Variation of hemodynamic response following induction and tracheal intubation: etomidate vs midazolam

Abstract

Background: Induction and endotracheal intubation are invariably associated with certain cardiovascular changes during anaesthesia practice and can lead to sudden swings of blood pressure, arrhythmias, MI and cardiovascular collapse especially in geriatric and haemodynamically unstable patients. Therefore it is desirable to use a safer agent with fewer adverse effects to minimise these complications. Present prospective randomized study is designed to compare the haemodynamic alterations and various adverse effects following induction with etomidate and midazolam.Methods: Hundred ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving etomidate (0.3mg/kg) and midazolam (0.15mgk/kg) as an induction agent. Vital parameters before and after induction and thereafter at specified time interval following laryngoscopy and intubation were recorded for comparison. Adverse effect viz. pain on injection, apnea and myoclonic activity were also carefully watched.Results: Demographic variables in both the groups were comparable. Patients in both the groups showed little change in mean arterial pressure (MAP) and heart rate (HR) from baseline value (p >0.05). Pain on injection and myoclonic activity were seen in etomidate group while delayed awakening was seen with Midazolam group.Conclusions: This study concludes that both etomidate and midazolam provides haemodynamic stability but Midazolam can be preferred as an induction agent in view of fewer side effects.

Observation of hemodynamic variability and level of blood cortisol while induction with propofol and etomidate: A prospective, randomized, double blind study

“…We found that after induction, there was a decrease in heart rate from the baseline in both the groups which on comparison was found to be non-significant (p value 0.0615). The findings of this study corroborates with the study report of Sarkar Molly et al (2005), 9 Shagun Bhatia Shah et al (2015), 13 Kaushal Ram Prasad et al (2015), 14 Binod Pegu et al (2017) 15 that decrease in heart rate is more on induction with injection propofol than with injection etomidate which on comparison found to be non-significant. The mean MAP is significantly decreased in both the groups (p<0.001) but the fall is more in group A and at 5 min after intubation MAP is increased in both the groups which becomes comparable in both the groups at 10 min.…”