A Comparative Study of Effect of Propofol, Etomidate and Propofol Plus Etomidate Induction on Hemodynamic Response to Endotracheal Intubation: A RCT

Abstract

Objective: The primary objective of this study was to compare the efficacy of 3 different anesthesia induction approach (Inj. Propofol, Inj. Etomidate and Inj. propofol plus Inj Etomidate) in maintaining hemodynamic stability during induction and following endotracheal intubation in elective surgery. Material and method:Ethical committee clearance taken, 90 patients aged 15 to 60 years of either sex and ASA physical status I or II scheduled for elective surgery under general anesthesia were taken for study. Written and informed consent was taken. The patients were randomly placed into three groups. Group I induced with Inj. Propofol (2.5 mg/kg) intravenous, Group II with Inj. Etomidate (0.3 mg/kg) intravenous and Group III with Inj. Propofol (1 mg/kg) plus Inj. Etomidate (0.2 mg/kg) intravenous. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and oxygen saturation (SPO 2 ) were noted at different time interval.Results: Heart rate in all study groups decreases after induction and it was more in group I compared to group II and III (p<0.000) and after intubation HR increases in all three groups but this increase is greater in group II than other two groups. MAP among all three groups decreases after induction and it was more in group I than group II and III. Significant increase in MAP was seen at 1 min after intubation in all three groups but this increase was not sustained and returned to baseline in group II and III. Conclusion:The combination of etomidate plus propofol has better hemodynamic stability than etomidate alone at 1 min after intubation, though etomidate was equally stable at other points of time. The combination proved to be significantly better than either propofol or etomidate alone.

Comparative Study of Propofol and Etomidate on the Haemodynamic Effects During Induction and Endotracheal Intubation

“…1,2,14 There are various studies which have compared the haemodynamic variations with propofol and etomidate following induction and endotracheal intubation. Similar to our finding, Meena K et al 16 showed that heart rate decreased after induction but increased after laryngoscopy and intubation and the increase with the etomidate group was statistically significantly higher than that of propofol. Their study also showed a significant decrease in arterial blood pressure after induction with propofol which did not increase above baseline value after intubation while with etomidate, there was a significant increase in arterial pressure following intubation, hence showing better haemodynamic condition with etomidate as compared to propofol.…”

To Evaluate the Haemodynamic Effects of Etomidate and a Combination of Etomidate and Propofol as Induction Agents in Elective Surgeries

“…8 Combination of different induction agents has been used in the past which cause an evident decrease in anaesthetic, better sedation and amnesia, decreased side effects and reduce cost. 10 Demographic profile with respect to age, sex and weight were comparable in both the groups and consistent with the study by K Meena et al with age group (p=0.178) and gender distribution (p=0.241). 2 Statistically significant difference was found in heart rate, SBP, DBP and MAP in both the groups at 0 min and after 1 minute of induction with hemodynamic parameters significantly higher in etomidate group than the etofol group but did not require any clinical intervention.…”

“…There has been search of an ideal induction agent that is haemodynamically stable during laryngoscopy and without side effects since the advent of anaesthesia. 10 Thiopentone, Etomidate, Propofol, Midazolam, and Ketamine are the commonly used induction agents. 11,12 There are concerns regarding smooth induction and emergence from anaesthesia with thiopentone, midazolam and ketamine.…”

Pro: Propofol Is a Better Induction Agent than Etomidate

“…1 A combination of propofol and etomidate was found to be better than either propofol or etomidate alone when used for induction during general anesthesia. 2 The primary concern with the use of propofol is hypotension. It was shown that propofol causes a 34% reduction in mean arterial pressure-time integral from the baseline after induction when compared with etomidate, despite the use of vasopressors.…”