Comparison of Induction Characteristics of Propofol-Lipuro and Etomidate-Lipuro in Cardiac Patients in Non-cardiac Surgery

Background: Induction of anesthesia is a critical period in cardiac patients. The anesthetic induction techniques for these patients are usually based on considerations such as hemodynamic stability and minimizing intubation stress response. Aim of the present study was to compare induction and recovery characteristics and hemodynamic parameters of etomidate-lipuro and propofol-lipuro in cardiac patients. Materials and Methods: In a prospective, randomized, double blind study, 60 cardiac patients of American Society of Anesthesiologists Grade II and III in the age group 40-70 years of either sex scheduled for elective non cardiac surgery were divided into two groups of 30 each. Premedication was given as injection glycopyrrolate, midazolam, and fentanyl. Induction was done with injection propofol-lipuro 2 mg/kg in Group A and injection etomidate-lipuro 0.3 mg/kg in Group B followed by injection rocuronium hydrobromide 0.6 mg/kg for intubation and anesthesia was maintained with 40% O-2, 60% N2O, and 0.5-2% isoflurane. Two groups were compared with respect to pain on injection, the induction time, myoclonus and apnea. Hemodynamics, bispectral index scale, ETCO2, SPO2, and electrocardiography were monitored before induction of anesthesia, immediately after induction, at intubation and at 1, 3, 5 min, and every 10 min interval till the end of surgery. Results: Incidence of apnea, pain on injection and induction time was less, but myoclonus and post-operative nausea and vomiting was more in Group B as compared to Group A. The mean heart rate was comparable in the two groups. The mean systolic blood pressure measured up to 15 min was on the lower side in Group A as compared to Group B. The mean diastolic blood pressure up to 5 min was on lower side in Group A as compared to Group B. Recovery time and steward recovery score was comparable in both the groups. Conclusion: Etomidate is a better alternative to propofol as an induction agent in cardiac patients because of hemodynamic stability, less injection pain and faster induction.