Septic Shock
Conditions
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.
Interventions
DRUGKetamine
After fluid resuscitation, patients will receive :1 mg/Kg ketamine + 0.5 ug/Kg fentanyl + 0.05 mg/Kg midazolam for induction of anesthesia
DRUGThiopental
After fluid resuscitation, patients will receive :2 mg/Kg Thiopental + 0.5 ug/Kg fentanyl + 0.05 mg/Kg midazolam for induction of anesthesia
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Sepsis patients with shock index (heart rate divided by systolic blood pressure) \>0.7. or Sepsis patients with norepinephrine infusion.
Exclusion criteria
* Traumatic brain injury * Cerebrovascular disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean arterial pressure | 30 minutes after induction of anesthesia | Mean arterial blood pressure measured by invasive transducer attached to arterial catheter |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| stroke volume | 30 minutes after induction of anesthesia | cardiac stroke volume in milliliters measured by electrical velocimetry |
| heart rate | 30 minutes after induction of anesthesia | heart rate measured in beat per minute |
| Serum lactate | 30 minutes after induction of anesthesia | serum lactate measured in mmol/liter |
| cardiac output | 30 minutes after induction of anesthesia | cardiac output measured in litres per minute measured by electrical velocimetry |
| 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 |
| total norepinephrine dose | 30 minutes after induction of anesthesia | total dose of norepinephrine measured in micrograms |
Countries
Egypt
Outcome results
None listed