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The effects of propofol-ketamine combination on QTc interval in patients with coronary artery disease

Erdinc Koca, Feray Akgul Erdil, Huseyin Ilksen Toprak, Nurcin Gulhas Ozcan Ersoy, Mahmut Durmus.


The purpose of this study was to evaluate the effects of propofol-ketamine combination on QTc, T wave (Tp-e) interval, hemodynamics during the induction of anesthesia in patients with coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG). Patients were prospectively randomized, in a double blinded manner, to either the propofol group (Group P, n=41) or the propofol-ketamine combination group (Group PK, n=45). In both groups the drugs were infused at an IV dose of 2 mg/kg administered over 30 seconds. After that, 5µg/kg fentanyl and 0.1mg/kg vecuronium were administered and tracheal intubation was performed. ECG recordings were performed prior to induction of anesthesia (baseline, T1), 2 min after the beginning of study drugs (T2), 3 min after vecuronium (immediately before intubation, T3), and 30 s (T4), 1 min (T5) and 5 min (T6) after intubation. Eighty-six patients were evaluated in the study. The baseline QTc interval values were similar between the groups, In Group P, QTc interval increased significantly for T3-T6 in all periods according to baseline value. Also in Group P, QTc interval increased significantly in T4, T5, T6 according to T3. In group PK, QTc interval increased significantly in T3-T6 according to baseline value. Group PK increased significantly in T5 and T6 compared to T3. In both groups a statistically significant change was not found in Tp-e intervals of all periods. Following induction with propofol-ketamine combination, QTc interval did not increase, but it prolonged postintubation QTc interval just like propofol. Assuming that increased repolarization transmural dispersion (TDR) is a reliable indicator of risk of torsade de pointes (TdP), and lack of any change in Tp-e interval, in the presence of depressed hemodynamic response to intubation, we think that this combination can be safely used for the induction of anesthesia in patients with CAD undergoing CABG.

Key words: Propofol; ketamine; QT interval; Tp-e interval

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