A clinical comparison of propofol and etomidate in patients with end-stage renal disease undergoing renal transplantation

Abstract

Background: Induction of anesthesia is a critical part of anesthetizing patients with end-stage renal disease, as they are at risk of wide hemodynamic fluctuation due to their pathophysiological alterations in the cardiovascular system. It is desirable to use pharmacological agents that provide hemodynamic stability with fewer adverse effects. Aims and Objectives: This study aimed to evaluate the effects of propofol and etomidate by comparing hemodynamic variables such as a change in mean arterial pressure (MAP) and heart rate (HR) during induction, laryngoscopy, and up to 10 min after tracheal intubation as a primary outcome and any associated adverse effect as a secondary outcome. Methods: After getting institutional ethical committee approval, 60 American Society of Anesthesiologist Grade III patients aged 20–60 years, scheduled for renal transplantation, were randomized into two groups (Group P: propofol 1% and Group E: etomidate). The dose of induction agents was targeted to achieve a bispectral index value of 40. Hemodynamic variables were recorded at induction, laryngoscopy, and up to 10 min after tracheal intubation. Adverse effects related to the study drug were recorded. Results: The decrease in MAP in Group P was statistically significant (P < 0.05) as compared to Group E, at induction of anesthesia. We observed a significant increase in HR at induction of anesthesia in Group E (P < 0.05). The incidence of myoclonus was 0 versus 73.3% in Groups P and E, respectively, while pain on injection and hypotension were more in Group P (P < 0.05). Conclusions: In conclusion, etomidate provides better hemodynamic stability with fewer adverse effects in patients with end-stage renal disease.