Objective: To compare the effects of propofol and etomidate on blood flow velocity in the middle cerebral artery during anesthesia induction.
Methods: Patients aged 18-64 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ, scheduled for laparoscopic surgery under general anesthesia with laryngeal mask airway (LMA) insertion were enrolled. Patients were randomly divided into two groups: propofol group (group P) and etomidate group (group E). The primary outcome was peak systolic velocity (PSV) of the middle cerebral artery at 10 minutes after LMA insertion. Secondary outcomes included PSV on admission and at 5 minutes after LMA insertion, pulsatility index (PI), resistance index (RI), end-diastolic velocity (EDV), time-averaged maximum velocity (TAmax), time-averaged mean velocity (TAmean), HR, MAP on admission and 5 and 10 minutes after LMA insertion. The rates of change in PSV, PI, RI, EDV, TAmax, TAmean, HR, and MAP 5 and 10 minutes after LMA insertion. Adverse reactions during anesthesia induction included injection pain and myoclonus.
Results: A total of 120 patients were included, 60 patients in each group. Compared with baseline values on admission, PSV, EDV, TAmax, TAmean, HR, and MAP were significantly decreased 5 and 10 minutes after LMA insertion in both groups (P < 0.05). Compared with group E, group P had significantly lower HR and MAP 5 minutes after LMA insertion, as well as higher PSV, PI, and RI 10 minutes after LMA insertion, and lower MAP 10 minutes after LMA insertion, and smaller percentage changes in PSV and PI 10 minutes after LMA insertion (P < 0.05). There were no significant differences in EDV, TAmax, or TAmean between the two groups. Compared with group E, group P had higher incidence of injection pain, and lower incidence of myoclonus during anesthesia induction (P < 0.05).
Conclusion: Compared with etomidate, propofol provides more stable PSV of middle cerebral artery during anesthesia induction with less impact on middle cerebral artery blood flow. |
