Optimal Etomidate Induction Dosage Combined With Nerve Block Minimizes Postoperative Cognitive Dysfunction and Enhances Hemodynamic Stability in Elderly Hernia Patients

BACKGROUND: Etomidate combined with nerve block is commonly used for elderly hernia surgery, but standardized dosing regimens remain lacking. OBJECTIVE: This study aimed to evaluate the effects of different induction doses of etomidate combined with nerve block on hemodynamic stability and cognitive function in elderly hernia patients, aiming to optimize the induction strategy. METHODS: 106 elderly patients scheduled for elective hernia surgery were randomly assigned to low-dose (0.1 mg/kg, n = 35), medium-dose (0.2 mg/kg, n = 36), or high-dose (0.3 mg/kg, n = 35) etomidate groups. All received sufentanil 0.3 μg/kg and remimazolam 0.3 mg/kg with nerve block. Intraoperative vital signs, postoperative cognitive function, and adverse events were compared. Multivariate analysis identified postoperative cognitive dysfunction (POCD) risk factors. RESULTS: The medium-dose group showed superior hemodynamic stability with smaller fluctuations in mean arterial pressure (MAP), systolic blood pressure (SBP), and heart rate (HR), the lowest POCD rate on day 1 (8.3%) and lowest adverse events (13.9%), and shorter recovery and hospital stays. The high-dose group had the highest hypotension (28.6%) and POCD (40.0%) rates. Age ≥75 years, high-dose etomidate, and operative time >60 minutes were independent POCD risk factors. CONCLUSIONS AND RELEVANCE: Etomidate 0.2 mg/kg with nerve block achieves favorable hemodynamics and minimizes POCD and adverse reactions in elderly hernia surgery, supporting a moderate-dose strategy for this vulnerable population.