A Comparative Study of Effect of Propofol, Etomidate Lipuro and Propofol-Etomidate Lipuro Admixture on Haemodyanamic Response and on BIS Values at Induction of General Anaesthesia- A RCT

Abstract

Background: Patients undergoing elective surgical procedures require an anesthetic agent which would provide a smooth, pleasant, rapid induction and recovery along with   hemodynamic stability and minimal side effects. To achieve these goals Propofol, Etomidate and propofol – etomidate lipuro admixture may be the agents of choice. Bispectral index (BIS) monitoring has emerged as a convenient and versatile tool to titrate hypnotic agentsAim: 1. To compare the time of onset, of ,loss of consciousness and induction of anaesthesia using BIS index value among the propofol (1%), etomidate-lipuro (0.2%) and 50% (1:1) admixture of these agents (Etofol) in various  procedures to choose the better induction agent. 2. To compare the hemodynamic changes caused by these agents.Material and methods:90 patients of either sex and of ASA physical status I or II scheduled for elective surgery under general anesthesia were selected for the study and were randomly placed into three groups. Group P was induced with intravenous Propofol 1%, Group E with intravenous Etomidate (2mg/ml) and Group PE with intravenous mixture of Propofol plus Etomidate (1:1) @ 400ml/hr till the BIS value reached 40.  Patient was considered to be induced once the BIS value reached 40 and this time was noted for all three groups.  BIS values and hemodynamic measurements were recorded before induction (T1), at induction (T2), before intubation (T3) after intubation (T4) and then after intubation, at 1 min (T5), at 3 min (T6), at 5 min (T7) and at 10 min (T8).Results: The Induction (time to reach BIS value of 40) was fastest in Etofol group. Induction dose of Etofol provided better control of BIS values after orotracheal intubation. It was also noted that Heart Rate remained near baseline in Etofol group at different time intervals. In the Post intubation period, a significant increase in the Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP), was noted in Group E. The increase in blood pressure at different intervals after intubation was found to be lowest in Group PE.Conclusion: We conclude that Etofol is associated with a shorter induction time and better haemodyanamic stability than Etomidate and Propofol alone. It also provides effective control of BIS values during induction, orotracheal intubation and thereafter. Key words: Etomidate, Propofol, Etofol, bispectral index (BIS) and haemodyanamic stability