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A Comparative Study Between Thiopental Sodium and Etomidate

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A Comparative Study Between Thiopental Sodium and Etomidate IndianJournalofAnesthesiaandAnalgesia OriginalResearchArticle January–February2020;7(1)(Part-I):143-149 DOI:http://dx.doi.org/10.21088/ijaa.2349.8471.7120.20 A Comparative Study between Thiopental Sodium and Etomidate on HemodynamicResponseinAdult TreatedHypertensivesScheduledfor ElectiveSurgery VPraveenKumar1,JHymavathi2 1,2AssistantProfessor,DepartmentofAnesthesiology,MallaReddyInstituteofMedicalSciences,Suraram,Hyderabad,Telangana 500055,India. Abstract Context:Idealdrugsusedforanesthesiaforinductionshouldcountertheresponsetostressatthesame time not affecting the changes in the hemodynamics of the patient. This is required because induction is animportantpartinanesthesia.Aim:Tocomparehemodynamic responsetoinductionofanesthesia with thiopentoneoretomidateinadulttreatedhypertensivepatients.SettingsandDesign:Presenthospitalbased comparative study was carried out at Adichunchanagiri Institute of Medical Sciences, BG Nagar, Bellur. Methods:60adulttreatedhypertensivepatientsofeithersex,agedbetween29and61years,belongingtoASA IandIIwhowererandomlyallottedtoTwoGroupsof30each.GroupTreceived5mg/kgofthiopentone sodiumandGroupEreceivedEtomidate0.3mg/kg.Pulserate,systolic,diastolicandmeanarterialpressures bothafterpremedication(level0)andateveryminuteforfiveminutes(levels1–5)postinductionwithboth drugs were recorded. Statistical Analysis: The data was analyzed using t-test for comparing mean values betweenTwoGroups.Results:SBPfellto120±28.8from131.70±16.03(level0)inGroupTandfellto120.80 ±20.05from131.23±16.03(level0)inGroupE.DBPhadaslightfallto77.73±17.00at4minutesinGroupT. MAPfellfrom94.52±12.10(level0)to91.72±21.34inGroupTandfellfrom96.96±12.96(level0)to90.37 ±17.51inGroupE.Comparisonofvariationsinheartrate,SBP,DBPandmapfromlevel0topostinduction recordingsat1–5levelsbetweenTwoGroupswasinsignificant(p>0.05).PatientsinbothGroupsdidnothave anysideeffects.Conclusion:Bothdrugsarecomparableinefficacyandsafety.Thiopentonecomparativelyhas bettercosteffectivenessandeaseofavailability. Keywords:Thiopentalsodium;Etomidate;Hemodynamicresponse;Hypertension;Surgery. Howtocitethisarticle: VPraveenKumar,JHymavathi.AComparativeStudybetweenThiopentalSodiumandEtomidateonHemodynamicResponse inAdultTreatedHypertensivesScheduledforElectiveSurgery.IndianJAnesthAnalg.2020;7(1Part-I):143–149. Introduction total number of hypertensive patients were 972 million and by 2025, 1.6 billion will be suffering 1 Hypertensionisextremelycommon,affectingover fromhypertension. one billion people worldwide, and is responsible When the cause for the hypertension is not for over seven million deaths annually. In 2000, known,itiscalledtheessentialhypertension.Itisa CorrespondingAuthor:JHymavathi,AssistantProfessor,DepartmentofAnesthesiology,MallaReddyInstituteofMedicalSciences, Suraram,Hyderabad,Telangana500055,India. E-mail:[email protected] Receivedon22.10.2019,Acceptedon28.11.2019 ©RedFlowerPublicationPvt.Ltd. 144 IndianJournalofAnesthesiaandAnalgesia well-knownfactthathypertensionisanimportant 2. Patients with controlled essential risk-factor for cardiovascular diseases. During hypertension. anesthesiasuchpatientsarepronetodevelopalotof variationsinthebloodpressure.Duringinduction Exclusioncriteria the arterial blood pressure falls drastically. They • Patients not willing to participate, ASA III arealsopronetohyperresponsivenesstointubation andabove; andlaryngoscopy.2 • Endorgandamage,emergencysurgeries; Ideal drugs used for anesthesia for induction should countertheresponseto stressatthesame • Co-morbid conditions like epilepsy, COPD timenotaffectingthechangesinthehemodynamics etc.Obstetric,Pediatricandobesepatients; ofthepatient.Thisisrequiredbecauseinductionis • Patientswithshock; animportantpartinanesthesia.Thiopentonewas • Drugallergies. therstagentwhichactsveryfastandalsoaidsin increasingtheoxygenconcentration.3 Methods Etomidateisalsoafast-actinghypnoticagentbut Institutional ethical committee permission was notabarbituratelikethiopentone.Itdoesnotcause taken.Writteninformedconsentwastakenfromall sideeffectsrelatedtorespiratorysystemandalso eligiblepatientsincludedinthestudy.Samplesize the cardiovascular system. Studies have proved was60patientsundergoingelectivesurgeries.This thatithasfewadverseeffects. wasaprospectivecomparativestudy.Thepatients weredividedintoTwoGroupsasfollows: It isarelativelynewagent.4Inroutinepractice theanestheticagentofchoiceisdesiredwhichwill GroupE-Inj.Etomidate:30patients; have minimum adverse effects especially with GroupT-Inj.Thiopentalsodium:30patients. knowncasesofhypertension.5 Patients foundtonpreanestheticexamination Hence, study was undertaken to compare were posted for surgery. A detailed history hemodynamicresponsetoinductionofanesthesia