Fentanyl-Midazolam versus Ketamine-Midazolam in Anesthesia of Patients with Sepsis undergoing Abdominal Surgery

Abstract Background 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. Aim of the Work to compare the effect of ketamine midazolam versus fentanyl midazolamin anesthesia of septic patients and find which one of them is more effective to maintain hemodynamic stability in patients with sepsis. Patients and Methods A randomized controlled double-blinded study was conducted in Ain Shams University hospital after research ethics board approval during the period from June 2020 to June 2022. Written informed consent was obtained from participants or their surrogates before enrollment. Randomization was achieved using a computer-generated sequence. Concealment was achieved using opaque envelopes. Results there was no difference between study groups according to serum lactate. intra operative mean arterial blood pressure was higher in ketamine group than fentanyl group and norepinephrine infusion rate was increased in the two groups over the period from the baseline, but the most increase was in the fentanyl compared with ketamine group; as there was a statistically significant difference between them at 2-5 minutes then from 10 to 90 minutes with 10-minutes intervals. There was no statistically significant difference between study groups according to ICU length of stay and mortality rates. In this study we found that ketamine- based induction of anesthesia maintained hemodynamics better than fentanyl-based induction of anesthesia in patient with abdominal sepsis. Conclusion In anesthesia of septic patients ketamine midazolam was more effective than fentanyl midazolam in maintenance of hemodynamic stability.