Comparative study of propofol vs etomidate as an induction agent to evaluate hemodynamic changes during induction of anesthesia in controlled hypertensive patients

Abstract

Background and Aim: An ideal inducing agent for general anesthesia should have hemodynamic stability, minimal respiratory side effects and rapid clearance. Presently there are a number of induction agents available. Present study was done with an aim to compare propofol with etomidate as an induction agent to evaluate hemodynamic changes during induction of anesthesia in controlled hypertensive patients.
Methodology: A prospective randomized double blind study was conducted at our hospital. Sixty patients undergoing surgery under general anesthesia during April 2015 to April 2016 were randomly divided into two equal groups. Patients of Group-P were given inj fentanyl 2 µg/kg, followed by inj propofol 1-2 mg/kg; and patients of Group-E were given inj fentanyl 2 µg/kg, followed by inj etomidate 0.2- 0.4 mg/kg. Patients’ hemodynamic parameters like systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure and heart rate (HR) were recorded at regular intervals. Any adverse event like pain during injection, myoclonus etc. were noted.
Results: Post-induction, heart rate did not change significantly in etomidate group, but in propofol group it decreased significantly compared to the pre-induction value (3.8% vs. 6.5%). The mean fall in SBP at T2 (3 min post induction) in Group-E was 4.7% which was less than that seen in Group-P (7.6%). Three min after induction the fall in DBP was observed to be 16.24% vs. 4.8% in Group-P vs. Group-E respectively. In etomidate group, post-induction SBP did not change significantly as compared to pre-induction. But in propofol group, SBP decreased significantly in post-induction. Post-induction, DBP did not change significantly in etomidate group, but the fall was significant in propofol group.
Conclusion: Etomidate is better in maintaining the heart rate and blood pressure and hence preferable to propofol in controlled hypertensive patients during induction of general anesthesia.