Compare The Influence Of Etomidate And Propofol On Patients’ Hemodynamics During General Anesthesia Induction

Objective:To compare the influence of etomidate and propofol on patients’ hemodynamics during general anesthesia induction.Methods:100 patients who underwent elective endotracheal intubation of general anesthesia were randomized into two groups:etomidate group (group E) and propofol group (group P). All of them were diagnosed with malignant tumor on digestive system. Etomidate and propofol were respectively applied during plasma concentration target-controlled induction. This study adopted single-blind method. Two anesthesiologists respectively took account of drug administration and endotracheal intubation. Before anesthesia, all the patients were out of service of sedative and cholinoceptor blocking drugs. Preoperation, routinely no drinking for 6 hours and no diet for 8 hours was applied. In the operating room, the monitor included electrocardiograph (ECG), Oxygen saturation by pulse oxime (SPO2), non-invasive blood pressure (NIBP) and bispectral index (BIS). After establishment of peripheral venous access, under local anesthesia radial artery and vena jugularis interna were punctured, Vigileo cardiac output monitor was connected, and mean arterial pressure (MAP), central venous pressure (CVP) and cardiac output (CO) and the like were monitored.Firstly, the group E employed CONCERT-TCI-I injection pump TCI etomidate with blood plasma target concentration around 0.6μg·ml-1 by Arden model. In accordance with patients’BIS values and the state of consciousness, adjusted target concentration if patients’consciousness disappeared and BIS values<40, then brought down target concentration. If patients’consciousness did not vanish and BIS values >60, target concentration was increased. As for group P, we firstly employed CONCERT-TCI-I injection pump TCI propofol with blood plasma target concentration around 4μg·ml-1 by Marsh model, as well adjusted target concentration on the basis of patients’BIS values and consciousness status. During induction process, if the patients turned up with tongue glossocoma, jaw-lift was applied to guarantee respiratory tract unobstructed. When respiratory depression appeared, assisted respiration was given to the patients.After patients’consciousness vanished, BIS values<60, we gave sufentanil 0.3μg·kg-1 and vecuronium bromide 0.1mg·kg-1 by intravenous injection. After muscle relaxed perfectly, the same skillful anesthetist applied endotracheal intubation, required within 30 seconds use Glide Scope once for all.5 minute after endotracheal intubation succeeded, we stopped TCI etomidate (propofol) and inhaled volume fraction 2-3% sevoflurane, intravenous pumping remifentanil 0.01 mg·kg-1·h-1. During induction, if patients’MAP<50 mmHg, ephedrine was given, once HR< 45 times per minute, atropine was given, when SV<55ml, dobutamine was given. After endotracheal intubation, if patients’MAP> 120 mmHg, urapidil hydrochloride was given, HR> 110 times per minute, esmolol was given.During general anesthesia induction, the observational index included patients’ general condition, induction time, induction dosage, bispectral index(BIS)value, Mean arterial pressure(MAP), central venous pressure (CVP), heart rate (HR), stroke volume (SV), cardiac output (CO), cardiac index (CI), systemic peripheral vascular resistance (SVR), and systemic peripheral vascular resistance index (SVRI), applied vasoactive drug condition and intraoperative awareness were recorded.During general anesthesia induction, we observed time-points before anesthesia induction immediately (To), loss of consciousness and BIS<60 immediately (T1), induction succeed before endotracheal intubation immediately(T2), induction succeed endotracheal intubation immediately(T3),1 minute after intubation(T4),3 minutes after intubation (T5),5 minutes after intubation(T6).Results:1. No difference between two group of patients in general condition, BIS value of the same timing and general anesthesia induction time (p>0.05).2.SV, CO and CI of group E were significantly lower at T1 and T2 than at To (p<0.05), however, SVR and SVRI were significantly higher at T1 and T2 than at To (p<0.05) and MAP, HR, CVP had no obvious difference(p>0.05), SV,CO and CI of group E were significantly lower at T3 and T4 than at T0(p<0.05), however, MAP, HR, SVR, SVRI of group E were significantly higher at T3 and T4 than at To (p<0.05) and CVP had no obvious difference(p>0.05).3. MAP, HR, SV, CO, CI, SVR and SVRI of group P were significantly lower at T1 and T2 than at To (p<0.05) and no difference in CVP (p>0.05), SV, CO and CI of group P were significantly lower at T3 and T4 than at To (p<0.05) and MAP, HR and CVP were similar (p>0.05).4. No difference in MAP, CVP, HR, SV, CO, CI, SVR and SVRI of group E comgared with group P at To (p>0.05),MAP, HR, SVR and SVRI of group E were significantly higher than group P at T1 and T2, however, CVP, SV, CO and CI of group E had no obvious difference than group P at T1 and T2(p>0.05),MAP,HR, SVR and SVRI of group E were significantly higher than group P at T3 and T4; MAP, CVP, HR, SV, CO, CI, SVR and SVRI of group E were similar to group P at T5 and T6 (p >0.05).Conclusion:The study found that etomidate make peripheral vessel shrink, cardiac muscle restrain, stroke volume drop, blood pressure and heart rate reduce slightly, and peripheral vessel shrink offset part of blood pressure reduce which is caused by cardiac muscle restrain and hemodynamics make a difference, and propofol make peripheral vessel relax, cardiac muscle restrain, stroke volume drop, blood pressure and heart rate reduce, obviously influence hemodynamics than etomidate.