A Comparative Study of the Effect of Etomidate and Propofol Induction on Haemodynamic Response and Serum Cortisol Levels in Patients Undergoing Laparoscopic Cholecystectomy

Author(s): Zarina Wahab1 , Ibemhal Heisnam2 , Md. Nushrat3 , Rashima Banu4 , Sonia Nahakpam5 , Linthoingambi Samjetsabam6 , Daili Khuo7 , Thangavelu Ravichandran Kumaran8

BACKGROUND The choice of an anaesthetic agent for induction of anaesthesia is based mainly on its pharmacodynamic properties. We wanted to compare the effect of etomidate and propofol induction on haemodynamic response, serum cortisol level, and adverse effects in patients undergoing laparoscopic cholecystectomy. METHOD After approval from the institutional ethics committee, eighty-three American Society of Anaesthesiologist (ASA) grade I or II patients of 20-60 yrs. undergoing elective laparoscopic cholecystectomy were enrolled in the study. Patients were allocated randomly to receive either propofol or etomidate for induction of anaesthesia. Anaesthesia was maintained in both the groups with sevoflurane air and oxygen mixture, vecuronium bromide 0.08 mg/Kg for muscle relaxant. RESULTS The mean baseline haemodynamic parameters (SBP, DBP, MAP, HR) are comparable in both the groups. Post induction blood pressure was significantly lower in propofol group as compared to etomidate group. Immediately after intubation surge in blood pressure was more in etomidate group than propofol group. Also there was no difference in mean baseline serum cortisol levels in both the groups. But after induction, serum cortisol level was significantly decreased in etomidate group. However, after 24 hrs. of induction mean serum cortisol level in both the groups returns to baseline value. CONCLUSIONS Etomidate has more stable cardiovascular profile than propofol. It has the added advantage of minimizing induction hypotension which can cause coronary hypoperfusion, dysrhythmia and even cardiac arrest. Etomidate causes temporary reduction in serum cortisol level and this reduction in serum cortisol gets normalized 24 hrs. after induction.