Comparative Effects of Propofol and Etomidate on Postoperative Outcomes in Off-Pump Coronary Artery Bypass Grafting: A Retrospective Study
Propofol and Etomidate in Off-Pump Coronary Artery Bypass Grafting
DOI:
https://doi.org/10.5281/zenodo.10019856Keywords:
Coronary Artery Bypass, Off-Pump, Propofol, Etomidate, HospitalizationAbstract
Abstract:
Aim:
Cardiac surgeries often necessitate potent anaesthetic agents to optimize perioperative outcomes. This study aimed to evaluate and compare the postoperative effects of Propofol and Etomidate, two widely used anaesthetic agents, following Off-pump Coronary Artery Bypass Grafting (CABG).
Materials and Methods:
We conducted a retrospective review of patients who underwent off-pump CABG at Koç University Hospital from January 2018 through December 2021. Primary and secondary outcomes included the duration of Intensive Care Unit (ICU) stay, time to extubation post-surgery, and overall duration of hospitalization. Statistical analyses employed the Kolmogorov-Smirnov test, Independent Samples t-test, Chi-squared test, and Mann-Whitney U test.
Results:
Data from 66 patients were assessed, with 36 receiving Propofol and 30 receiving Etomidate during the induction phase of anaesthesia. No significant demographic or anthropometric differences existed between the groups. The median ICU stay for Propofol recipients was 1 day, while Etomidate recipients had a median stay of 1.5 days. The time to extubation post-surgery was 8 hours for Propofol and 6 hours for Etomidate. Both groups had a similar median hospitalization duration of 6 days. There were no statistically significant differences between groups for any of the outcomes.
Conclusion:
The study found marginal differences in postoperative outcomes between Propofol and Etomidate users undergoing CABG. Both anaesthetics demonstrated comparable efficacies concerning ICU stay, extubation time, and overall hospitalization duration. Further prospective studies with larger cohorts are suggested to consolidate these findings and refine anaesthesia strategies in cardiac surgical contexts.
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References
- Grant MC, Isada T, Ruzankin P, et al. Opioid-Sparing Cardiac Anesthesia: Secondary Analysis of an Enhanced Recovery Program for Cardiac Surgery. Anesth Analg. 2020;131(6):1852-1861.
- Landoni G, Lomivorotov VV, Nigro Neto C, et al. Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery. N Engl J Med. 2019;380(13):1214-1225.
- Wagner CE, Bick JS, Johnson D, et al. Etomidate use and postoperative outcomes among cardiac surgery patients. Anesthesiology. 2014;120(3):579-589.
- Krzych LJ, Szurlej D, Bochenek A. Rationale for propofol use in cardiac surgery. J Cardiothorac Vasc Anesth. 2009;23(6):878-885.
- Malhotra AK. Con: etomidate--the ideal induction agent for a cardiac anesthetic?. J Cardiothorac Vasc Anesth. 2013;27(1):178-179.
- Wagner RL, White PF. Etomidate inhibits adrenocortical function in surgical patients. Anesthesiology. 1984;61(6):647-651.
- Chan CM, Mitchell AL, Shorr AF. Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis. Crit Care Med. 2012;40(11):2945-2953.
- Hidalgo DC, Amin V, Hukku A, Kutlu K, Rech MA. Etomidate Use for Rapid Sequence Intubation Is Not Associated With Nosocomial Infection. J Pharm Pract. 2022;35(3):383-387.
- Hannam JA, Mitchell SJ, Cumin D, et al. Haemodynamic profiles of etomidate vs propofol for induction of anaesthesia: a randomised controlled trial in patients undergoing cardiac surgery. Br J Anaesth. 2019;122(2):198-205.
- Aggarwal S, Goyal VK, Chaturvedi SK, Mathur V, Baj B, Kumar A. A comparative study between propofol and etomidate in patients under general anesthesia. Braz J Anesthesiol. 2016;66(3):237-241.
- Paternoster G, Guarracino F. Sepsis After Cardiac Surgery: From Pathophysiology to Management. J Cardiothorac Vasc Anesth. 2016;30(3):773-780.
- Ailawadi G, Chang HL, O'Gara PT, et al. Pneumonia after cardiac surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network. J Thorac Cardiovasc Surg. 2017;153(6):1384-1391.e3.
- Howitt S.H., Herring M., Malagon I., McCollum C.N., Grant, S.W. Incidence and outcomes of sepsis after cardiac surgery as defined by the Sepsis-3 guidelines. Br. J. Anaesth. 2018, 120, 509–516.
- Weiss B, Schiefenhövel F, Grunow JJ, et al. Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery-Results of a Retrospective, before-after Study. J Clin Med. 2021;10(13):2908. Published 2021 Jun 29.
- Sunshine J.E., Deem S., Weiss N.S., et al. Etomidate, adrenal function, and mortality in critically ill patients. Respir. Care 2013, 58, 639–646.
- Asehnoune K., Mahe P.J., Seguin P., et al. Etomidate increases susceptibility to pneumonia in trauma patients. Intensive Care Med. 2012, 38, 1673–1682.
- Albert S.G., Ariyan S., Rather A. The effect of etomidate on adrenal function in critical illness: A systematic review. Intensive Care Med. 2011, 37, 901–910.
- Morel J., Salard M., Castelain C., et al. Haemodynamic consequences of etomidate administration in elective cardiac surgery: A randomized double-blinded study. Br. J. Anaesth. 2011, 107, 503–509.
- Basciani R.M., Rindlisbacher A., Begert E., et al. Anaesthetic induction with etomidate in cardiac surgery: A randomised controlled trial. Eur. J. Anaesthesiol. 2016, 33, 417–424.
- Bruder E.A., Ball I.M., Ridi S., Pickett W., Hohl C. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst. Rev. 2015, 1.
- Kaushal RP, Vatal A, Pathak R. Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass. Ann Card Anaesth. 2015;18(2):172-178.
- Vinclair M., Broux C., Faure P., et al. Duration of adrenal inhibition following a single dose of etomidate in critically ill patients. Intensive Care Med. 2008, 34, 714–719.
- McPhee L.C., Badawi O., Fraser G.L., et al. Single-dose etomidate is not associated with increased mortality in ICU patients with sepsis: Analysis of a large electronic ICU database. Crit Care Med. 2013, 41, 774–783.
- Heinrich S, Schmidt J, Ackermann A, Moritz A, Harig F, Castellanos I. Comparison of clinical outcome variables in patients with and without etomidate-facilitated anesthesia induction ahead of major cardiac surgery: a retrospective analysis. Crit Care. 2014;18(4):R150. Published 2014 Jul 11.
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