Total intravenous anesthesia with a propofol-ketamine combination during coronary artery surgery

Objective: To evaluate the cardiovascular effects of a propofol-ketamine co mbination in patients undergoing coronary artery surgery. Design: Prospective, randomized study. Setting: Tertiary care teaching hospital, single center. Participants: Seventy-eight adult patients. Interventions: Patients were ra ndomly allocated to receive propofol-ketamine for induction and maintenance of anesthesia (n = 36) or fentanyl-enflurane (controls, n = 42). Measurements and Main Results: Hemodynamics and other variables were record ed during and after surgery and for 24 hours in the intensive care unit. Be fore cardiopulmonary bypass (CPB), there was similar incidence of treatment for hypotension (42% of patients in both groups), tachycardia (propofol-ke tamine, 6%; controls, 5%), and myocardial ischemia (propofol-ketamine, 3%; controls, 12%). In the propofol-ketamine group, there was a decreased requi rement for inotropic agents after CPB (22% of patients) compared with contr ols (49% of patients; p = 0.02). There was a reduced incidence of myocardia l infarctions (creatine kinase myocardial band >133 U/L) in the propofol-ke tamine group compared with the control group (0% v14%; p = 0.02; Fisher's e xact test). Patients in the propofol-ketamine group were more likely to hav e their tracheas extubated within 8 hours of arrival in the intensive care unit compared with controls (33% v7%; p = 0.01; Cochran-Mantel-Haenzel test ). Conclusions: The propofol-ketamine combination was associated with a simila r incidence of pre-CPB hypotension and ischemia, a decreased need for inotr opes after CPB, an earlier time to tracheal extubation, and a reduced incid ence of myocardial infarctions compared with controls. Copyright (C) 2000 b y W.B. Saunders Company.