The use of noninvasive continuous cardiac output to monitor the hemodynamic effects of propofol–fentanyl versus propofol–ketamine induction

Background: Noninvasive continuous cardiac output monitoring method utilizing ECG and a pulse oximeter wave was based on hemodynamic analysis combined with pulse wave transit time. Propofol injection may induce a significant decrease in blood pressure. The use of ketamine with propofol may reduce the dose and the hemodynamic effect of propofol. Patients and methods: Sixty female patients, ASA I and II, undergoing dilatation and curettage were divided into two equal groups. The first group received propofol (1 mg/kg) + fentanyl (1 μg/kg), whereas the second group received propofol (1 mg/kg) + ketamine (0.5 mg/kg) as induction agents. Continuous cardiac output monitoring was performed using pulse wave transit time technology. Hemodynamic data such as oxygen saturation through pulse oximetry, heart rate, and blood pressure were recorded every minute. Results: Statistically significant differences between both groups were observed in diastolic, systolic, mean blood pressure, heart rate, and cardiac output. The propofol/fentanyl group showed a significant decrease in diastolic, systolic, and mean blood pressure, heart rate, and cardiac output compared with the propofol/ketamine group. Conclusion: Noninvasive cardiac output measurement utilizing ECG, noninvasive blood pressure, and a pulse oximeter is a reliable method. Hemodynamic parameters including blood pressure, heart rate, cardiac output, and cardiac output index decreased with the induction of propofol and fentanyl combination, but were stable with the use of a propofol and ketamine combination.