Effect of Etomidate Induction on Intraoperative Hemodynamics, Postoperative Inflammation, and Recovery After Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study
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Jiazheng Qi1,2, Zhiying Zheng1,2, Yanrong Gu1,2
1Department of Anesthesiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, 210008, People's Republic of China.
Background:
Etomidate is commonly used for anesthetic induction because of its favorable hemodynamic profile but may cause adrenocortical suppression. Whether its use is associated with hemodynamic stability, and postoperative inflammatory and recovery outcomes after laparoscopic sleeve gastrectomy (LSG) remains uncertain.
Methods:
This single-center retrospective cohort study included adults undergoing elective LSG from January 2014 through December 2024. The exposure was etomidate use during anesthetic induction. The primary outcome was time-weighted average MAP (TWA-MAP). Secondary outcomes included time-weighted average MAP below 65 mmHg (TWA65), hypotensive event rate, proportion of time with hypotension, generalized average real variability of MAP (ARV-MAP), postoperative C-reactive protein (CRP) and interleukin-6 (IL-6), and recovery outcomes. Propensity score-based inverse probability of treatment weighting (IPTW) adjusted for measured baseline confounding; sensitivity analyses assessed the robustness of the findings.
Results:
A total of 1215 patients were screened, of whom 935 were included (271 received etomidate and 664 did not). After IPTW, etomidate use was associated with higher TWA-MAP (adjusted mean difference [MD], 3.01 mmHg; 95% CI, 1.78 to 4.24) and lower TWA65 (adjusted MD, -0.05 mmHg; 95% CI, -0.09 to -0.01), hypotensive event rate (adjusted MD, -0.16 n/h; 95% CI, -0.24 to -0.07), and proportion of time with hypotension (adjusted MD, -1.27 percentage points; 95% CI, -2.07 to -0.47). However, ARV-MAP was higher (adjusted MD, 0.28 mmHg/min; 95% CI, 0.10 to 0.47). CRP concentrations were higher on postoperative days 1 and 3 (adjusted MD, 9.15 mg/L; 95% CI, 5.41 to 12.89; and adjusted MD, 16.15 mg/L; 95% CI, 9.86 to 22.45, respectively), as were IL-6 concentrations (adjusted MD, 14.35 pg/mL; 95% CI, 11.52 to 17.18; and adjusted MD, 8.56 pg/mL; 95% CI, 6.66 to 10.46, respectively). Etomidate use was also associated with longer time to extubation and postoperative length of stay, and higher odds of ICU admission (all P <0.05). Sensitivity analyses yielded consistent results.
Conclusion:
In patients with obesity undergoing LSG, etomidate use during anesthetic induction was associated with a lower intraoperative hypotension burden but greater MAP variability, higher postoperative inflammatory marker concentrations, and worse recovery outcomes. These associations warrant prospective investigation to clarify their clinical significance.
Trial Registration:
Chinese Clinical Trial Registry (ChiCTR2600123339).
