Comparison of the Effects of Different Anesthetic Agents on Hemodynamics, Recovery, and Postoperative Cognitive Function in Ambulatory Gynecologic Procedures

Öz

ABSTRACT Objective: The aim of this study was to compare the effects of three different intravenous induction agents—propofol, etomidate, and thiopental—on hemodynamic parameters, recovery times, and postoperative cognitive functions in patients undergoing short-duration ambulatory vaginal gynecologic procedures. Methods: This prospective observational study was conducted at the Gynecology and Obstetrics Operating Room of Istanbul Training and Research Hospital between March and May 2010. A total of 120 patients, aged 25–75 years and classified as ASA physical status I–II, were included. Patients were randomly divided into three groups: Group P (Propofol 2 mg·kg⁻¹), Group E (Etomidate 0.3 mg·kg⁻¹), and Group T (Thiopental 5–7 mg·kg⁻¹). All groups received fentanyl 1.5 µg·kg⁻¹ for analgesia. Hemodynamic parameters, recovery times, Ramsey Sedation Scores, and Mini-Mental Test (MMT) scores were recorded and analyzed. Results: In Group P, significant decreases in systolic and diastolic blood pressure were observed following induction (p<0.05). Group E maintained hemodynamic stability, whereas Group T exhibited moderate hypotension. Recovery time was significantly shorter in Group P compared to the other groups (p<0.01). There were no significant differences in MMT scores among the groups at the postoperative 30ᵗʰ minute (p>0.05), whereas at the 2ⁿᵈ hour, Groups P and E showed higher scores than Group T (p<0.05). Conclusion: In ambulatory gynecologic procedures, propofol demonstrated a favorable profile with respect to rapid recovery and early improvement in postoperative cognitive function. Etomidate appeared advantageous in maintaining hemodynamic stability and may be considered a suitable alternative, particularly for patients with cardiovascular risk or hemodynamic vulnerability. However, anesthetic selection in the general population should be individualized based on patient characteristics and surgical conditions. Thiopental was associated with prolonged recovery and delayed cognitive restoration in some cases, and these findings warrant confirmation in larger, multicenter studies.

Anahtar Kelimeler

• ambulatory surgery,
• intravenous anesthesia
• cognitive function
• hemodynamic response

Günübirlik Jinekolojik Girişimlerde Farklı Anestezik Ajanların Hemodinami, Derlenme ve Postoperative Kognitif Fonksiyonlar Üzerine Etkilerinin Karşılaştırılması

Öz

ÖZET Amaç: Bu çalışmanın amacı, günübirlik kısa süreli vajinal jinekolojik girişimlerde kullanılan üç farklı indüksiyon ajanı olan propofol, etomidat ve tiyopentalin hemodinamik parametreler, derlenme süreleri ve postoperatif kognitif fonksiyonlar üzerine etkilerini karşılaştırmaktır. Yöntem: İstanbul Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Ameliyathanesi’nde, Mart–Mayıs 2010 tarihleri arasında yürütülen bu prospektif, gözlemsel çalışmaya ASA I–II grubunda, 25–75 yaş aralığında toplam 120 hasta dahil edildi. Hastalar üç gruba ayrıldı: Grup P (Propofol 2 mg/kg), Grup E (Etomidat 0.3 mg/kg), Grup T (Tiyopental 5–7 mg/kg). Tüm gruplarda analjezi için 1.5 µg/kg fentanil uygulandı. Hemodinamik parametreler, derlenme süreleri, Ramsey Sedasyon Skoru ve Mini Mental Test (MMT) skorları kaydedildi. Bulgular: Grup P’de indüksiyon sonrası SKB (sistolik kan basıncı) ve DKB (diastolik kan basıncı)’de anlamlı düşüşler izlendi (p<0.05). Grup E’de hemodinamik stabilite korunurken, grup T’de orta dereceli hipotansiyon gözlendi. Derlenme süresi Grup P’de anlamlı derecede kısa bulundu (p<0.01). Postoperatif 30. dakikada MMT skorlarında üç grup arasında anlamlı fark saptanmadı (p>0.05), ancak 2. saat değerlendirmesinde grup P ve grup E’de skorlarının tiyopental grubuna göre daha yüksek olduğu görüldü (p<0.05). Sonuç: Günübirlik jinekolojik girişimlerde propofol, hızlı derlenme ve erken bilişsel toparlanma açısından avantajlı bir profil sergilemiştir. Etomidat, hemodinamik stabiliteyi koruması ve bilişsel fonksiyonları minimal düzeyde etkilemesiyle özellikle kardiyovasküler riski yüksek veya hemodinamik açıdan hassas hastalarda uygun bir alternatif olarak değerlendirilebilir. Tiyopental ise bazı olgularda uzamış derlenme süresi ve gecikmiş bilişsel iyileşme ile ilişkili bulunmuştur. Bununla birlikte, ajan seçiminin her hastada klinik özellikler ve cerrahi koşullar dikkate alınarak bireyselleştirilmesi önerilmektedir. Bulguların daha geniş örneklemli, çok merkezli çalışmalarla desteklenmesi gerekmektedir

