Comparison of hemodynamic and serum cortisol levels in response to anesthetic induction with Etomidate or Propofol in patients undergoing CABG surgery

Introduction: To compare the effects of induction agent etomidate and propofol on hemodynamic and serum cortisol levels in patients undergoing coronary artery bypass graft surgery on cardiopulmonary bypass. Materials and Method: After approval from the Institute Ethics committee sixty patients of ASA grade II or III were enrolled in study. Patients were randomized to receive either propofol or etomidate for anesthesia induction. Result: Hemodynamically, etomidate was more stable than propofol, because propofol causes significant fall in SBP and SVR but after intubation there was significant increase in HR and SBP(P > 0.05) in etomidate group. Baseline serum cortisol values were within normal limits in both the groups. The cortisol level in the etomidate group decreased after weaning from cardiopulmonary bypass (CPB) upto 60% of baseline while in the propofol group it increased twice than baseline. The values were close to double the baseline at twenty-four hours after induction, but statistically not significant. Conclusion: The surge in serum cortisol levels on the initiation of CPB seen after propofol is prevented by the use of etomidate. Serum cortisol levels in both groups was raised above the baseline after twenty-four hours. Etomidate group shows stable hemodynamic parameters during induction of anesthesia compared to propofol group but after intubation there is more hemodynamic variation in etomidate group because etomidate does not inhibit sympathetic stimulation by laryngoscopy and suggest that some agents should be used to attenuate laryngoscopy response with etomidate.