Why the study?
The optimal choice of inducing agent can partially modify post-induction hypotension, which has a reported incidence of 9-40%.
Does propofol or etomidate improve induction time, intubation response, and recovery time compared to thiopentone in patients undergoing laparoscopic cholecystectomy?
Does propofol or etomidate improve induction time, intubation response, and recovery time compared to thiopentone in patients undergoing laparoscopic cholecystectomy?
Propofol is the preferred induction agent for laparoscopic cholecystectomy due to faster induction, better attenuation of intubation response, faster recovery, and stable hemodynamics compared to thiopentone and etomidate.
Propofol warrants preference for induction in laparoscopic cholecystectomy; extends RCT evidence favoring it over etomidate and thiopentone.
: Optimal choice of inducing agent can partially modify the post induction hypotension, having a reported incidence of 9-40% in various studies. So, we compared the induction and recovery profile of the routinely available induction agents. This prospective randomized, comparative study was carried out on 120, ASA 1 and II patients undergoing routine laparoscopic cholecystectomy. Patient received either thiopentone 5 mg/kg, propofol 2.0 mg/kg or 0.3mg/kg injection etomidate at induction in group T, P and E respectively. The time taken from the administration of inducing agent to loss of eyelash reflex was noted. Heart rate, systolic, diastolic and mean arterial pressure, SpO2 was recorded at 1, 2, 3, 4, 5, 6 minutes and every five minutes after intubation. Steward score and the vitals were noted every 5 minutes after extubation till 30 minutes. It was noted that how long it took to get a Steward score of 6. The mean induction time (sec) was 49.85 ±2.54 in group T, 43.45 ±2.66 in group P and 52.675 ±2.11 in group E. (p<0.0001). The increase in mean heart rate from baseline upon induction and intubation was (10%, 31% in group T), (3%, 23% in group E) and (-7%, 16% in group P) (p<0.0001). Post induction decrease in systolic, diastolic and mean blood pressures observed in group T was (-9%, -4.5%, -6%), (-12.8%, -9.8%, -11%), in group P and (-4.6%, -1.7%, -2.9%) in group E. (p<0.0001). Post intubation increase in systolic, diastolic and mean blood pressures was (21.76%, 18%, 19.7%) in group T, (16%, 8.1%, 11.7%) in group E and (9.6%, 0%, 4%) in group P. Mean recovery time in min was 5.87 ±0.23 min with propofol, 6.97 ±0.28 with etomidate and 8.96 ±0.28 with thiopentone. (p<0.0001). : Amongst the three agents, we recommend propofol as preferred agent for induction due to faster induction, better attenuation of intubation response, faster recovery and stable hemodynamic parameters.
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Kumar et al. (2023) studied this question.
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