was obtained. Thorough clinical examination of with thiopentone or etomidate in adult treated each and every patient was carried out. Surgical hypertensive patients. A note was also made of prolewasalsocarriedoutforallpatients.Tablet costeffectivenessofeachdrug. alprazolamaswellastabletranitidinewasgivenin thenightbeforesurgery.Patientswerealsoadvised MaterialsandMethods tocontinuetheirantihypertensivedrugs. Hemodynamicparameters before surgery were StudyDesign noted.Then,aftergivingdrugslikeglycopyrrolate, midazolam and fentanyl and after giving oxygen A hospital based comparative study with 60 and once the patient stabilized, hemodynamic adult elective surgical hypertensive patients, parameters were again recorded and marked as 30 in Group T (Thiopental) and 30 patients in level 0 recording. Group E patients were given GroupE(Etomidate)wasundertakentostudythe general anesthesia with etomidate 0.3 mg/kg hemodynamicresponsetoinductionofanesthesia bodyweight.GroupTpatientsweregivengeneral with thiopentone or etomidate between January anesthesia with thiopentone 5 mg/kg body 2011 to September 2012. The number of patients weight.BothGrouppatientsreceivedvecuronium was22ingeneralsurgicalcategory,18inorthopedic afterwards. and20ingynecologicalcategory. Later all hemodynamic parameters were Sourcesofdata observedandnoteddownat1,3,4,and5minutes after induction. Routine ECG monitoring was Data was randomly collected from 60 ASA II carried out for all patients. Complications were adult treated hypertensive patientsaged between observed and noted down from induction of 29–61 years scheduled for elective surgeries at anesthesiatill24hoursafter. AdichunchanagiriInstituteofMedicalSciences,BG Nagar,BellurforaperiodoftwoyearsSeptember StatisticalMethods (2010–2012). Descriptive and inferential statistical analysis Inclusioncriteria hasbeencarriedoutinthepresentstudy.Results on continuous measurements are presented 1. Patientsofage29–61years; IJAA/Volume7Number1(Part-I)/January-February2020 VPraveenKumar,JHymavathi/AComparativeStudybetweenThiopentalSodiumandEtomidateon 145 HemodynamicResponseinAdultTreatedHypertensivesScheduledforElectiveSurgery on Mean ± SD (Min./Max.) and results on Results categorical measurements are presented in Number(%).Signicanceis assessedat 5% level Table 1 shows distribution of all the patients as ofsignicance. pertypeofsurgerydone.Majorityofthepatients underwentgeneralsurgeryfollowedbygynecology surgeryandrestorthopedicsurgery. Table1:Distributionofallthepatientsaspertypeofsurgerydone Typeofsurgery Nos. Percentage(%) Generalsurgery 22 36.7 Orthopedicsurgery 18 30 Gynecologysurgery 20 33.3 Total 60 100 Table 2 shows comparison of Two Groups of comparable in Two Groups of patients. Both the patients on different variables. There were 14 Groupswerealsocomparableintermsofduration male(46.7%)and16females(53.3%)inGroup–T. of hypertensionand also in terms of various age Therewere14male(46.7%)and16females(53.3%) Groups. in Group –E. The mean age, mean weight were Table2:Comparisonoftwogroupsofpatientsondifferentvariables GroupT GroupE Chi-square/ Variables p-value % Nos. % Nos. t-value Gender Male 14 46.7 14 46.7 0.06696 0.7958 Female 16 53.3 16 53.3 Durationof <6months 22 73.3 26 86.7 3.476 0.4815 hypertension 6months1year 4 13.3 3 10.0 1–2years 2 6.7 0 0.0 3–5years 1 3.3 1 3.3 >5years 1 3.3 0 0.0 Age(years) <30 01 3.3 01 3.3 1.111 0.8925 31–40 05 16.7 04 13.3 41–50 11 36.7 11 36.7 51–60 13 43.3 13 43.3 >60 0 0.0 1 3.3 MeanWeight(kg) 52.43±9.53 50.63±9.40 0.7365 0.4644 MeanAge(years) 48.93±7.80 49.90±8.83 0.4509 0.6537 Table 3 shows comparison of Two Groups of received Calcium channel blockers with Beta patients for treatment received. 14 patients in blockers.Sixpatientsineachgroupreceivedbeta thegroupTand17ingroupEreceivedCalcium blockers. Two patients in each group received channel blockers. Four patients in group E ACEinhibitors. Table3:Comparisonoftwogroupsofpatientsfortreatmentreceived GroupT(n=30) GroupE(n=30) Treatments Nos. % Nos. % Calciumchannelblockers 14 46.7 17 56.7 CalciumchannelblockerswithBetablockers 0 0.0 4 13.3 Betablockers 6 20.0 6 20.0 ACEinhibitors 2 6.7 2 6.7 ARBwithDiuretics 2 13.3 1 3.3 ARB 3 10.0 0 0.0 Alphablockers 1 3.3 0 0.0 IJAA/Volume7Number1(Part-I)/January-February2020 146 IndianJournalofAnesthesiaandAnalgesia Table 4 shows comparison of Two Groups of GroupE–3(10.0%).Thenumberofpatientswith patientsonfunduschanges.Thenumberofpatients hypertensivechangesonfundusstudy–Group-T– withnormalstudyoffundsGroupT–5 (16.7%); 25(83.3%);Group-E–27(90.0%). Table4:Comparisonoftwogroupsofpatientsonfunduschanges GroupT(n=30) GroupE(n=30) Fundus Nos. % Nos. % Nochange 5 16.7 3 10.0 Changepresent 25 83.3 27 90.0 FundusI 11 36.7 9 30.0 FundusII 14 46.7 18 60.0 Table 5 shows comparison of two Groups of 11 (36.7%); Group –E – 9 (30.0%). The number patientsoncomplications.Thenumberofpatients
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