgery. Patients bloodpressure and heart rate will be monitored at 1st ,3rd ,5th and 10th minute fromthe time of loss of consciousness. .Once this is done, the pateint will bemanaged as per the attending Anaesthesiologist and he/she will be instructednot to administer steroids during or upto 24 hours. Similar to before the surgery,3 more blood samples at 4, 12 and 24 hours after loss of consciousness will betaken to estimate the change in serum cortisol levels after administration ofthe allocated anesthetized drug. The suppression in serum cortisol level betweenthe intervention and the control arm will be compared by the samples takenbefore induction and at 4 hours,12 hours and 24 hours.