Sarda Bhagyashree Gopal, Raipure Amrusha Mukesh, Ruparel Dipakkumar Hiralal
Department of Anaesthesiology, Government Medical College and Hospital, Nagpur, Maharashtra, India.
Department of Anaesthesiology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
Anesth Essays Res. 2021 Jul-Sep;15(3):312-315. doi: 10.4103/aer.aer_118_21. Epub 2022 Feb 14.
Hemodynamic stability during induction of anesthesia is always a concern for an anesthesiologist. Propofol remains the most popular induction agent with its favorable characteristics and few drawbacks like decrease in heart rate and blood pressure (BP). Although etomidate provides better hemodynamic stability, its use declined due to reports of adrenocortical suppression.
We designed a study to compare the effect of anesthetic induction with etomidate versus propofol on serum cortisol levels and hemodynamics.
This was a prospective randomized double-blind comparative study.
Sixty ASA PS classes I and II patients scheduled for laparoscopic inguinal hernia repair under general anesthesia were included in the study. Thirty patients received propofol 2 mg.kg and thirty, etomidate 0.3 mg.kg. Blood samples for serum cortisol were withdrawn preoperatively, immediate postoperatively, and 24 h after surgery. Vitals were monitored throughout.
All data are presented as mean ± standard deviation and proportions. Demographic data were analyzed by Student's -test, and Chi-square test was used to analyze changes over time. The statistical software SPSS version 25.0 was used for data analysis.
Systolic blood pressure (BP), diastolic BP, and mean BP were more stable in the etomidate group compared to the propofol group. Serum cortisol levels before surgery in both the groups were within normal limits and comparable, followed by a significant decline in the etomidate group and rise in the propofol group in the immediate postoperative period. The levels in the third sample were comparable in both the groups.
Etomidate offers superior hemodynamic compared to propofol. A decrease in serum cortisol level in the etomidate group was transient returning back to normal within 24 h.
麻醉诱导期间的血流动力学稳定性一直是麻醉医生关注的问题。丙泊酚因其良好的特性以及诸如心率和血压（BP）下降等较少的缺点，仍然是最常用的诱导药物。尽管依托咪酯能提供更好的血流动力学稳定性，但由于有肾上腺皮质抑制的报道，其使用有所减少。
我们设计了一项研究，比较依托咪酯与丙泊酚麻醉诱导对血清皮质醇水平和血流动力学的影响。
这是一项前瞻性随机双盲对照研究。
纳入60例计划在全身麻醉下行腹腔镜腹股沟疝修补术的美国麻醉医师协会（ASA）分级为I级和II级的患者。30例患者接受2mg/kg丙泊酚，30例患者接受0.3mg/kg依托咪酯。术前、术后即刻及术后24小时采集血清皮质醇血样。全程监测生命体征。
所有数据均以均值±标准差和比例表示。人口统计学数据采用学生t检验分析，卡方检验用于分析随时间的变化。使用统计软件SPSS 25.0进行数据分析。
与丙泊酚组相比，依托咪酯组的收缩压（BP）、舒张压和平均血压更稳定。两组术前血清皮质醇水平均在正常范围内且相当，术后即刻依托咪酯组显著下降，丙泊酚组上升。两组第三个样本的水平相当。
与丙泊酚相比，依托咪酯具有更好的血流动力学稳定性。依托咪酯组血清皮质醇水平的下降是短暂的，在24小时内恢复正常。
