Comparison of hemodynamic effects of intravenous etomidate versus propofol during induction and intubation using entropy guided hypnosis levels.

Abstract

Background and Aims:This study aimed to compare the hemodynamic responses during induction and intubation between propofol and etomidate using entropy guided hypnosis.Material and Methods:Sixty ASA I & II patients in the age group 20-60 yrs, scheduled for modified radical mastectomy were randomly allocated in two groups based on induction agent Etomidate or Propofol. Both groups received intravenous midazolam 0.03 mg kg-1 and fentanyl 2 μg kg-1 as premedication. After induction with the desired agent titrated to entropy 40, vecuronium 0.1 mg kg-1 was administered for neuromuscular blockade. Heart rate, systolic, diastolic and mean arterial pressures, response entropy [RE] and state entropy [SE] were recorded at baseline, induction and upto three minutes post intubation. Data was subject to statistical analysis SPSS (version 12.0) the paired and the unpaired Student's T-tests for equality of means.Results:Etomidate provided hemodynamic stability without the requirement of any rescue drug in 96.6% patients whereas rescue drug ephedrine was required in 36.6% patients in propofol group. Reduced induction doses 0.15mg kg-1 for etomidate and 0.98 mg kg-1 for propofol, sufficed to give an adequate anaesthetic depth based on entropy.Conclusion:Etomidate provides more hemodynamic stability than propofol during induction and intubation. Reduced induction doses of etomidate and propofol titrated to entropy translated into increased hemodynamic stability for both drugs and sufficed to give an adequate anaesthetic depth.