Key result
Etomidate resulted in a significantly lower incidence of respiratory depression (26.7% vs 76.7%, p=0.0001), less injection site pain, and better hemodynamic stability compared to propofol.
Why the study?
Many short-duration anal and perianal surgeries are performed on a day care basis to decrease hospital stay and financial burden, prompting a comparison of propofol and etomidate for general anaesthesia.
Does etomidate improve hemodynamic stability compared to propofol in adults undergoing ambulatory anal and perianal surgeries?
RCT (n=60)
Open-label
Computer generated random numbers
No
Does etomidate improve hemodynamic stability compared to propofol in adults undergoing ambulatory anal and perianal surgeries?
Absolute Event Rate: 26.67% vs 76.67%
p-value: p=0.0001
Etomidate provides better hemodynamic stability and fewer local side effects compared to propofol for short-duration ambulatory surgeries.
Etomidate may be preferred over propofol for short ambulatory anal procedures; extends RCT evidence of respiratory and hemodynamic advantages to this setting.
Background: - In present times many anal and perianal surgeries of shorter duration are preferably performed on day care basis leading to decrease in hospital stay and financial burden on patient. We conducted randomized clinical study to compare propofol and etomidate for general anaesthesia in ambulatory anal and perianal surgeries. Methods: - 60 adult patients of age groups (18-60 years) ASA grade I and II posted for anal and perianal surgeries of 25-30 minutes duration were randomly divided into two groups. Group I (E) n=30 patients received etomidate as bolus dose of 0.1mg/kg IV followed by 0.05mg/kg every 4 minutes and in Group II (P) n=30 patients propofol as bolus dose of 1.5 mg/kg IV followed by 0.5mg/kg IV every 4-5 minutes as induction agent till completion of surgery. Hemodynamic parameters (SBP, DBP, HR) Variations and oxygen saturation were recorded at various time intervals. Clinical characteristics like pain at injection site, any adverse effects like incidence of myoclonus, nausea & vomiting, anaphylaxis were also recorded. Results: - The two groups were statistically comparable regarding demographic characteristics and duration of surgery. Systemic SBP, DBP& HR were significantly decreased in propofol groups as compared to etomidate group. There was statistical no significant difference between clinical variables (recovery time and patient satisfaction) between two groups. However pain at injection site and incidence of respiratory depression was statistically significant between two groups. Regarding incidence of anaphylaxis, nausea, vomiting, myoclonus difference between two groups were statistically non-significant. However, incidence of myoclonus was in etomidate group.but was antagonized by premedication with inj. fentanyl or midazolam. Conclusion: - We conclude that etomidate can be better alternative to propofol due to minimum local side effects like pain on injection, less incidence of PONV where variation of hemodynamic parameters are of concern especially in patients having medical co-morbidities in shorter duration day care surgeries. Limitation of our study is that we have not taken into account incidence of thrombophlebitis, further study is also needed to establish the safety of patients with etomidate in poor left ventricle function, hypotension and shock.
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Singh et al. (2022) conducted an RCT in Ambulatory anal and perianal surgeries (n=60). Etomidate vs. Propofol (1.5 mg/kg IV bolus followed by 0.5 mg/kg IV every 4-5 minutes) was evaluated on Incidence of respiratory depression (p=0.0001). Etomidate resulted in a significantly lower incidence of respiratory depression (26.7% vs 76.7%, p=0.0001), less injection site pain, and better hemodynamic stability compared to propofol.
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