Haemodynamic Consequences after Etomidate Administration for Short Surgical Procedures in Patients Aged Above 50 Years - A Prospective Study

Background: Haemodynamic perturbances due to anaesthesia in various surgeries have become a great concern especially in older patients [1]. All methods used in anaesthesia induction are designed so that the haemodynamic stability is maintained throughout surgery and even postoperative period too [2]. Anaesthetic challenges are quite high in short surgical procedures same as long surgeries. Intravenous anaesthetics are preferred for induction of general anaesthesia (GA) because of more rapid and smoother action with fewer risks. Cardiovascular and Respiratory systems appear to be minimally affected by Etomidate and myocardial oxygen supply-to-demand ratio is also well maintained. A prospective study “Use of Etomidate for short surgical procedures in patients aged above 50 years” conducted in MBS hospital and Government Medical College, Kota, Rajasthan, India; to determine the effect of etomidate on haemodynamics. Material and Method: After institutional ethical approval and meeting of inclusion criteria, we enrolled 100 patients of more than 50 years age; who were planned for short surgical procedures. Pre-anaesthetic examination and routine investigations were done. After receiving baseline parameters, all patients were pre-medicated with injection Midazolam (0.25mg/kg), Glycopyrrolate (0.004 mg/kg) and Fentanyl (2 mcg/kg) intravenously 10 minutes prior to procedure. Patient was induced with Etomidate 0.2 mg/kg loading dose. An additional dose of Etomidate 0.1 mg/kg was given intravenously if needed. Induction of anaesthesia was confirmed by loss of verbal communication with the patient and loss of eyelash reflex. Once an adequate depth of anaesthesia was achieved, the patient was mask ventilated with 100% oxygen during operative time. Observation and Result: Heart rate, Systolic blood pressure, Diastolic blood pressure, Mean arterial pressure and SpO2 were recorded preoperatively before induction and intra-operatively after induction of anaesthesia at every 1 min intervals up to 5 minute and then 5 min intervals up to 20 min, then post operatively at 60 minutes. Data were reported as mean ± SD and percentage. In our study the mean systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and mean heart rate observed at various time interval, they were not change significantly from baseline values in intra-operative and post-operative period. (p>0.05). Conclusion: As per our prospective study and review of literature, etomidate is a relatively safe and sufficient pharmacotherapeutic agent for short surgical procedures in elderly people with minor adverse reactions.