Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial

Abstract

BACKGROUND The ideal depth of general anesthesia should achieve the required levels of hypnosis, analgesia, and muscle relaxation while minimizing physiologic responses to awareness. The choice of anesthetic strategy in patients with coronary heart disease (CHD) undergoing major noncardiac surgery is becoming an increasingly important issue as the population ages. This is because general anesthesia is associated with a risk of perioperative cardiac complications and death, and this risk is much higher in people with CHD. AIM To compare hemodynamic function and cardiovascular event rate between etomidate- and propofol-based anesthesia in patients with CHD. METHODS This prospective study enrolled consecutive patients (American Society of Anesthesiologists grade II/III) with stable CHD (New York Heart Association class I/II) undergoing major noncardiac surgery. The patients were randomly allocated to receive either etomidate/remifentanil-based or propofol/remifentanil-based general anesthesia. Randomization was performed using a computer-generated random number table and sequentially numbered, opaque, sealed envelopes. Concealment was maintained until the patient had arrived in the operating theater, at which point the consulting anesthetist opened the envelope. All patients, data collectors, and data analyzers were blinded to the type of anesthesia used. The primary endpoints were the occurrence of cardiovascular events (bradycardia, tachycardia, hypotension, ST-T segment changes, and ventricular premature beats) during anesthesia and cardiac troponin I level at 24 h. The secondary endpoints were hemodynamic parameters, bispectral index, and use of vasopressors during anesthesia. RESULTS The final analysis included 40 patients in each of the propofol and etomidate groups. The incidences of bradycardia, hypotension, ST-T segment changes, and ventricular premature beats during anesthesia were significantly higher in the propofol group than in the etomidate group ( P < 0.05 for all). The incidence of tachycardia was similar between the two groups. Cardiac troponin I levels were comparable between the two groups both before the induction of anesthesia and at 24 h after surgery. When compared with the etomidate group, the propofol group had significantly lower heart rates at 3 min after the anesthetic was injected (T 1 ) and immediately after tracheal intubation (T 2 ), lower systolic blood pressure at T 1 , and lower diastolic blood pressure and mean arterial pressure at T 1 , T 2 , 3 min after tracheal intubation, and 5 min after tracheal intubation ( P < 0.05 for all). Vasopressor use was significantly more in the propofol group than in the etomidate group during the induction and maintenance periods ( P ...

Effect of remimazolam induction on hemodynamics in patients undergoing valve replacement surgery: A randomized, double‐blind, controlled trial

“…Dai et al found that propofol‐based anesthesia was associated with significantly higher incidences of bradycardia, hypotension, ST‐T segment abnormalities, and ventricular premature beats in patients with coronary heart disease undergoing noncardiac surgery under general anesthesia. 21 Kleiman RB et al confirmed that remimazolam did not prolong QT interval and did not increase the risk of ventricular arrhythmia. 22 In this study, the hemodynamics of the remimazolam induction group was more stable, the incidences of hypotension, and the cumulative norepinephrine doses used per patient, averaged per group were lower than those in the propofol induction group during anesthesia induction of patients undergoing valve replacement surgery under CPB, which was undoubtedly more favorable for patients undergoing valve replacement surgery.…”

“…Dai et al found that propofol‐based anesthesia was associated with significantly higher incidences of bradycardia, hypotension, ST‐T segment abnormalities, and ventricular premature beats in patients with coronary heart disease undergoing noncardiac surgery under general anesthesia 21 . Kleiman RB et al confirmed that remimazolam did not prolong QT interval and did not increase the risk of ventricular arrhythmia 22 .…”

The difference in mean arterial pressure induced by remimazolam compared to etomidate in the presence of fentanyl at tracheal intubation: A randomized controlled trial

“…General anesthesia is associated with cardiovascular depression and disruption of the autonomic nervous control system by anesthetic agents, which leads to redistribution of intravascular volume, thus resulting in PIHO. Etomidate is considered to be one of the most suitable anesthetic induction drugs because of its reliable sedation and hemodynamic stability ( Aggarwal et al, 2016 ; Mohr et al, 2020 ; Dai et al, 2021 ). The lack of hemodynamic depression is a good characteristic of remimazolam ( Doi et al, 2020a ; Doi et al, 2020b ; Zhu et al, 2021 ).…”

Determination of the median effective dose of sufentanil for inhibiting the laryngeal mask insertion response in geriatric patients: a prospective, double-blinded, dose–response trial

“…However, propofol has a strong circulatory inhibitory effect, which often causes a significant drop in blood pressure, which is more pronounced in geriatric patients or patients with insufficient effective circulating blood volume. Because etomidate has little effect on circulation [ 7 , 8 ], it is often used for induction in geriatric patients, but etomidate does not inhibit the upper airway reflex, and it can make LMA insertion very difficult when used alone, so it needs to be combined with opioids. Among the opioids used, sufentanil is often used for anesthesia in the elderly.…”