The Effects of Etomidate and Propofol Induction on Hemodynamic and Endocrine Response Undergoing CABG Surgery

Abstract

Objectives: Effects of propofol and etomidate induction on hemodynamic and endocrine stress response in patients undergoing elective coronary artery bypass graft (CABG) surgery were investigated in this study. Patients and Methods: After the approval of the local ethics committee was obtained, forty, American Society of Anesthesiologists (ASA) status II-III patients undergoing scheduled coronary artery bypass surgery were enrolled in the study. Patients were allocated randomly to receive either propofol or etomidate for anesthesia induction. Anesthesia was maintained in both groups with 1% isoflurane, 50% nitrous oxide and 50% oxygen. Results: Hemodynamically, Group E was more stable than Group P following induction of anesthesia (p<0.05). There were no significant differences between the groups in terms of glucose response. There was a significant difference in Adrenocorticotropic hormone (ACTH) levels between the groups in control and t4 measurements (p<0.05). In group P, levels of blood cortisol significantly decreased after induction (p<0.05) but increased with Cardio Pulmonary By-pass (CPB). In group E, significant decrements ase in cortisol levels continued also during CPB, (p<0.05). Conclusion: Etomidate may be preferred to propofol for the induction of anesthesia in CABG because of its hemodynamic stability. Etomidate inhibited cortisol secretion temporarily and this inhibition may be useful to prevent stress response due to CABG surgery. Turkish Başlık: KABG Cerrahisinde Etomidat ve Propofol İndüksiyonunun Hemodinamik ve Endokrin Yanıt Üzerine Etkileri Anahtar Kelimeler: Anestezikler; propofol; etomidat; KABG; stres yanıt; kortizol Amaç: Bu çalışmada elektif koroner arter baypas grefti (KABG) planlanan hastalarda, propofol ve etomidatla indüksiyonun hemodinamik ve endokrin stres yanıt üzerine etkileri araştırıldı. Hastalar ve Yöntemler: Hastane etik kurul onayı alındı ktan sonra, American Society of Anesthesiologists (ASA) II-III statüsünde elektif koroner arter baypas cerrahisi yapılacak 40 hasta çalışmaya alındı. Hastalar anestezi indüksiyonunda propofol (grup P) veya etomidat (grup E) alacak şekilde rastgele iki gruba ayrıldı. Anestezi idamesi %1 izofloran, %50 azotropotoksit, %50 oksijenle yapıldı. Bulgular: Grup E anestezi indüksiyondan itibaren hemodinamik açıdan grup P'den daha stabil seyretti (p<0.05). İki grupta glukoz yanıtı açısından anlamlı bir fark yoktu. Adrenokortikotrop hormon (ACTH) seviyesinde kontrol ve t4 ölçümlerinde iki grup arasında anlamlı fark olduğu görüldü (p<0.05). Kan kortizol seviyesi grup P'de indüksiyondan sonra kontrol değerine göre anlamlı olarak azaldı (p<0.05) fakat kardiyopulmoner baypasla (KPB) yükseldi. Grup E'de KPB süresince de anlamlı olarak düşmeye devam etti (p<0.05). Sonuç: Etomidat KABG'de anestezi indüksiyonunda sağladığı hemodinamik stabilite nedeniyle propofole tercih edilebilir. Etomidat geçici bir süreyle kortizol sekresyonunda inhibisyona neden olmuştur, bu inhibisyon KABG'ye bağlı stres yanıtın önlenmesinde faydalı olabilir.

Keywords

• Anaesthetics; propofol; etomidate; CABG; stress response; cortisol

KABG Cerrahisinde Etomidat ve Propofol İndüksiyonunun Hemodinamik ve Endokrin Yanıt Üzerine Etkileri

Öz

Amaç: Bu çalışmada elektif koroner arter baypas grefti (KABG) planlanan hastalarda, propofol ve etomidatla indüksiyonun hemodinamik ve endokrin stres yanıt üzerine etkileri araştırıldı. Hastalar ve Yöntemler: Hastane etik kurul onayı alındıktan sonra, American Society of Anesthesiologists (ASA) II-III statüsünde elektif koroner arter baypas cerrahisi yapılacak 40 hasta çalışmaya alındı. Hastalar anestezi indüksiyonunda propofol (grup P) veya etomidat (grup E) alacak şekilde rastgele iki gruba ayrıldı. Anestezi idamesi %1 izofloran, %50 azotropotoksit, %50 oksijenle yapıldı. Bulgular: Grup E anestezi indüksiyondan itibaren hemodinamik açıdan grup P’den daha stabil seyretti (p < 0.05). İki grupta glukoz yanıtı açısından anlamlı bir fark yoktu. Adrenokortikotrop hormon (ACTH) seviyesinde kontrol ve t4 öl- çümlerinde iki grup arasında anlamlı fark olduğu görüldü (p < 0.05). Kan kortizol seviyesi grup P’de indüksiyondan sonra kontrol değerine göre anlamlı olarak azaldı (p < 0.05) fakat kardiyopulmoner baypasla (KPB) yükseldi. Grup E’de KPB süresince de anlamlı olarak düşmeye devam etti (p < 0.05). Sonuç: Etomidat KABG’de anestezi indüksiyonunda sağladığı hemodinamik stabilite nedeniyle propofole tercih edilebilir. Etomidat geçici bir süreyle kortizol sekresyonunda inhibisyona neden olmuştur, bu inhibisyon KABG’ye bağlı stres yanıtın önlenmesinde faydalı olabilir.

Anahtar Kelimeler

• Anestezikler, propofol, etomidat, KABG, stres yanıt, kortizol

Kaynakça

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