Effect Of Etomidate-lipuro-propofol Admixture On Hemodynamics Of Elderly Patients During Anesthesia Induction

Object: The purpose of this study was to compare propofol,etomidate-lipuro and1:1admixture of these induction agentsat Bispectral index-guided induction of general anesthesia inelderly patients, with special reference to hemodynamicchanges.Method: Sixty-nine patients, whose ASA is II-III, and ageis65~80were assigned at random to3groups in which inductionwas performed with a BIS value of50titrated infusion of eitherpropofol (P group), etomidate-lipuro （E group), or1:1etomidate-lipuro-propofol admixture (PE group). Afterpalpebral reflex loss, Cisatracuriun0.15mg·kg-1was givenand3min later the patient was oro-tracheally intubated andmechanically ventilated. Systolic blood pressure (SBP) andmean arterial pressure (MAP) and heart rate (HR), cardiac index(CI) and BIS value were measured before Induction (T0),1min before laryngoscopy (T1), immediately when intubation (T2),1min after intubation(T3),3min after intubation(T4),5minafter intubation (T5). The time from the start of the infusionuntil the loss of palpebral reflex, until BIS value decreasedto50were measured.Result：(1) There were no significant differences amongthree study groups with respect to demographic data andbaseline hemodynamic status (SBP, MAP, HR, and CI) beforeinduction(T0).(2) In three group, MAP, SBP and CI (P<0.05) wassignificantly decreased after induction until the end ofmeasurements (T1~T5) compared with baseline (before induction,T0). In P group, MAP and SBP (P<0.05) still decreased and wassignificantly lower during intubation and after intubation(T1~T5) compared with E or PE group; CI (P<0.05) wassignificantly lower after intubation (T4~T5)with respect to Eand PE group. In E group, MAP, SBP (P<0.05) was significantlyhigher at intubation (T2) with respect to P and PE group; CI(P<0.05) was significantly higher than in P and PE group, andHR remained increased over baseline value1min afterintubation(T3).(3) There were no significant differences among three groups with respect to BIS value in the period ofmeasurements(T0~T5).Conclusion: Etofol (1:1admixture of propofol andetomidate-lipuro) is associated with better hemodynamicstability than propofol and etomidate-lipuro, and I think itis a valuable induction agent for the general anesthesia inelderly patients.