Question

Which of the following anaesthetic drugs is contraindicated in a patient with hypertension who is being posted for cholecystectomy?

• A. Ketamine
• B. Propofol
• C. Etomidate
• D. Midazolam

Hint:

Which induction agent raises BP and heart rate via sympathetic stimulation?

Answer 1

The Correct Option is A

The clinical decision here rests on cardiovascular safety. A hypertensive patient should not be given an induction agent that pushes blood pressure and pulse upward. Work through the pharmacology: ketamine is unique among the choices in being a sympathomimetic. By increasing central sympathetic outflow and blocking the re-uptake of catecholamines, it elevates heart rate, arterial pressure, cardiac output, and the heart's oxygen consumption. That is exactly the wrong direction for someone already hypertensive, which is why ketamine is avoided in such patients (and also in coronary disease and raised intracranial pressure). The remaining agents behave oppositely or neutrally: propofol typically drops the pressure through vasodilation and mild myocardial depression, etomidate is prized for keeping haemodynamics steady, and midazolam produces only a gentle fall in pressure. So the one drug to keep away from a hypertensive surgical candidate is ketamine, in agreement with the answer key. $Ketamine$ is contraindicated.\[\boxed{\text{Ketamine}}\]