Etomidate vs Propofol-Induction Characteristics
Condition: Hemodynamics; Side Effects
Study type: Interventional
Phase: Phase 4

Summary: 
      The ideal induction agent for day care surgery should have properties of rapid, smooth
      induction, better haemodynamic profile, faster recovery and devoid of side effects in the
      form of pain on injection, involuntary movements, respiratory depression and post-operative
      nausea/vomiting. Propofol is the drug being used for day care surgeries because of its rapid,
      smooth induction and faster recovery. But its use is associated with pain on injection (even
      with added lidocaine), hypotension and respiratory depression. So the need for an agent with
      better hemodynamic control and lesser side effects was felt. The introduction of etomidate
      lipuro revolutionised the anaesthesia practice. It possesses many of the properties of an
      ideal induction agent. This newer formulation of etomidate in lipid emulsion i.e. etomidate
      lipuro is known to have rapid, smooth induction, haemodynamic stability and lesser side
      effects than older etomidate with propylene glycol (hypnomidate).

      Hence, investigators devised a prospective randomized controlled open trial and compared this
      newer lipid formulation of etomidate with propofol in terms of - induction time, haemodynamic
      parameters and side effect profile.
    

Detailed description: 
      The administration of a suitable drug by intravenous route for induction of anaesthesia has
      been an important component of anaesthetic management.The ability to deliver safe and
      effective anaesthesia with minimal side effects and rapid recovery is critically important to
      ensure safe and early discharge. An ideal intravenous (IV) anaesthetic agent should, have
      rapid onset, rapid recovery, be without undesirable cardiac and respiratory depression and
      lesser untoward effects like pain on injection, nausea, vomiting etc.No single drug is ideal.

      Propofol (propofol 1%) has a smooth and rapid induction, rapid recovery, cerebro-protective
      effect but it causes hypotension, bradycardia, respiratory depression pain on
      injection.Etomidate is a hypnotic agent causing minimal histamine release and very stable
      hemodynamic profile. In the present study, investigators evaluated the induction
      characteristics and side effect profile of this newer lipid formulation of etomidate and
      compared it with propofol in same lipid formulation.

      Material and Methods: Hundred ASA I & II patients in the age group 18-60 yrs, scheduled for
      dilatation and curettage procedure were randomly allocated in two groups based on induction
      agent Etomidate lipuro or Propofol.

      Both groups received intravenous midazolam 0.02mg /kg and fentanyl 2 µg /kg as premedication.
      After induction with the desired agent titrated to bispectral index Entropy 40, the time to
      achieve BIS values to 40 (BIS 40 time) were measured. Heart rate, mean arterial pressures
      were recorded at baseline, induction and upto 10 minutes. Patients were asked for pain at the
      injection site, postoperative nausea and observed visually for myoclonus, apnea and
      thrombophlebitis.
    

Intervention name(s): Inj Etomidate; Injection Propofol; Placebo for Propofol
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Induction of anesthesia using IV Etomidate 0.3mg kg-1 as a single dose in patients undergoing day care procedure, after premedication with IV midazolam 0'.2mg kg-1 and IV Fentanyl 2ug kg-1.; Induction of anesthesia using IV Propofol 2mg kg-1 as a single dose in patients undergoing day care procedure, after premedication with IV midazolam 0.2mg kg-1 and IV Fentanyl 2ug kg-1; After premedication with IV midazolam 0.2mg/kg and IV Fentanyl 2ug/kg Placebo was given.
Other intervention name(s): Etomidate Lipuro
Intervention MeSH terms: Propofol; Etomidate
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Screening
Keywords: Etomidate lipuro; Induction characteristics