The Application Of Etomidate Emulsion For Noncardiac Surgery Of Patients With Coronary Heart Disease

Objective:Although propofol is recognized as one of the best general anesthetic agents in clinical at present, as it inhibits the circulatory system to lead to arrhythmia or obvious decline in blood pressure during anesthesia induction, therefore, the application of propofol was subjected to a certain restrictions in clinical. How to search for a better anesthesia induction strategy to meet the need of the endotracheal intubation and maintain hemodynamic relatively stable has always been a pursuing goal of clinical anesthesists. Etomidate is a kind of intrarenous anesthetic of midazole derivatives and has many features such as rapid onset, short action duration, and mild circulatory system inhibition effection. However, the shortcoming of injection pain etomidate makes etomidate be limited to a certain degree in clinical. By observing and comparing the effection on hemodynamic of propofol and etomidate emulsion that apply to patients with coronary heart disease during anesthesia, to evaluate the application value of etomidate in patients with coronary heart disease who need to receive non-cardiac surgery.Methods: In this study 80 patients of coronary heart disease were randomly divided into propofol group(group P)and etomidate group(group E),40 cases in each group. In group P, patients were injected the midazolam, fentany, propofol and atracurium in turn during anesthesia induction, the target control infusion of propofol and remifentanyl were used to maintain anesthesia. In group E, patients were injected the midazolam, fentnyl, etomidate and atracurium in turn during anesthesia induction,the continuous intravenous infusion of etomidate and the target control infusion remifentanyl were used to maintain anesthesia. Observing items include thehemodynamic changes,anesthesia depth(BIS values),ST-T changes and the occurrence of adverse reactions(include high blood pressure, low blood pressure,retricular premature beat, bradycardia and tachycardia) of the patients in two groups at the time points of before induction,3 min after injection, immediately after intubation and 5 min after intubation.Results:During anesthesia induction, there had occurred 17 cases of obvious hypotension,1 cases of tachycardia,11 cases of bradycardia,8 cases of positive ST-T and 11 cases of ventricular premature beat in group P patients; As for the patients in group E, there had occurred 4 cases of obvious hypotension,3 cases of tachycardia,3cases of bradycardia, 2 cases of positive ST-T and 3 cases of ventricular premature beat. The incidence rate of hypotension and bradycardia in group P was obviously higher than group E,by the way,the differences between two groups were statistical significance; The systolic pressure, diastolic pressure and mean arterial pressure decreased obviously in group P, the comparison of difference in two groups were statistical significance,the incidence rate of ventricular premature beat and positive ST-T change in two groups were statistical significance. The cTnI levels before and after surgery in two groups had no obviously changes, comparison between two groups was no statistical significance.The comparison of bispectral index before and after anesthesia induction in two groups had no significant difference(P> 0.05).Conclusion: The inhibition effect of etomidate fat emulsion to the patients' circulatory system is small, and during anesthesia induction, patients have relatively stable hemodynamic, high anesthesia safety and no pain stimulation from intravenousinjection. So etomidate is an ideal intravenous anesthetic for the patients with coronary heart disease that need to receive non-cardiac surgeries especially suitable to anesthesia induction for these subjects.