Hemodynamic Profiles of Etomidate versus Propofol-phenylephrine Combination for Induction of Anesthesia in Adult...

Etomidate (ET), a cardiostable drug, is preferred to propofol while inducing anesthesia in patients with cardiac disease or sepsis despite concerns of increased mortality due to adrenocortical suppression. Phenylephrine (PE) was coadministered to counteract the hypotension associated with the propofol induction with success in low-risk patients undergoing noncardiac surgery. The primary objective of this prospective observational cohort study was to compare the incidence of hypotension at induction with ET versus propofol-PE (PP) combination in patients undergoing elective cardiac surgery.

Group ET patients (n = 45) received ET, and group PP patients (n = 45) received a PP mixture (20 µg PE in every 10 mg of propofol) in titrated doses for anesthesia induction. The heart rate and mean arterial pressure (MAP) were recorded at 21 time points (baseline and every 30 s for 10 min after induction). Hypotension (fall in MAP more than 20% from the baseline) was managed by administering rescue bolus PE 1 μg/kg.

In groups ET and PP, respectively, there were 28 and 37 patients (P - 0.264) who had hypotension requiring 41 and 52 rescue PE doses (P - 0.254), during the first 10 min after induction of anesthesia. ET group patients had a significantly higher number of time points with hypertension (67 in group ET vs 14 in group PP; P < 0.0001) and tachycardia (124 in group ET vs 52 in group PP; P < 0.0001) after direct laryngoscopy and intubation.

The incidence of hypotension is comparable in both the groups with PP combination attenuating the hemodynamic response to the intubation better.