Clinical Trials Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2021; 9(6): 1293-1303
Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1293
Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial
Zhong-Liang Dai, Xing-Tao Cai, Wen-Li Gao, Miao Lin, Juan Lin, Yuan-Xu Jiang, Xin Jiang
Zhong-Liang Dai, Xing-Tao Cai, Wen-Li Gao, Miao Lin, Juan Lin, Yuan-Xu Jiang, Department of Anesthesiology, The First Affiliated Hospital of Southern University, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen 518020, Guangdong Province, China
Xin Jiang, Department of Geriatrics, The First Affiliated Hospital of Southern University, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen 518020, Guangdong Province, China
Author contributions: Dai ZL, Jiang YX, and Jiang X designed the study and analyzed the data; Cai XT, Gao WL and Lin M collected the data; Dai ZL, Lin J, and Cai XT interpreted the data; Dai ZL, Jiang YX, and Jiang X prepared the manuscript; all authors have read and approved the manuscript.
Supported by Shenzhen Municipal Science and Technology Foundation, No. JCYJ20170307100314152; Shenzhen Health Research Fund, No. SZLY2018011 and No. SZXJ2017029; Guangdong Medical Research Fund, No. A2018008 and No. A2019382; Scientific Research Fund of Shenzhen People’s Hospital, No. SYLY201706; and Shenzhen Key Medical Discipline Construction Fund, No. SZXK012.
Institutional review board statement: The study was approved by the Ethics Committee of Shenzhen People’s Hospital (No. LL-KT-2014211) and conducted according to the Declaration of Helsinki.
Clinical trial registration statement: The trial was registered in Chinese Clinical Trial Registry on August 15, 2019 (ChiCTR1900025174) and is available at http://www.chictr.org.cn/showproj.aspx?proj=42063.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin Jiang, MD, Doctor, Department of Geriatrics, the First Affiliated Hospital of Southern University, the Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, No. 1017 Dongmen North Road, Luohu District, Shenzhen 518020, Guangdong Province, China. jiangxinsz@163.com
Received: November 10, 2020
Peer-review started: November 10, 2020
First decision: December 8, 2020
Revised: December 17, 2020
Accepted: December 27, 2020
Article in press: December 27, 2020
Published online: February 26, 2021
Abstract
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 (T1) and immediately after tracheal intubation (T2), lower systolic blood pressure at T1, and lower diastolic blood pressure and mean arterial pressure at T1, T2, 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.

Keywords: Etomidate, Propofol, General anesthesia, Coronary heart disease, Hemodynamic, Cardiovascular events

Core Tip: The results show that in patients with coronary heart disease undergoing noncardiac major surgery, etomidate-based anesthesia was associated with fewer cardiovascular events and smaller hemodynamic changes than propofol-based anesthesia.