Septic Shock Clinical Trial
Official title:
Lidocaine-Ketamine Versus Ketamine for Induction of Anesthesia in Septic Shock Patients: a Randomized Controlled Trial
The aim of the work is to investigate the effect of using lidocaine in combination with low dose ketamine in induction of anesthesia for septic shock patients compared to normal dose of ketamine.
Most of the drugs used for induction of anesthesia negatively impact patient hemodynamics.
Thus, induction of anesthesia in shocked patients might result in deleterious hypotension.
Patients with severe sepsis and septic shock frequently need surgical interventions. The best
protocol for induction of anesthesia in septic shock patients is lacking.
Ketamine is an agent used for induction of anesthesia with known positive cardiovascular
effects. However, these positive effects were reported in individuals with intact sympathetic
nervous system. Invitro studies showed that ketamine direct action on the cardiac muscles is
negative. Thus, it had been recommended that ketamine should be used with caution in
hemodynamically vulnerable patients till further randomized controlled trials are present.
Lidocaine is a drug with multiple local and systemic uses. Having local anesthetic
properties, lidocaine was proposed to have an anesthetic sparing effect. Lidocaine was
previously reported to enhance the hypnotic effect of thiopentone, propofol, and midazolam
during induction of anesthesia. Lidocaine showed a sparing effect for volatile as well as
intravenous requirements for maintenance of anesthesia; thus, we hypothesize that its use as
an adjuvant during induction of anesthesia in septic shock patient could provide a sparing
effect for ketamine and minimize its negative circulatory sequelae.
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