Key result
Etomidate resulted in a significantly lower fall in mean arterial pressure after induction compared to propofol in both normotensive (10.22% vs 23.97%) and hypertensive (12.21% vs 33.33%) patients (p<0.001).
Why the study?
Induction of anaesthesia can cause adverse haemodynamic effects detrimental in hypertensive patients, and the advantages of etomidate in hypertensive patients had not yet been investigated.
Does etomidate improve haemodynamic stability compared to propofol in normotensive and hypertensive patients undergoing general anaesthesia?
RCT (n=120)
Randomly allocated
No
Does etomidate improve haemodynamic stability compared to propofol in normotensive and hypertensive patients undergoing general anaesthesia?
p-value: p=<0.001
Etomidate provides better mean arterial pressure stability than propofol during induction of general anaesthesia in both normotensive and hypertensive patients, though propofol better maintains heart rate.
Etomidate should be considered for induction when MAP stability is critical; confirms haemodynamic advantage over propofol in this RCT.
Background: Induction of anaesthesia and endotracheal intubation are associated with adverse haemodynamic effects which are detrimental in hypertensive patients. Although etomidate is found to be a cardio stable induction agent, its advantages in hypertensive patients are not yet investigated. Aim of the present study is to compare the haemodynamic parameters following induction of anaesthesia with etomidate and propofol in normotensive and hypertensive patients. Methods: In a prospective comparative study, 120 patients aged 18 to 60 years, of both sex and ASA status I & II posted for elective surgery under general anaesthesia were divided into 4 groups of 30 each. Anaesthesia was induced with either propofol or etomidate. Heart rate(HR), Systolic Blood Pressure(SBP), Diastolic Blood Pressure(DBP), Mean Arterial Pressure(MAP) and SpO2 were noted down at baseline, pre-induction, after induction, at laryngoscopy and 1, 3 & 5 minutes post intubation. Results: There was a significant fall in HR after induction with propofol which was more in the hypertensive group. After intubation, a rise in HR was observed in all 4 groups which returned to baseline by 5 minutes. A fall in MAP, SBP and DBP were observed in all the groups following induction, which shooted up after intubation. The fall in MAP with propofol was significantly higher when compared to etomidate which offered stable haemodynamic conditions. Conclusion: The present study suggests that induction of anaesthesia with etomidate is associated with better stability of MAP in normotensive as well as hypertensive patients when compared with propofol. However, HR is better maintained with propofol. Thus there is no clear evidence supporting induction by etomidate in hypertensive patients.
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Alappat et al. (2020) conducted an RCT in Normotensive and hypertensive patients undergoing elective surgery under general anaesthesia (n=120). Etomidate vs. Propofol was evaluated on Fall in Mean Arterial Pressure (MAP) from baseline after induction (p=<0.001). Etomidate resulted in a significantly lower fall in mean arterial pressure after induction compared to propofol in both normotensive (10.22% vs 23.97%) and hypertensive (12.21% vs 33.33%) patients (p<0.001).
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