{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:10:14Z","timestamp":1756361414608,"version":"3.44.0"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian J Neurosurg"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n               Objectives\u2003During anesthesia induction, fluctuations in systemic hemodynamic may also alter cerebral hemodynamic, especially in patients with intracranial tumors, as these patients might have impaired cerebral autoregulation. This study compared the effects of ketofol (a mixture of ketamine and propofol) and etomidate on cerebral blood flow, oxygenation, and systemic hemodynamics during anesthesia induction for craniotomy in patients with supratentorial tumors.<\/jats:p><jats:p>\n               Materials and Methods\u2003This prospective, randomized, double-blind study included 50 patients aged 18 to 65 years, American Society of Anesthesiologists (ASA) classes I to II, undergoing elective craniotomy. Patients were assigned to receive either ketofol or etomidate for induction. Middle cerebral artery (right and left side) mean flow velocity (mFV) and pulsatility index (PI) were measured using transcranial Doppler, and cerebral oxygenation (rSO2%) of both hemispheres was measured using near-infrared spectroscopy (NIRS) during the first 10\u2009minutes (1, 3, 5, and 10\u2009minutes) following anesthesia induction.<\/jats:p><jats:p>\n               Statistics\u2003An independent sample \u201ct\u201d test and one-way analysis of variance was used for continuous data. Chi-squared test was used for categorical data. Linear correlation between two continuous variables was explored using Pearson's correlation (normally distributed data) and Spearman's correlation (non-normally distributed data). A p-value of less than 0.05 was considered statistically significant.<\/jats:p><jats:p>\n               Results\u2003Both groups showed a fall in mFV (cm\/s) following induction, with a greater fall in the etomidate group (38.32\u2009\u00b1\u20092.54 vs. 28.88\u2009\u00b1\u20093.07; p\u2009=\u20090.001). In the etomidate group, mFV returned to baseline within 3\u2009minutes and rose after laryngoscopy, while it remained below baseline in the ketofol group. rSO2 decreased immediately postinduction but was better preserved in the ketofol group. Mean arterial pressure and heart rate significantly increased during laryngoscopy in the etomidate group (p\u2009&lt;\u20090.001).<\/jats:p><jats:p>\n               Conclusion\u2003Ketofol provided more stable cerebral hemodynamics, cerebral oxygenation, and systemic parameters compared with etomidate during anesthesia induction in patients undergoing craniotomy for supratentorial tumors.<\/jats:p>","DOI":"10.1055\/s-0045-1804530","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T18:52:51Z","timestamp":1740077571000},"page":"314-321","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the Effects of Ketofol and Etomidate on Cerebral Blood Flow and Oxygenation during Anesthesia Induction in Supratentorial Tumor Patients: A Randomized Double-Blind Study"],"prefix":"10.1055","volume":"20","author":[{"given":"Siddharth","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Department of Neuroanesthesia and Critical Care, Kalinga Institute of Medical Sciences, Bhuvneshwar, Orissa, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priyanka","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharmishtha","family":"Pathak","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8552-7861","authenticated-orcid":false,"given":"Ashutosh","family":"Kaushal","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivam","family":"Shekhar","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aditya R.","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"ref1","first-page":"189","volume-title":"Supratentorial masses: anesthetic considerations","author":"N J Bruder","year":"2017","edition":"6th ed."},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1097\/ANA.0b013e3181c9fbf1","article-title":"Cerebral autoregulation and CO2 reactivity before and after elective supratentorial tumor resection","volume":"22","author":"D Sharma","year":"2010","journal-title":"J Neurosurg Anesthesiol"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/ANA.0000000000000588","article-title":"Impact of anesthesia on long-term outcomes in patients with supratentorial high-grade glioma undergoing tumor resection: a retrospective cohort study","volume":"32","author":"J Dong","year":"2020","journal-title":"J Neurosurg Anesthesiol"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1097\/ACO.0000000000000365","article-title":"Recent trends in the anesthetic management of craniotomy for supratentorial tumor resection","volume":"29","author":"S E Gruenbaum","year":"2016","journal-title":"Curr Opin Anaesthesiol"},{"key":"ref5","first-page":"74","volume-title":"Effects of anesthetic agents and other drugs on cerebral blood flow, metabolism, and intracranial pressure","author":"M Matsumoto","year":"2017","edition":"6th ed."},{"issue":"12","key":"ref6","doi-asserted-by":"crossref","first-page":"2192","DOI":"10.1177\/0271678X18789273","article-title":"Effects of anesthesia on cerebral blood flow, metabolism, and neuroprotection","volume":"38","author":"A M Slupe","year":"2018","journal-title":"J Cereb Blood Flow Metab"},{"issue":"07","key":"ref7","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.7863\/jum.2010.29.7.1017","article-title":"Brain blood flow and velocity: correlations between magnetic resonance imaging and transcranial Doppler sonography","volume":"29","author":"F A Sorond","year":"2010","journal-title":"J Ultrasound Med"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/978-1-4615-1875-4_85","article-title":"Investigation of the effects of hypocapnia upon cerebral haemodynamics in normal volunteers and anaesthetised subjects by near infrared spectroscopy (NIRS)","volume":"361","author":"H Owen-Reece","year":"1994","journal-title":"Adv Exp Med Biol"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1023\/A:1009940031063","article-title":"Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia","volume":"16","author":"M B Kim","year":"2000","journal-title":"J Clin Monit Comput"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s12871-024-02446-4","article-title":"The effect of esketamine combined with propofol-induced general anesthesia on cerebral blood flow velocity: a randomized clinical trial","volume":"24","author":"S Yan","year":"2024","journal-title":"BMC Anesthesiol"},{"issue":"01","key":"ref11","first-page":"84","article-title":"Ketamine does not increase cerebral blood flow velocity or intracranial pressure during isoflurane\/nitrous oxide anesthesia in patients undergoing craniotomy","volume":"81","author":"T S Mayberg","year":"1995","journal-title":"Anesth Analg"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/BF01617730","article-title":"Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia","volume":"11","author":"A Thiel","year":"1995","journal-title":"J Clin Monit"},{"issue":"01","key":"ref13","first-page":"1","article-title":"The effect of propofol versus etomidate induction on middle cerebral artery flow velocities and its derived parameters using transcranial doppler ultrasonography","volume":"2","author":"R Dash","year":"2017","journal-title":"J Clin Anesth Manage"},{"issue":"01","key":"ref14","first-page":"21","article-title":"The effects of anaesthesia induction with propofol or ketofol on cerebral oxygenation in patients above 60 years of age","volume":"9","author":"H Duran","year":"2020","journal-title":"Medicine 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