Cardioversion: What to choose? Etomidate or propofol

Abstract

Context:Electrical cardioversion is a short painful procedure to regain normal sinus rhythm requiring anaesthesia for haemodynamic stability, sedation, analgesia and early recovery.Aims:To compare propofol and etomidate as sedatives during cardioversion.Settings and Design:Single centred, prospective and randomized single blind study comprising 60 patients.Subjects and Methods:Patients more than 18 years, American Society of Anesthesiologists I/II/III grades undergoing elective cardioversion, randomly divided to receive propofol 1 mg/kg intravenous (IV) bolus followed by 0.5 mg/kg (Group P, n = 30) or etomidate (Group E, n = 30) 0.1 mg/kg followed by 0.05 mg/kg. All patients received IV fentanyl (1 μg/kg) before procedure. Heart rate, blood pressure (BP) (systolic BP [SBP], diastolic BP [DBP], mean arterial pressure), respiratory rate, Aldrete recovery score (ARS) and Ramsay sedation score (RSS) were assessed at 1, 2, 5, 10, 15, 20 and 30 min post cardioversion. Incidence of hypotension, respiratory depression and side effects were compared.Statistical analysis used:Student's unpaired t-test, Chi-square test and Mann–Whitney test. P < 0.05 was taken as significant.Results:Group P showed significant fall in SBP, DBP, and mean BP at 2 min after cardioversion. Hypotension (33.3% Group P vs. 16.65% Group E) occurred more with propofol (P < 0.05). Group E showed better ARS at 1, 2, 5, 10, 15 and 20 min. Time required to attain RSS = 2 (659.1 s Group P and 435.7 s Group E) indicated longer recovery with propofol. Left atrial size (35.5-42.5 mm) did not affect success rate of cardioversion (80% Group P vs. 83.3% Group E). Incidence of myoclonus (Group E 26.67% vs. Group P 0%) showed significant difference.Conclusions:Etomidate/fentanyl is superior over propofol/fentanyl during cardioversion for quick recovery and haemodynamic stability.

Comparison of ketamine/propofol (ketofol) and etomidate/fentanyl (etofen) combinations for procedural sedation and analgesia in the emergency department: An observational study

“…Previous studies reported a sedation duration of 7.3–15 min with etomidate or etofen, and the sedation duration of our etofen cohort is among this range. 6 , 7 , 8 , 20 Kalogridaki et al. reported that 40% of the patient in etofen group needed additional doses, which is also similar to our findings (42.1%).…”

“…In previous research with etofen or etomidate alone, myoclonus was also the most commonly reported AE with a proportion of 6.6%–52%. 6 , 7 , 8 , 20 , 23 , 24 In our study, no treatment has been needed for emergence reactions, and the rate of this AE was similar to previous reports (1.8%–41.9%). 11 , 14 , 15 , 16 , 25 …”

“…In previous studies, minimal hypotension was consistently reported with etofen and etomidate and this decrease was reported as clinically insignificant by authors, which is consistent with our findings. 8 , 20 , 24 Last, in ketofol group, we observed a significantly higher median maximum change in ETCO 2 (+8% vs +2%), which is consistent with the higher rate of observed respiratory AEs with ketofol. We concluded from our findings that ketofol creates hypertension, and tachycardia at a significant level.…”

“…Addition of fentanyl to etomidate was proposed to decrease the required dose of etomidate and rate of myoclonus, and this combination was studied in several different clinical situations for almost 40 years. 17 , 18 , 19 , 20 , 21 , 22 However, in several studies no desaturation, respiratory AE or need for an airway intervention were reported. 21 , 22 The routine use nasal continuous oxygen at the rate of 4–5 L/min during PSA may have prevented patients to desaturate in those studies.…”

Effects of transcutaneous acupoint electrical stimulation combined with low-dose sufentanil pretreatment on the incidence and severity of etomidate-induced myoclonus

“…Since the introduction of etomidate as an agent for the induction of general anesthesia in 1973, [ 1 ] its use has gained popularity because of a favorable cardiovascular profile, [ 2 – 4 ] minimal respiratory side effects, [ 5 ] and rapid onset of action and clearance from the body. [ 6 ] Etomidate is a common choice of anesthetic drug for procedures that cause short-term pain, particularly in hemodynamically compromised patients.…”