COMPARISON OF PROPOFOL AND KETAMINE ON HEMODYNAMIC STABILITY DURING INDUCTION OF GENERAL ANESTHESIA: A PROSPECTIVE COMPARATIVE OBSERVATIONAL STUDY

Abstract

Background: Hemodynamic stability during induction of general anesthesia is a critical determinant of perioperative safety. The choice of induction agent significantly influences cardiovascular parameters including heart rate and blood pressure. Propofol and Ketamine represent two pharmacologically distinct induction agents with opposing hemodynamic profiles, yet comprehensive comparative data from resource-limited clinical settings remain limited.

Objective: To compare the hemodynamic effects of Propofol and Ketamine on heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) during induction of general anesthesia and following endotracheal intubation in patients undergoing elective surgical procedures.

Methods: A prospective comparative observational study was conducted at PHQ Teaching Hospital Gilgit from March 2026 to July 2026. A total of 120 patients undergoing elective surgery under general anesthesia were enrolled and divided into two groups: Group P (Propofol 2 mg/kg IV, n=63) and Group K (Ketamine 2 mg/kg IV, n=57). Hemodynamic parameters including HR, SBP, and DBP were recorded at baseline, after induction, and after endotracheal intubation. Data were analyzed using SPSS v25.0, employing Chi-square tests and independent samples t-tests, with p≤0.05 considered statistically significant.

Results: Baseline demographic and clinical characteristics including age (p=0.299), gender (p=0.632), and ASA classification (p=0.570) were comparable between groups. Following induction, the Propofol group demonstrated significantly lower heart rates (61–70 bpm: 60.3%) compared to the Ketamine group (81–90 bpm: 43.9%; 91–100 bpm: 36.8%) (χ²=64.934, p<0.001). After intubation, Ketamine recipients showed markedly elevated HR (91–110 bpm: 70.2% vs. 7.9% in Propofol, χ²=66.363, p=0.001). Post-induction SBP was significantly higher in the Ketamine group (131–150 mmHg: 38.6%) compared to Propofol (90–110 mmHg: 44.4%) (χ²=39.437, p=0.001). Post-intubation DBP was also markedly elevated in the Ketamine group (81–120 mmHg: 91.2%) versus Propofol (41.3%) (χ²=37.941, p=0.001).

Conclusion: Propofol provided significantly superior hemodynamic stability during induction of general anesthesia and endotracheal intubation compared to Ketamine. Ketamine’s sympathomimetic properties resulted in clinically significant elevations in heart rate and blood pressure, particularly following intubation. Propofol should be considered the preferred induction agent when hemodynamic stability is a primary clinical concern, while Ketamine may be reserved for patients with pre-existing cardiovascular depression or hemodynamic instability.