Comparative study of propofol and etomidate as intravenous induction agents for general anesthesia: hemodynamic effects, adrenal suppression, and blood glucose response in controlled hypertensive patients
Keywords:Adrenal suppression, Controlled hypertension, Etomidate, General anesthesia induction
Background: General anesthesia induces unconsciousness and loss of reflexes, facilitating complex medical treatments. The induction of anesthesia is crucial for patient comfort and procedural success, with propofol and etomidate being common intravenous induction agents. Propofol offers a rapid onset and short duration, while etomidate is known for cardiovascular stability.
Methods: A prospective randomized controlled trial involving 100 controlled hypertensive patients compared propofol and etomidate for induction. Hemodynamic parameters and biochemical responses were monitored at various intervals. Injection site discomfort and myoclonus were assessed, and cortisol and glucose levels were measured.
Results: Baseline hemodynamic values were similar. Etomidate resulted in stable hemodynamics as compared to propofol. Blood sugars were comparable. Though serum cortisol levels were reduced after etomidate was given. But it came back to normal range 24 hours after surgery. Injection site pain was reported by 20% of etomidate patients and 10% of propofol patients. No myoclonus occurred.
Conclusions: Etomidate is an effective induction agent for controlled hypertensive individuals, causing transient adrenal suppression without affecting blood sugar levels.
Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Coté CJ, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2006;104(5):1081-118.
Bevan JL, Stoelting RK. Basics of anesthesia. 6th ed. New York, NY: McGraw-Hill Education; 2017.
Etches DJ. Glass P. Anesthesia for the patient with hypertension. Anesth Analgesia. 2016;123(1):33-45.
Gupta A, Pandharipande PP. Induction agents for general anesthesia. In: BA Miller (Ed.), Miller's anesthesia. 8th ed. Philadelphia, PA: Elsevier; 2019:571-92.
Lee CJ, Eisenkraft J. Cardiovascular effects of induction agents. In T. A. Greenbaum (Ed.), Anesthesia secrets. 7th ed. Philadelphia, PA: Mosby; 2016:167-74.
Malviya S, Vohra S. Induction agents for general anesthesia in children. Pediatric Anesthesia. 2019;29(10):1081-91.
Pandit AA, O'Leary PD. Adrenal suppression and anesthesia. Anesthesiol. 2016;125(5):1254-66.
Srivastava S, Aggarwal R, Gupta R, Kaushal RP. Comparison of etomidate and propofol for induction of anaesthesia in controlled hypertensive patients: A prospective randomized study. J Anaesth. 2015;29(2):133-9.
Kaushal RP, Vatal A, Pathak R. Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass. Ann Card Anaesthe. 2015;18(2):172.
Naya, K, Nitha S. Variation in plasma cortisol levels in response to etomidate and ketamine in paediatric patients undergoing patent ductus arteriosus ligation. Ind J Anaesth. 2016;60(1):51-5.
Mozanski M, Sessler DI, Sigl J. Comparison of serum cortisol levels in morbidly obese patients scheduled for elective laproscopic surgeries using etomidate and thiopental. J Clin Anesth. 2016;38(4):313-7.
Gu H, Zhang M, Cai M, Liu J. Comparison of adrenal suppression between etomidate and dexmedetomidine in children with congenital heart disease. Medical Science Monitor: Int Med J Experi Clin Res. 2015;21(4):1569.