A Compar a Tive Study of Haemodynamic Effects of Propofol and Etomidate as an Induction Agent in Coronory Artery Surgery

Abstract

BACKGROUND:Patients undergoing coronary artery bypass grafting are susceptible to haemodynamic labiality during anaesthesia induction. AIMS AND OBJECTIVE: To evaluate the hemodynamic effects of etomidate in comparison to that of propofol during induction of general anaesthesia. SETTINGS AND DESIGN: The study was conducted in the department of anaesthesia of a tertiary care medical college setting over a period of one year from October 2013 to October 2014 on patients undergoing elective coronary artery bypass surgery under general anaesthesia. MATERIAL AND METHODS: 40 adult patients who are aged 35-65 years belonging to American Society Anaesthesia grades 1 and 2 undergoing elective surgery under general anaesthesia, were divided randomly into two groups of 20 patients each. By using bispectral index of 50 as a goal for induction, group a patients were given intravenous propofol injection, and group B were given etomidate injection. STASTICAL ANALYSIS: Data is presented as mean and standard deviation. The statistical analysis was performed using SPSS 15.0, Stata 8.0, medicals 9.0.1 and Systat 11.0. A "p" value of less than 0.05 was taken as significant. RESULTS: Our results in both (P and E respectively) groups showed significant reduction in arterial pressure (30%-22%), SVRI (31%-23%), and LVSWI (38%-32%) after anaesthesia induction. However, the heart rate (3%-10%) and cardiac index did not change significantly. SVRI significantly increased in the etomidate group after intubation. CONCLUSION: Propofol can produce a larger reduction in contractility, arterial pressure, and after load when compared to etomidate as an induction agent in patients with coronary artery disease. Etomidate is less effective in preventing stress response to intubation.

Comparison of hemodynamic effects of etomidate and propofol as an induction agent in patients with LVEF 40% undergoing elective coronary artery bypass grafting surgery – A prospective and randomized study

“…We observed that post intubation pressor response occurred more in etomidate group and required drug to control this response, and this comparison was statistically significant. (p=0.002) This observation is consistent with Singh R et al 14 and Shivanna S et al 18 study.…”

“…Thereafter SBP, DBP and MAP returned slowly around baseline at post intubation 15 min.in both the groups. These observations are consistent with Kaushal RP et al, 11 Kamath MN et al, 16 Sivanna S et al, 18 and Shukla N et al 19 The observations of Singh R et al 14 are dissimilar to the present study as they concluded that both anesthetic agents were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction despite a 27-32% decrease in the mean arterial pressure and the outcome of anesthetic induction may depend on factors such as the speed of injection, route, dose and experience of the clinician, other than the property of the agent itself.…”

Haemodynamic Effects of Etomidate and Propofol on Induction of General Anaesthesia and Endotracheal Intubation- A Clinical Comparison

“…However, the heart rate (3%-10%) and cardiac index did not change significantly. 9 In 2008, Jack and colleagues conducted a study on 10 patients to know cardiovascular changes after achieving constant effect-site concentration of propofol. Propofol TCI was started with a target of 8 μg/mL and then reduced to 4 μg/mL after 2 minutes.…”