Cardioversion: What to choose? Etomidate or propofol

Area of Science:

• Anesthesiology
• Cardiology
• Pharmacology

Background:

• Electrical cardioversion is a critical procedure for restoring normal sinus rhythm.
• Anesthesia is essential for patient comfort, hemodynamic stability, and recovery during cardioversion.
• Sedative choice impacts procedure safety and patient outcomes.

Purpose of the Study:

• To compare the efficacy and safety of etomidate versus propofol as sedatives during electrical cardioversion.
• To evaluate hemodynamic stability, recovery time, and side effects associated with each sedative.
• To determine the optimal sedative agent for cardioversion procedures.

Main Methods:

• A single-centered, prospective, randomized, single-blind study involving 60 adult patients undergoing elective cardioversion.
• Patients received either propofol or etomidate, combined with fentanyl, for sedation.
• Hemodynamic parameters, sedation scores (Ramsay Sedation Score), recovery scores (Aldrete Recovery Score), and adverse events were meticulously recorded and compared.

Main Results:

• Etomidate demonstrated superior hemodynamic stability, with significantly less hypotension compared to propofol.
• Patients sedated with etomidate exhibited faster recovery, evidenced by higher Aldrete Recovery Scores and shorter times to achieve target sedation levels.
• While myoclonus was more frequent with etomidate, overall side effect profiles favored etomidate due to reduced hypotension and quicker recovery.

Conclusions:

• Etomidate, in combination with fentanyl, is a superior sedative agent for electrical cardioversion compared to propofol/fentanyl.
• Etomidate facilitates quicker patient recovery and enhances hemodynamic stability during and after cardioversion.
• The findings support the use of etomidate for improved patient outcomes in electrical cardioversion procedures.