{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:15:16Z","timestamp":1777936516157,"version":"3.51.4"},"reference-count":46,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,4,12]],"date-time":"2025-04-12T00:00:00Z","timestamp":1744416000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Semin Cardiothorac Vasc Anesth"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Etomidate has minimal cardiovascular depressant effects at the cost of endogenous cortisol production suppression, whereas propofol has vasodilatory and myocardial depressant properties, which may be poorly tolerated in the cardiac surgical population. To offset the undesirable effects of propofol, ketamine can be co-administered to harness its cardiac stimulatory properties. Though etomidate is a more cardio-stable induction agent than propofol, its superiority over the combination of propofol and ketamine\u2014colloquially known as \u201cketofol\u201d\u2014remains controversial.\n                    <jats:bold>Methods:<\/jats:bold>\n                    United States National Library of Medicine Database (MEDLINE) and Excerpta Medica Database (EMBASE) were searched for randomized controlled trials published since 2010 comparing etomidate and ketofol relative to propofol alone for induction of general anesthesia for coronary artery bypass grafting (CABG). Key data collected included post-induction nadir mean arterial pressure (MAP), heart rate, cardiac index, systemic vascular resistance (SVR), and serum cortisol levels at 24\u00a0hours postoperatively. Variables were compared by calculating a weighted mean difference (WMD) [95% confidence interval (CI)].\n                    <jats:bold>Results:<\/jats:bold>\n                    This analysis included 15 studies (1125 patients). Anesthetic induction with etomidate was associated with a higher nadir MAP and SVR compared to ketofol during the peri-induction period by WMD 4.77\u00a0mmHg [95% CI 0.31, 9.23,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.04] and 42.22\u00a0dynes\/cm\n                    <jats:sup>5<\/jats:sup>\n                    [95% CI 0.49-83.94,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.05]. However, there was no difference in the frequency of needed boluses of vasopressors or fluids for peri-induction hypotension.\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Though etomidate appears to provide a superior hemodynamic profile compared to ketofol, both agents require similar degrees of clinical response to hypotension during the induction of CABG surgery patients.\n                  <\/jats:p>","DOI":"10.1177\/10892532251332079","type":"journal-article","created":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T01:24:51Z","timestamp":1744507491000},"page":"246-257","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Etomidate vs Ketamine-Propofol for Induction of Anesthesia in Coronary Artery Bypass Grafting: An Updated Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2299-8436","authenticated-orcid":false,"given":"Nicolas","family":"Kumar","sequence":"first","affiliation":[{"name":"Massachusetts General Hospital"},{"name":", Harvard Medical School"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit","family":"Bardia","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital"},{"name":", Harvard Medical School"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael G.","family":"Fitzsimons","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital"},{"name":", Harvard Medical School"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9156-065X","authenticated-orcid":false,"given":"Michael","family":"Essandoh","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Mitchell","sequence":"additional","affiliation":[{"name":"University of California Los Angeles"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel R.","family":"Falkson","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital"},{"name":", Harvard Medical School"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6054-9650","authenticated-orcid":false,"given":"Adam","family":"Dalia","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital"},{"name":", Harvard Medical School"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Tang","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamara R.","family":"Sawyer","sequence":"additional","affiliation":[{"name":"Central Michigan University College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manoj H.","family":"Iyer","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,4,12]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2020.03.054"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-200007000-00014"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-59-6-1143"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2021.01.034"},{"issue":"1","key":"e_1_3_6_6_2","first-page":"35","article-title":"Hemodynamic and cardiodynamic effects of propofol and etomidate: negative inotropic properties of propofol","volume":"69","author":"Br\u00fcssel T","year":"1989","unstructured":"Br\u00fcssel T, Theissen JL, Vigfusson G, Lunkenheimer PP, Van Aken H, Lawin P. Hemodynamic and cardiodynamic effects of propofol and etomidate: negative inotropic properties of propofol. Anesth Analg. 1989;69(1):35-40.","journal-title":"Anesth Analg"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-021-06577-x"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00135"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aew126"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/78.6.642"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-135"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2005.06.006"},{"key":"e_1_3_6_14_2","volume-title":"Review Manager (RevMan): Version 5.3","year":"2020","unstructured":"Review Manager (RevMan): Version 5.3. 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Droperidol inhibits the effects of intravenous ketamine on central hemodynamics and myocardial oxygen consumption in patients with generalized atherosclerotic disease. Anesth Analg. 1983;62(2):193-197.","journal-title":"Anesth Analg"},{"key":"e_1_3_6_44_2","doi-asserted-by":"publisher","DOI":"10.1080\/09595239600185801"},{"key":"e_1_3_6_45_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2019.12.013"},{"key":"e_1_3_6_46_2","doi-asserted-by":"publisher","DOI":"10.1186\/1749-8090-5-26"},{"key":"e_1_3_6_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)00136-7"}],"container-title":["Seminars in Cardiothoracic and Vascular Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10892532251332079","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10892532251332079","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10892532251332079","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:34:51Z","timestamp":1777692891000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10892532251332079"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,12]]},"references-count":46,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1177\/10892532251332079"],"URL":"https:\/\/doi.org\/10.1177\/10892532251332079","relation":{},"ISSN":["1089-2532","1940-5596"],"issn-type":[{"value":"1089-2532","type":"print"},{"value":"1940-5596","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,12]]}}}