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CC BY 4.0 · J Neuroanaesth Crit Care 2023; 10(03): 175-182
DOI: 10.1055/s-0043-1771219
Original Article

Etomidate versus Propofol as Induction Agents in Patients Undergoing Decompressive Procedures for Cervical Compressive Myelopathy with and without Impaired Heart Rate Variability

Geetha Lakshminarasimhaiah 
1   Department of Neuroanesthesia and Neuro Critical Care, Ramaiah Institute of Neurosciences, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
,
Arun K. Mohan
2   Department of Physiology, Ramaiah Institute of Neurosciences, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
,
Parichay J. Perikal
3   Department of Neurosurgery, Ramaiah Institute of Neurosciences, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
,
Smruthi K. Bhat
4   Department of Anaesthesia, Ramaiah Institute of Neurosciences, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
,
Umesh Gangadhar
4   Department of Anaesthesia, Ramaiah Institute of Neurosciences, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
,
Ashna Manoj
4   Department of Anaesthesia, Ramaiah Institute of Neurosciences, Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
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Abstract

Background Patients with cervical compressive myelopathy (CCM) are known to have autonomic dysfunction, which can impact surgical outcomes. In such patients, screening patients for heart rate variability (HRV) may enable the anesthesiologist to predict hypotension, thereby attempting to modify the anesthetic technique. This study aimed to compare the hemodynamic changes in CCM patients between propofol and etomidate induction.

Methods Sixty CCM patients aged 18 to 70 years underwent an autonomic function test using HRV before decompressive surgery. The selected patients were randomized into two groups of 30 patients each to receive either etomidate or propofol for induction of anesthesia. The groups were compared for hemodynamic changes, the incidence of pain on injection, and the occurrence of myoclonus. While analyzing the hemodynamic changes, the two groups were subdivided into four groups, namely, propofol group with or without autonomic dysfunction (AD) and etomidate group with or without AD.

Results In the abnormal HRV group, patients induced with propofol showed a significantly higher incidence of hypotension at 3-minute (p = 0.02) and 5-minute (p = 0.04) time points. On the other hand, in HRV normal patients, induction with propofol showed a significantly higher (p = 0.03) incidence of hypotension at 5 minutes. During induction, higher grades of pain (p = 0.01) were observed in the propofol group, whereas the occurrence of myoclonus was more in the etomidate group (p = 0.07).

Conclusion As compared with propofol, the use of etomidate in patients with CCM undergoing decompressive procedures reduces hypotensive episodes, more so in patients with impaired HRV. Thus, HRV-based AD categorization may assist in optimal management of postinduction hypotension in patients with CCM.

Keywords

cervical compressive myelopathy - autonomic dysfunction - heat rate variability - propofol - etomidate - hypotension


Publication History

Article published online:
23 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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