Etomidate for anesthetic induction may cause minimal changes in systemic hemodynamics in TBI, finds Study

Maintaining optimal cerebral perfusion and oxygenation following anesthetic induction is crucial for preventing secondary brain insults in vulnerable acute brain injury patients and is a primary goal in the neurosurgical management of traumatic brain injury. Recent observational study compared the effects of three different anesthetic induction agents - etomidate, thiopental, and propofol - on systemic hemodynamics, regional cerebral oxygenation (rScO2), and serum cortisol levels in patients with acute traumatic brain injury (TBI).

The key findings of the study were: 1. Hemodynamic changes: Etomidate induction resulted in the least hemodynamic changes, with a significant decrease in mean arterial pressure (MAP) and heart rate (HR) observed with thiopental and propofol induction compared to etomidate. 2. Cerebral oxygenation: All three induction agents led to a significant increase in bilateral rScO2 after induction. The increase in contralateral rScO2 was maximal with etomidate compared to propofol. The trend changes in bilateral rScO2 were comparable between thiopental and etomidate. 3. Serum cortisol: An insignificant decrease in serum cortisol levels was observed with etomidate and thiopental, while a significant increase was seen with propofol at 24 hours post-induction. 4. Neurological outcome: The Glasgow Coma Scale (GCS) score improved significantly in all three groups at discharge, with no significant differences between the groups. In conclusion, in patients with acute TBI, anesthetic induction with etomidate resulted in the most stable hemodynamics and maximal increase in cerebral oxygenation compared to thiopental and propofol. Additionally, etomidate showed an insignificant impact on serum cortisol levels. The neurological outcome at discharge was comparable across the three induction agents.

Key Points -

Here are the 6 key points from the scientific article:

1. Hemodynamic changes: Etomidate induction resulted in the least hemodynamic changes, with a significant decrease in mean arterial pressure (MAP) and heart rate (HR) observed with thiopental and propofol induction compared to etomidate.

2. Cerebral oxygenation: All three induction agents led to a significant increase in bilateral regional cerebral oxygenation (rScO2) after induction. The increase in contralateral rScO2 was maximal with etomidate compared to propofol. The trend changes in bilateral rScO2 were comparable between thiopental and etomidate.

3. Serum cortisol: An insignificant decrease in serum cortisol levels was observed with etomidate and thiopental, while a significant increase was seen with propofol at 24 hours post-induction.

4. Neurological outcome: The Glasgow Coma Scale (GCS) score improved significantly in all three groups at discharge, with no significant differences between the groups.

5. Conclusion: In patients with acute traumatic brain injury (TBI), anesthetic induction with etomidate resulted in the most stable hemodynamics and maximal increase in cerebral oxygenation compared to thiopental and propofol.

6. Conclusion: Additionally, etomidate showed an insignificant impact on serum cortisol levels. The neurological outcome at discharge was comparable across the three induction agents.

Reference –

Sharma KK, Surve RM, Reddy KRM, Christopher R, Chakrabarti D, Pandarisamy S, et al. Impact of anesthetic induction with etomidate, thiopentone, and propofol on regional cerebral oxygenation: An observational study in patients with traumatic brain injury. J Anaesthesiol Clin Pharmacol 2024. DOI:10.4103/joacp.joacp_315_23.