Comparison of cardiovascular responses measured with a Vigileo-FloTrac device after propofol or etomidate with remifentanil for the induction of general anesthesia in geriatric patients

Chung, Woo Suk; Kim, Yo Han; Kim, Jae Kook; Kim, Bum June; Lee, Jungun

Clinical Research

Anesthetic Pharmacology

Anesthesia and Pain Medicine 2014;9(3):179-184.
Published online July 31, 2014.

Comparison of cardiovascular responses measured with a Vigileo-FloTrac device after propofol or etomidate with remifentanil for the induction of general anesthesia in geriatric patients

Woo Suk Chung, Yo Han Kim, Jae Kook Kim, Bum June Kim, Jungun Lee

Department of Anesthesiology and Pain Medicine, Chungnam University Hospital, Daejeon, Korea. julee@cnu.ac.kr

Received: 18 February 2014 • Revised: 12 March 2014

Abstract

BACKGROUND
Remifentanil efficiently blunts the stress response during endotracheal intubation, but also causes hypotension, especially in geriatric patients. Hence, this study was designed to compare the hemodynamic changes during the induction with propofol or etomidate in geriatric patients.
METHODS
Sixty ASA physical status class I or II geriatric patients, who were scheduled for elective surgery, were randomly assigned to two groups (n = 30 each). Induction was performed with either propofol (2 mg/kg mixed with lidocaine 40 mg, Group P) or etomidate (0.2 mg/kg, Group E). Both groups received a bolus dose of remifentanil (1 microg/kg), followed with continuous administration (0.1 microg/kg/min). An additional bolus dose (50 microg) was repeated, if needed. The systolic, diastolic, mean arterial blood pressure, heart rates and cardiac index were measured before induction (baseline vital signs), after propofol or etomidate administration, before intubation, immediately after intubation and at 1, 3, 5 and 10 minutes after intubation.
RESULTS
Patient characteristics and baseline vital signs were similar in both groups. Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and cardiac output were significantly decreased in group P compared with those in group E (P < 0.05). Heart rates decreased after the injection of both propofol or etomidate, but were recovered after intubation. 5 patients in group P and 14 patients in group E needed an additional bolus dose of remifentanil (P < 0.05).
CONCLUSIONS
Etomidate can be used safely with remifentanil for the stable induction of anesthesia in geriatric patients.

Key Words: Cardiovascular response, Etomidate, Propofol, Remifentanil, Vigileo-FloTrac device