Ketamine Versus Low Dose Thiopental for Induction of Anesthesia in Septic Shock
- Registration Number
- NCT03104140
- Lead Sponsor
- Cairo University
- Brief Summary
The aim of this work is to compare two protocols (ketamine-fentanyl-midazolam versus thiopental-fentanyl-midazolam) for induction of anesthesia in patients with septic shock aiming to find the most safe protocol with regards to hemodynamic status of patients.
- Detailed Description
Induction of anesthesia in hemodynamically compromised patients is a challenge for every anesthetist. Most of the intravenous induction agents have a negative effect on arterial blood pressure and cardiac output. Theoretically, the "ideal" emergency induction intravenous anesthetic should achieve rapid hypnosis and maintain the hemodynamic stability Ketamine has been reported as an induction anesthetic with a sympathomimetic activity. In patients with intact autonomic nervous system ketamine increases heart rate, cardiac output, and arterial blood pressure (ABP). Despite its sympathomimetic activity in hemodynamically stable patients, the hemodynamic response to ketamine in unstable cardiovascular conditions is not clear No studies to the best of our knowledge compared Ketamine and low dose thiopental in rapid sequence induction of anesthesia in hemodynamically unstable patients.
In this study, patients with severe sepsis or septic shock scheduled for surgery will be assigned to receive either ketamine or thiopental for induction of anesthesia. After induction of anesthesia, endotracheal tube will be inserted aided by succinyl choline. Invasive blood pressure will be monitored through a transducer connected to arterial catheter. Electrical velocimetry (cardiometry) device will be used for non-invasive monitoring of cardiac output and stroke volume.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 26
- Sepsis patients with shock index (heart rate divided by systolic blood pressure) >0.7. or Sepsis patients with norepinephrine infusion.
- Traumatic brain injury
- Cerebrovascular disorders
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Ketamine group Ketamine This group of patients will receive: 1 mg/Kg ketamine + 0.5 ug/Kg fentanyl + 0.05 mg/Kg midazolam for induction of anesthesia. Endotracheal tube will be inserted aided by 1 mg/Kg succinyl choline. Patients will undergo surgical procedure to eliminate the source of sepsis e.g. abdominal exploration. Invasive blood pressure monitor will be connected to the patient through an arterial catheter. Electrical velocimetry (cardiometry) device will be connected to the patient to measure cardiac output, stroke volume, and systemic vascular resistance. Thiopental group Thiopental 2 mg/Kg thiopental + 0.5 ug/Kg fentanyl + 0.05 mg/Kg midazolam for induction of anesthesia. Endotracheal tube will be inserted aided by 1 mg/Kg succinyl choline. Patients will undergo surgical procedure to eliminate the source of sepsis e.g. abdominal exploration. Invasive blood pressure monitor will be connected to the patient through an arterial catheter. Electrical velocimetry (cardiometry) device will be connected to the patient to measure cardiac output, stroke volume, and systemic vascular resistance.
- Primary Outcome Measures
Name Time Method Mean arterial pressure 30 minutes after induction of anesthesia Mean arterial blood pressure measured by invasive transducer attached to arterial catheter
- Secondary Outcome Measures
Name Time Method heart rate 30 minutes after induction of anesthesia heart rate measured in beat per minute
cardiac output 30 minutes after induction of anesthesia cardiac output measured in litres per minute measured by electrical velocimetry
stroke volume 30 minutes after induction of anesthesia cardiac stroke volume in milliliters measured by electrical velocimetry
Serum lactate 30 minutes after induction of anesthesia serum lactate measured in mmol/liter
total norepinephrine dose 30 minutes after induction of anesthesia total dose of norepinephrine measured in micrograms
intra-operative inhalational anesthetic concentration 30 minutes the concentration of inhalational anesthetic (%)
incidence of post-induction hypotension 5 minutes The percent of patients with severe hypotension after induction of anesthesia requiring stoppage of inhalational anesthesia
Trial Locations
- Locations (1)
Cairo University
🇪🇬Cairo, Egypt