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Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial

BACKGROUND: The ideal depth of general anesthesia should achieve the required levels of hypnosis, analgesia, and muscle relaxation while minimizing physiologic responses to awareness. The choice of anesthetic strategy in patients with coronary heart disease (CHD) undergoing major noncardiac surgery...

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Autores principales: Dai, Zhong-Liang, Cai, Xing-Tao, Gao, Wen-Li, Lin, Miao, Lin, Juan, Jiang, Yuan-Xu, Jiang, Xin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896684/
https://www.ncbi.nlm.nih.gov/pubmed/33644196
http://dx.doi.org/10.12998/wjcc.v9.i6.1293
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author Dai, Zhong-Liang
Cai, Xing-Tao
Gao, Wen-Li
Lin, Miao
Lin, Juan
Jiang, Yuan-Xu
Jiang, Xin
author_facet Dai, Zhong-Liang
Cai, Xing-Tao
Gao, Wen-Li
Lin, Miao
Lin, Juan
Jiang, Yuan-Xu
Jiang, Xin
author_sort Dai, Zhong-Liang
collection PubMed
description BACKGROUND: The ideal depth of general anesthesia should achieve the required levels of hypnosis, analgesia, and muscle relaxation while minimizing physiologic responses to awareness. The choice of anesthetic strategy in patients with coronary heart disease (CHD) undergoing major noncardiac surgery is becoming an increasingly important issue as the population ages. This is because general anesthesia is associated with a risk of perioperative cardiac complications and death, and this risk is much higher in people with CHD. AIM: To compare hemodynamic function and cardiovascular event rate between etomidate- and propofol-based anesthesia in patients with CHD. METHODS: This prospective study enrolled consecutive patients (American Society of Anesthesiologists grade II/III) with stable CHD (New York Heart Association class I/II) undergoing major noncardiac surgery. The patients were randomly allocated to receive either etomidate/remifentanil-based or propofol/remifentanil-based general anesthesia. Randomization was performed using a computer-generated random number table and sequentially numbered, opaque, sealed envelopes. Concealment was maintained until the patient had arrived in the operating theater, at which point the consulting anesthetist opened the envelope. All patients, data collectors, and data analyzers were blinded to the type of anesthesia used. The primary endpoints were the occurrence of cardiovascular events (bradycardia, tachycardia, hypotension, ST-T segment changes, and ventricular premature beats) during anesthesia and cardiac troponin I level at 24 h. The secondary endpoints were hemodynamic parameters, bispectral index, and use of vasopressors during anesthesia. RESULTS: The final analysis included 40 patients in each of the propofol and etomidate groups. The incidences of bradycardia, hypotension, ST-T segment changes, and ventricular premature beats during anesthesia were significantly higher in the propofol group than in the etomidate group (P < 0.05 for all). The incidence of tachycardia was similar between the two groups. Cardiac troponin I levels were comparable between the two groups both before the induction of anesthesia and at 24 h after surgery. When compared with the etomidate group, the propofol group had significantly lower heart rates at 3 min after the anesthetic was injected (T(1)) and immediately after tracheal intubation (T(2)), lower systolic blood pressure at T(1), and lower diastolic blood pressure and mean arterial pressure at T(1), T(2), 3 min after tracheal intubation, and 5 min after tracheal intubation (P < 0.05 for all). Vasopressor use was significantly more in the propofol group than in the etomidate group during the induction and maintenance periods (P < 0.001). CONCLUSION: In patients with CHD undergoing noncardiac major surgery, etomidate-based anesthesia is associated with fewer cardiovascular events and smaller hemodynamic changes than propofol-based anesthesia.
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spelling pubmed-78966842021-02-26 Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial Dai, Zhong-Liang Cai, Xing-Tao Gao, Wen-Li Lin, Miao Lin, Juan Jiang, Yuan-Xu Jiang, Xin World J Clin Cases Clinical Trials Study BACKGROUND: The ideal depth of general anesthesia should achieve the required levels of hypnosis, analgesia, and muscle relaxation while minimizing physiologic responses to awareness. The choice of anesthetic strategy in patients with coronary heart disease (CHD) undergoing major noncardiac surgery is becoming an increasingly important issue as the population ages. This is because general anesthesia is associated with a risk of perioperative cardiac complications and death, and this risk is much higher in people with CHD. AIM: To compare hemodynamic function and cardiovascular event rate between etomidate- and propofol-based anesthesia in patients with CHD. METHODS: This prospective study enrolled consecutive patients (American Society of Anesthesiologists grade II/III) with stable CHD (New York Heart Association class I/II) undergoing major noncardiac surgery. The patients were randomly allocated to receive either etomidate/remifentanil-based or propofol/remifentanil-based general anesthesia. Randomization was performed using a computer-generated random number table and sequentially numbered, opaque, sealed envelopes. Concealment was maintained until the patient had arrived in the operating theater, at which point the consulting anesthetist opened the envelope. All patients, data collectors, and data analyzers were blinded to the type of anesthesia used. The primary endpoints were the occurrence of cardiovascular events (bradycardia, tachycardia, hypotension, ST-T segment changes, and ventricular premature beats) during anesthesia and cardiac troponin I level at 24 h. The secondary endpoints were hemodynamic parameters, bispectral index, and use of vasopressors during anesthesia. RESULTS: The final analysis included 40 patients in each of the propofol and etomidate groups. The incidences of bradycardia, hypotension, ST-T segment changes, and ventricular premature beats during anesthesia were significantly higher in the propofol group than in the etomidate group (P < 0.05 for all). The incidence of tachycardia was similar between the two groups. Cardiac troponin I levels were comparable between the two groups both before the induction of anesthesia and at 24 h after surgery. When compared with the etomidate group, the propofol group had significantly lower heart rates at 3 min after the anesthetic was injected (T(1)) and immediately after tracheal intubation (T(2)), lower systolic blood pressure at T(1), and lower diastolic blood pressure and mean arterial pressure at T(1), T(2), 3 min after tracheal intubation, and 5 min after tracheal intubation (P < 0.05 for all). Vasopressor use was significantly more in the propofol group than in the etomidate group during the induction and maintenance periods (P < 0.001). CONCLUSION: In patients with CHD undergoing noncardiac major surgery, etomidate-based anesthesia is associated with fewer cardiovascular events and smaller hemodynamic changes than propofol-based anesthesia. Baishideng Publishing Group Inc 2021-02-26 2021-02-26 /pmc/articles/PMC7896684/ /pubmed/33644196 http://dx.doi.org/10.12998/wjcc.v9.i6.1293 Text en ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Clinical Trials Study
Dai, Zhong-Liang
Cai, Xing-Tao
Gao, Wen-Li
Lin, Miao
Lin, Juan
Jiang, Yuan-Xu
Jiang, Xin
Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial
title Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial
title_full Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial
title_fullStr Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial
title_full_unstemmed Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial
title_short Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial
title_sort etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: a randomized clinical trial
topic Clinical Trials Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896684/
https://www.ncbi.nlm.nih.gov/pubmed/33644196
http://dx.doi.org/10.12998/wjcc.v9.i6.1293
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