A comparison of propofol and etomidate for anesthesia induction in patients with diabetic autonomic neuropathy: The use of propofol and etomidate

Rabia Sarı Küçük; Sinan Uzman

doi:10.5281/zenodo.7699091

Authors

Rabia Sarı Küçük University of Health Sciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, Department of Anesthesiology and Reanimation, İstanbul, Turkey https://orcid.org/0000-0002-7597-8279
Sinan Uzman Haseki Training and Research Hospital, Department of Anesthesiology and Reanimation, İstanbul, Turkey https://orcid.org/0000-0003-3166-7302

DOI:

https://doi.org/10.5281/zenodo.7699091

Keywords:

Anesthesia induction, diabetic neuropathy, etomidate, propofol

Abstract

Objective: Diabetic autonomic neuropathy (DAN) is closely related with higher perioperative hemodynamic abnormalities. We predicted that etomidate produces less hemodynamicabnormalities than propofol during anesthesia induction in DAN patients.
Methods: The study included 40 DAN patients that undergo elective abdominal surgery with American Society of Anesthesiology classifications 2 or 3. In Group E, etomidate 0.3 mg/kg was given for induction of anesthesia. In Group P, propofol 2.5 mg/kg was applied for induction of anesthesia. Each group was consisted of 20 patients. Diastolic (DAP), systolic (SAP), mean arterial pressure (MAP) and heart rate (HR) values were measured before anesthesia induction (T0). Following the anesthesia induction, same measurements were conducted every minute for 5 minutes (T1-T5). Before anesthesia induction, following five minutes of endotracheal intubation and the surgical incision, the levels of serum insulin, cortisol and adrenocorticotropic hormone (ACTH) were analyzed.
Results: Average HR measurements were not different among the groups., average HR considerably reduced at T1 compared with T0 in Group P. Average SAP at T2 was noticeably fewer in Group P. Average SAP considerably decreased at T2 in both groups (p0.001) when compared with T0 values. At T1, T2, T3, and T5 times, patients in Group P showed noticeably decreased average DAP values than those in Group E. T1 average DAP noticeably decreased only in Group P (p<0.001) when compared with T0 values. At T1, average MAP was noticeably decreased in Group P compared with Group E (p=0.033). MAP noticeably decreased at T1 in both groups compared with T0 measurements (p≤0.006). Serum levels of ACTH, cortisol, and insulin were not noticeably distinguishable among groups at any measurement time point.
Conclusion: When compared to propofol, etomidate is associated with fewer hemodynamic disturbances during anesthesia induction in diabetic patients with DAN.

References

El Sayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care. 2023 Jan 1;46(1):S19–40.

Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Kaabi J, et al. Epidemiology of Type 2 diabetes - Global burden of disease and forecasted trends. J Epidemiol Glob Health. 2020;10(1).

Williams S, Raheim SA, Khan MI, Rubab U, Kanagala P, Zhao SS, et al. Cardiac Autonomic Neuropathy in Type 1 and 2 Diabetes: Epidemiology, Pathophysiology, and Management. Vol. 44, Clinical Therapeutics. Elsevier Inc.; 2022. p. 1394–416.

Aso Y. Updates in diabetic neuropathy: A call for new diagnostic and treatment approaches. J Diabetes Investig. 2022;13(3).

Şahin M. Diyabetik otonom nöropatide güncel tanı ve tedavi yaklaşımları. Abant Tıp Dergisi. 2017;6(3):129–33.

Spallone V. Update on the impact, diagnosis and management of cardiovascular autonomic neuropathy in diabetes: What is defined, what is new, and what is unmet. Vol. 43, Diabetes and Metabolism Journal. 2019.

Oakley I, Emond L. Diabetic cardiac autonomic neuropathy and anesthetic management: Review of the literature. Vol. 79, AANA Journal. 2011.

Creagh O, Torres H, Rodríguez N, Gatica SR. Alpha-2B adrenergic receptor mediated hemodynamic profile of etomidate. Vol. 29, Puerto Rico Health Sciences Journal. 2010.

Ebert TJ, Muzi M, Berens R, Goff D, Kampine JP. Sympathetic responses to induction of anesthesia in humans with propofol or etomidate. Anesthesiology. 1992;76(5).

Argente-Pla M, Pérez-Lázaro A, Martinez-Millana A, del Olmo-García MI, Espí-Reig J, Beneyto-Castello I, et al. Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test. J Diabetes Res. 2020;2020.

Keyl C, Lemberger P, Palitzsch KD, Hochmuth K, Liebold A, Hobbhahn J. Cardiovascular autonomic dysfunction and hemodynamic response to anesthetic induction in patients with coronary artery disease and diabetes mellitus. Anesth Analg. 1999;88(5).

Baradari AG, Alipour A, Habibi MR, Rashidaei S, Zeydi AE. A randomized clinical trial comparing hemodynamic responses to ketamine-propofol combination (ketofol) versus etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery. Archives of Medical Science. 2017;13(5).

Hannam JA, Mitchell SJ, Cumin D, Frampton C, Merry AF, Moore MR, et al. Haemodynamic profiles of etomidate vs propofol for induction of anaesthesia: a randomised controlled trial in patients undergoing cardiac surgery. Br J Anaesth. 2019;122(2).

Kaushal RP, Vatal A, Pathak R. Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass. Ann Card Anaesth. 2015;18(2).