A clinical comparison of etomidate-lipuro, propofol and admixture at induction

Abstract

Objective:The purpose of this study was to compare etomidate-lipuro and propofol and 50%, (1:1) admixture of these agents at induction with special reference to injection pain, hemodynamic changes, and myoclonus.Methods:Ninety patients were assigned at random to three groups in which induction was performed with either etomidate-lipuro, propofol or etomidate-lipuro–propofol admixture. After monitorization with bispectral index (BIS) all agents were given with infusion with a perfuser at a constant rate of 200 ml/min till the BIS values decreased to 40. Blood pressure and heart rate were measured every 30 s at this period. Patients were asked for pain at the injection site and observed visually for myoclonus. The time BIS values decreased to 40 (BIS 40 time) and total amounts of induction doses were measured.Results:BIS 40 time measurements were P > E > PE (199.4 ± 40.9, 176.9 ± 31.6, 163.5 ± 20.6 s). The hemodynamic (systolic, diastolic and mean blood pressures, heart rate) changes were minimal in group PE than other two groups (P = 0.017). The intensity of myoclonus was graded as mild in 9, moderate in 12, and severe in 5 patients in the group E (76.3%). Myoclonus was not observed in group PE and group P. There were no injection pain in group PE as the incidence were (83.8%) in group P and in (63.2%) group E.Conclusion:Incidence of hemodynamic changes, myoclonus, and injection pain is significantly lower in group PE. BIS 40 times is least in group PE. We concluded that 1:1 admixture of etomidate-lipuro and propofol is a valuable agent for induction.

Induction of Anaesthesia With Etomidate in Lipid Emulsion: A Randomized Comparison With Thiopentone and Propofol

“…7 Saricaoglu F, et al (2015) reported significant decrease in mean and systolic blood pressure in propofol group compared to etomidate. 4 Similar findings also reported by Stephan et al (1986), Kaushal et al (2015), Singh R, et al (2015). 8,9,10 Our study is correlated with above studies.…”

“…3 Saricaoglu F et al (2015) reported statistically significant prolongation of induction time with etomidate compared to propofol, using time to reach BIS to 40 as end point of induction whereas in present study we have taken loss of eyelash reflex as criteria for induction time. 4 Gooding JM, et al (1977) studied effect of etomidate on the cardiovascular system and reported that an induction dose of etomidate given to cardiac patients for non-cardiac surgery results in almost no change in heart rate, mean arterial pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure and cardiac index. 5 Coates DP, et al (1987) studied haemodynamic effect of infusion of emulsion formulation of propofol.…”

“…Addition of lidocaine to the propofol solution is commonly practiced, but despite this the incidence of pain on injection remains unacceptably high (20-39%). 1,4 Solvent used in etomidate causes pain on injection. The side effects of etomidate dissolved in PG can be eliminated while retaining the profile of actions when it is dissolved in lipofundin (medium chain triglycerides).…”

Induction properties of propofol and etomida: a clinical comparative study

“…Similar results were obtained by Hashaam B Ghafoor et al and Fatma Saricaoglu et al when hemodynamic parameters were compared with etomidate and propofol at induction time. 6,12 These hemodynamic effects were dose dependent, attributable to a decrease in sympathetic activity, direct vasodilation and myocardial depression. 13,14 …”

Comparision of Etomidate versus Propofol for Anaesthesia in Short Case Surgical Procedures

“…Decrease in systemic blood pressure after bolus injection of propofol is dependent on both vasodilation with reduced preload and after load and myocardial depression (negative inotropic action). 4 Wu et al 5 also concluded that etomidate preserve hemodynamic stability during anesthesia. Larsen et al 6 examined the effects of propofol upon myocardial function by measuring changes in left ventricle function using transthoracic tissue-Doppler echocardiography and concluded that a decrease in MAP with propofol is secondary to reduce cardiac filling or a consequence of a direct negative inotropic action of propofol.…”