Hemodynamic Stability During Anesthesia Induction And Double Lumen Tracheal Intubation With Propofol,etomidate-propofol Combination In Geriatric Patients

Objective: To compare the hemodynamic responses to an etomidate-propofol combination and propofol alone during the induction of anesthesia and double lumen tracheal(DLT)intubation.A bispectral index scale guided study.Methods: Eighty patients of American Society of Anesthesiologist(ASA)I-III aged 65-85 years undergoing thoracic surgeries with double lumen intubations were randomly divided into group Propofol(Group P)and group Etomidate-Propofol(Group EP)40 cases each.For all the patients in the operating theatre,lactated Ringers solution infusion was started(5ml/kg/2)before anesthesia induction,and standard monitoring was applied in the form of noninvasive blood pressure,electrocardiogram ECG,and peripheral capillary oxygen saturation(Sp02)was applied.Arterial blood pressure and bispectral index(BIS)was inserted.After firstly the administration of sufentanil(SF)0.4μg/kg to all patients,patients in group P were administered propofol(P)at a rate of 150ml/hr via anesthesia infusion pump till BIS<50 then Rocuronium 0.8mg/kg while patients in group EP were administered etomidate 150ml/hr till BIS <50 followed by administration of propofol 50ml/hr(both administered via the anesthesia infusion pump and separate injectors),followed by Rocuronium 0.8mg/kg.When no response was obtained to the train of four(TOF)stimulus with the TOF guard device,the patient was intubated.The hemodynamics and adverse reactions were observed between the two groups.Heart rate(HR),mean arterial pressure(MAP),systolic blood pressure(SBP),diastolic blood pressure(DBP),bispectral index scale(BIS),and peripheral capillary oxygen saturation(Sp02)were recorded before induction(T0),after induction(train of four TOF = 0)(T1),one minute after intubation(T2),5 minutes after intubation(T3),and 10 minutes after intubation(T4).Rate product pressure(RPP)was calculated at measurement intervals.Results: Eighty patients were included in the statistical analysis,51 males and 29 females aged 65-78.There were 40 patients in group P and 40 patients in group EP.1.There was no significant difference in the base value of SBP,DBP,MAP,HR,RPP,and BIS between both groups(P > 0.05).The lowest values of SBP(P = 0.003),DBP(P = 0.002),MAP(P = 0.001),RPP(P = 0.002)and the highest value of RPP(P = 0.025)in the two groups were statistically significant.2.There were no significant differences in age,gender,height,weight,body mass index(BMI),ASA grade,and smoking history between the two groups(P > 0.05)3.There was a significant difference in myoclonus between the two groups.7(17.5%)patients in group EP had myoclonus with a statistical difference(P < 0.01),while 2(5%)had injection pain in group P with no statistical difference(P > 0.05).Conclusion: Induction of etomidate-propofol effectively maintains hemodynamic stability during anesthesia induction and after anesthesia intubation in patients undergoing thoracic surgeries with double lumen tube intubation.