European Journal of Molecular & Clinical Medicine

Etomidate is a rapidly acting induction agent and it has little effect on cardiovascular system and it allows rapid recovery from anaesthesia but associated with side effects. Pre-treatment with narcotic analgesics usually Fentanyl can decrease the incidence of pain on injection and myoclonus during induction of anaesthesia with Etomidate and also attenuates the stress response to endotracheal intubation.
OBJECTIVE: The objective was to find an optimal pre induction dose of &many with etomidate as induction agent which attenuates the haemodynamic changes and side-effects during induction and intuhatidn.
METHODS AND METHODS: Patients scheduled for elective surgeries under general anaesthesia were eligible for the study. 30 Patients were randomly assigned to two groups according to the pretreatment dose of Fnetanyl.
1)      Group I received 2 µg/kg of  Fentanyl
2)      Group II received 5 µg/kg of Fentanyl
         After 5 minutes of administration of either one of these all patients where induced with  Etomidate at a dose of 0.3 mg/kg.
RESULTS: We found that the hemodynamic response and side effects were lower in group II with increasing dose of Fentanyl. But at the same time there was increasing incidence of post operative nausea & vomiting and apnoea in group II.
CONCLUSION: We concluded that at a dose of 5 µg/kg of fentanyl, there is reduction of side effects of etomidate and also there is attenuation of hemodynamic response to intubation in patients undergoing elective surgeries under general anaesthesia with etomidate as induction agent.

Etomidate has been widely used in western countries has now become available in India. Etomidate is
preferred in patients with CAD, especially with poor left ventricular (LV) function as it provides stable
cardiovascular profile but it has less inhibitory effect on pharyngolaryngeal reflex thus may cause less
blunting of response to laryngoscopy and intubation. After getting approval from institutional ethics
committee, study was carried out in all patients fulfilling the inclusion and exclusion criteria during the
study period. Patient diagnosed or known case of CAD either from history, investigations were
included in the study after obtaining written valid informed consent. There was no hypertension or
hypotension in group A (EF<45%) but in group B (EF>45%) hypertension was noted in just 1 patient
and no hypotension noted. Statistically they were non-significant (p value-0.077). There was no
occurrence any arrhythmias or significant ST changes in either group at any point of time from
induction to 10min after intubation.

Etomidate is a popular intravenous induction agent because it has a stable haemodynamic profile and
results in minimal histamine release. Myoclonus is observed in 50%–80% of patients who did not
receive pretreatment before etomidate administration, which increases the risk of regurgitation and
aspiration in emergency conditions. Various drugs were used in the treatment of myoclonus but the
results have been inconclusive. Dexmedetomidine, a new alpha-2 agonist has been tried by several
authors to suppress the myoclonus induced by etomidate. A prospective randomized controlled double
blind study was conducted in seventy patients aged between 18-55 years belonging to ASA I and II
scheduled for elective surgery under general anaesthesia. After obtaining informed written consent, a
detailed preanaesthetic evaluation was done and investigations were obtained as indicated. The patients
were randomized into 2 groups with 35 patients each, received either 0.5 μg/kg of dexmedetomidine in
10 ml saline (Group D) or 10 ml of Saline (Group S) over a period of 10 minutes prior to etomidate
induction. The incidence of severe myoclonus was significantly less in group D compared to saline
group with p = 0.031 (8.57% in group D and 28.5% in group S). However there was no change in the
incidence of myoclonus (P = 0.237) and pain on injection (p = 0.309) in both groups. Recovery profile
was comparable in both groups. Our study shows that pretreatment with dexmedetomidine 0.5 μg/kg
IV is effective in reducing the severity of etomidate induced myoclonic muscle movements without
however dexmedetomidine does not have any significant effect on the incidence of myoclonus
following etomidate induction.

Background:The aim of the study is to compare induction with etomidate and propofol
on hemodynamic response to laryngoscopy and intubation.
Materials and Methods: The study was conducted in 60 ASA I & II patients in the age
group of 18 to 60 years who were posted for elective surgeries under general
anaesthesia. Their baseline heart rate, systolic blood pressure, diastolic blood pressure,
SpO2 and ETCO2 were recorded. Both the groups were premedicated with iv
glycopyrrolate 5mcg/kg, iv midazolam 0.025mg/Kg, iv fentanyl 2mcg/Kg. Following
premedication, the above variables were again recorded. Group P patients were
induced with iv propofol at the dose of 2 mg/Kg and Group E patients received iv
etomidate at 0.4mg/Kg. In both the groups, Injection vecuronium was given at the dose
0.08mg/Kg and they were maintained with O2:N2O =33%:66% and Isoflurane 1% dial
concentration. Laryngoscopy was performed by trained anesthesiologists after 5 mins.
Duration of laryngoscopy was kept at a maximum of 10 seconds. Trachea was intubated
with appropriate size endotracheal tube. The variables (HR, SBP, DBP, MAP, SpO2)
were measured during induction, intubation and post intubation at intervals of 1,2,3,5
and 10 mins.
Results: On comparing the two groups, the following results were obtained – Age, Sex,
Weight and ASA status were comparable in both the groups. Propofol was found to
produce hypotension in more or less 20%- 30% of patients irrespective of the
underlying condition. Etomidate was found to maintain hemodynamic stability though
there were no significant difference in heart rate variability in both the groups during
laryngoscopy and intubation. Myoclonus was seen in 4 out of 30 patients induced with
Etomidate, pain on injection was more common with Propofol. Apnea occurred in 12
out of 30 patients induced with Etomidate,28 patients out of 30 in propofol group,
vomiting and nausea are more with Etomidate than propofol but the difference was
statistically insignificant.
Conclusion: As per the results of the study, Propofol produced more hemodynamic
changes than Etomidate. Thus, we conclude that Etomidate is more stable in terms of
hemodynamic stability.

Aim: To compare the hemodynamic response to anaesthetic induction with thiopentone sodium or
etomidate in adult treated hypertensive patients posted for elective surgeries.
Materials and methods:A prospective randomised blind clinical study conducted in 60 adult treated
hypertensive patients(29-61 years) of ASA II posted for elective surgeries under general anaesthesia.
Patients were randomly allocated to two groups of 30 each. Group T-Thiopentone sodium 5mg/kg
body weight Group E-Etomidate 0.3mg/kg body weight. Pulse,systolic blood pressure, diastolic
blood pressure and mean arterial pressure were noted down every minute for five minutes post
induction.
Results: Both groups were comparable statistically for age, gender and weight.There was no
statistically significant variation in the extent of over all change in heart rate, systolic, diastolic and
mean arterial pressures between the two group of patients (p >0.05).All the studied hemodynamic
variations with respect to HR,SBP,DBPand MAP in the two groups were self corrective and did not
require any treatment. Patients in both groups did not have any side effects perioperatively and for 24
hours post operatively except for vomiting in one patient in group E.
Conclusion: Both thiopentone (5mg/kg) and etomidate (0.3mg/kg) have similar hemodynamic effects
when used for induction of anaesthesia in adult treated hypertensive patients and can be safely used in
them. However thiopentone comparatively has better cost effectiveness and ease of availability.