Anahtar Kelimeler

• günübirlik cerrahi
• intravenöz anestezi
• kognitif fonksiyon
• hemodinamik yanıt

Kaynakça

1. Aggarwal, S., Goyal, V. K., Chaturvedi, S. K., Mathur, V., Baj, B., & Kumar, A. (2016). A comparative study between propofol and etomidate in patients under general anesthesia. Brazilian journal of anesthesiology (Elsevier), 66(3), 237–241. https://doi.org/10.1016/j.bjane.2014.10.005
2. Alappat, A. M. (2018). Evaluation of Haemodynamic Stability Following Induction of General Anaesthesia with Propofol and Etomidate in Normotensive and Hypertensive Patients: A Comparative Study (Doctoral dissertation, Rajiv Gandhi University of Health Sciences (India)).
3. Apfelbaum, J. L., Hagberg, C. A., Connis, R. T., Abdelmalak, B. B., Agarkar, M., Dutton, R. P., Fiadjoe, J. E., Greif, R., Klock, P. A., Mercier, D., Myatra, S. N., O'Sullivan, E. P., Rosenblatt, W. H., Sorbello, M., & Tung, A. (2022). 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology, 136(1), 31–81. https://doi.org/10.1097/ALN.0000000000004002
4. Bilotta, F., Stazi, E., Zlotnik, A., Gruenbaum, S. E., & Rosa, G. (2014). Neuroprotective effects of intravenous anesthetics: a new critical perspective. Current pharmaceutical design, 20(34), 5469–5475. https:// doi.org/10.2174/1381612820666140325110113
5. Butterfield, N. N., Graf, P., Macleod, B. A., Ries, C. R., & Zis, A. P. (2004). Propofol reduces cognitive impairment after electroconvulsive therapy. The journal of ECT, 20(1), 3–9. https://doi.org/10.1097/00124509- 200403000-00002
6. Canbek, O., Ipekcıoglu, D., Menges, O. O., Atagun, M. I., Karamustafalıoglu, N., Cetinkaya, O. Z., & Ilnem, M. C. (2015). Comparison of Propofol, Etomidate, and Thiopental in Anesthesia for Electroconvulsive Therapy: A Randomized, Double-blind Clinical Trial. The journal of ECT, 31(2), 91–97. https://doi.org/10.1097/YCT.0000000000000190
7. Deng, Q., Tang, M., Gao, J., & Liang, P. (2025). Association between gut microbiota dysbiosis and perioperative neurocognitive disorder and postoperative complications after valve replacement surgery: a prospective cohort study. BMC anesthesiology, 26(1), 9. https://doi.org/10.1186/ s12871-025-03521-0
8. Evered, L., Silbert, B., Knopman, D. S., Scott, D. A., DeKosky, S. T., Rasmussen, L. S., Oh, E. S., Crosby, G., Berger, M., Eckenhoff, R. G., & Nomenclature Consensus Working Group (2018). Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery-2018. Anesthesiology, 129(5), 872–879. https://doi.org/10.1097/ ALN.0000000000002334

