The effect of etomidate or propofol on brainstem function during anesthesia induction: a bispectral index-guided study

Abstract

Purpose

To compare the effect of etomidate versus propofol infusion on hemodynamic profiles, spontaneous breathing, and corneal reflex during the induction of anesthesia.

Methods

Adult patients (n=80) were randomized to receive etomidate (Group E, n=40) or propofol (Group P, n=40) infusion during anesthesia induction. Throughout induction, mean blood pressure and heart rate were monitored. Time to loss of consciousness (LOC), bispectral index (BIS), existence of spontaneous breathing, and corneal reflex at LOC were recorded.

Results

Fewer changes in hemodynamic profile occurred in Group E compared with Group P during induction of anesthesia. The mean time to LOC was shorter with etomidate than propofol (129.5 s vs 189.5 s, P<0.0001). BIS was lower in Group E compared with Group P at LOC (46.3 vs 52.9, P=0.0141). More patients exhibited spontaneous breathing in Group E compared with Group P at LOC (80% vs 17.5%, P<0.0001). Similarly, more patients maintained corneal reflex in Group E compared with Group P (34 patients vs 4 patients, P<0.0001). The incidence of etomidate-induced myoclonus was 17.5%.

Conclusion

Compared with propofol infusion, etomidate infusion during anesthesia induction had fewer effects on the hemodynamic profile of patients. Among patients who received etomidate, the BIS value was lower at LOC, and more patients displayed spontaneous breathing and corneal reflex.

Trial Registry Number

China Clinical Research Information Service, ChiCTR-IOR-17011050

Keywords:

• anesthesia
• etomidate
• propofol
• consciousness monitors
• bispectral index

Acknowledgments

The authors thank the anesthesiologists, surgeons, and anesthesia assistants who participated in this study.

Availability of data and materials

The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethical Standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional guidelines on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Author contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.