9. Fredman, B., Noga, J., Zohar, E., Yaretzky, A., & Jedeikin, R. (1999). Influence of thiopental and propofol on postoperative cognitive recovery in the elderly patient undergoing general anesthesia. Journal of clinical anesthesia, 11(8), 635–640. https://doi.org/10.1016/s0952-8180(99)00108-7
10. Goettel, N., Burkhart, C. S., Rossi, A., Cabella, B. C., Berres, M., Monsch, A. U., Czosnyka, M., & Steiner, L. A. (2017). Associations Between Impaired Cerebral Blood Flow Autoregulation, Cerebral Oxygenation, and Biomarkers of Brain Injury and Postoperative Cognitive Dysfunction in Elderly Patients After Major Noncardiac Surgery. Anesthesia and analgesia, 124(3), 934–942. https://doi.org/10.1213/ANE.0000000000001803
11. Hannam, J. A., Mitchell, S. J., Cumin, D., Frampton, C., Merry, A. F., Moore, M. R., & Kruger, C. J. (2019). Haemodynamic profiles of etomidate vs propofol for induction of anaesthesia: a randomised controlled trial in patients undergoing cardiac surgery. British journal of anaesthesia, 122(2), 198–205. https://doi.org/10.1016/j.bja.2018.09.027
12. Joshi, G. P., & Vetter, T. R. (2024). Ambulatory Anesthesia: Current State and Future Considerations. Anesthesia and analgesia, 139(3), 453–457. https:// doi.org/10.1213/ANE.0000000000007127
13. Li, J., Liao, L., Shao, C., Yang, Y., Tang, Y., Wei, Q., & Xu, L. (2025). Comparison of remimazolam tosylate and propofol in hemodynamic stability, postoperative cognitive function, and recovery in general anesthesia combined with regional nerve blocks: a retrospective cohort study. BMC anesthesiology, 25(1), 126. https://doi.org/10.1186/s12871-025-02981-8
14. Li, X., Sun, Y., Chen, L., & Li, Y. (2026). The Impact of the Geriatric Nutritional Risk Index on Postoperative Cognitive Dysfunction and Complications after Total Hip Arthroplasty Under General Anesthesia: A Retrospective Study. Rejuvenation research, 29(1), 10–17. https://doi. org/10.1177/15491684251379234
15. Liu, J., Liu, R., Meng, C., Cai, Z., Dai, X., Deng, C., Zhang, J., & Zhou, H. (2017). Propofol decreases etomidate-related myoclonus in gastroscopy. Medicine, 96(26), e7212. https://doi.org/10.1097/ MD.0000000000007212
16. Liu, M., Song, W. L., Shen, H. J., & Liu, Y. M. (2025). Impact of ambient temperature on postoperative cognitive dysfunction in elderly patients surgery: A seasonal comparison in tropical regions. World journal of psychiatry, 15(11), 111917. https://doi.org/10.5498/wjp.v15.i11.111917
17. Marik P. E. (2004). Propofol: therapeutic indications and side-effects. Current pharmaceutical design, 10(29), 3639–3649. https://doi. org/10.2174/1381612043382846
18. Meng, Q. T., Cao, C., Liu, H. M., Xia, Z. Y., Li, W., Tang, L. H., Chen, R., Jiang, M., Wu, Y., Leng, Y., & Lee, C. C. (2016). Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study. Experimental and therapeutic medicine, 12(3), 1515–1524. https://doi.org/10.3892/etm.2016.3475
19. Mir, A. H., Shah, N. F., Din, M. U., Langoo, S. A., & Reshi, F. A. (2017). Effectiveness of sodium thiopentone, propofol, and etomidate as an ideal intravenous anesthetic agent for modified electroconvulsive therapy. Saudi journal of anaesthesia, 11(1), 26–31. https://doi.org/10.4103/1658- 354X.197339
20. Mizrak, A., Koruk, S., Bilgi, M., Kocamer, B., Erkutlu, I., Ganidagli, S., & Oner, U. (2010). Pretreatment with dexmedetomidine or thiopental decreases myoclonus after etomidate: a randomized, double-blind controlled trial. The Journal of surgical research, 159(1), e11–e16. https://doi.org/10.1016/j. jss.2009.07.031
21. Morgan, G. E., Mikhail, M. S., & Murray, M. J. (2022). Clinical Anesthesiology (7th ed.). McGraw-Hill Education. ISBN: 9781260473797
22. Padhi, P. P., Yeeda, S., Nayak, L. K., & Das, S. (2022). Procedural Sedation Using Two Different Proportions of Ketamine-Propofol Combination in Short Gynecological Procedures: A Randomized Controlled Trial. Cureus, 14(1), e21393. https://doi.org/10.7759/cureus.21393
23. Schmidt, M., Eckardt, R., Altmeppen, S., Wernecke, K. D., & Spies, C. (2018). Functional impairment prior to major non-cardiac surgery is associated with mortality within one year in elderly patients with gastrointestinal, gynaecological and urogenital cancer: A prospective observational cohort study. Journal of geriatric oncology, 9(1), 53–59. https://doi.org/10.1016/j. jgo.2017.07.011
24. Shetabi, H., Montazeri, K., & Ghoodjani, Y. (2022). A Comparative Study of the Effect of Anesthesia Induction with the Use of Four Drug Combinations Including "Propofol," "Etomidate-Propofol," "Thiopental," and "Midazolam-Thiopental" on Hemodynamic Changes during the Insertion of Laryngeal Mask in Eye Surgery. Advanced biomedical research, 11, 11. https://doi.org/10.4103/abr.abr_152_20
25. Tamdogan, I., Degermenci, M., Olgun Keles, B., & Tutar, M. S. (2025). Comparison of Sedation Efficacy Between Propofol-ketamine and Propofol-fentanyl Combinations in Short Gynecological Procedures. Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses, S1089-9472(25)00414-9. Advance online publication. https://doi. org/10.1016/j.jopan.2025.07.019
26. Turner, B. K., Wakim, J. H., Secrest, J., & Zachary, R. (2005). Neuroprotective effects of thiopental, propofol, and etomidate. AANA journal, 73(4), 297– 302.
27. Valk, B. I., & Struys, M. M. R. F. (2021). Etomidate and its Analogs: A Review of Pharmacokinetics and Pharmacodynamics. Clinical pharmacokinetics, 60(10), 1253–1269. https://doi.org/10.1007/s40262-021-01038-6
28. Wang, J., Li, Q. B., Wu, Y. Y., Wang, B. N., Kang, J. L., & Xu, X. W. (2018). Efficacy and Safety of Opioids for the Prevention of Etomidate-Induced Myoclonus: A Meta-Analysis. American journal of therapeutics, 25(5), e517–e523. https://doi.org/10.1097/MJT.0000000000000404
29. Zhi, Y., & Li, W. (2023). Effects of total intravenous anesthesia with etomidate and propofol on postoperative cognitive dysfunction. Physiological research, 72(2), 251–258. https://doi.org/10.33549/physiolres.934983