Etomidate stands better than Propofol for reducing in-hospital morbidity after abdominal surgery

Results: 

• 1944 participants were randomized, of whom 1917 (98.6%) completed the trial.
•  967 Patients were randomized to the etomidate group with a mean age of 70.3 years. Of these, there were 578 men [59.8%].
• 950 patients were in the propofol group with a mean age of 70.6 years. Of these there were 533 men [56.1%]).
• The primary endpoint occurred in 90 of 967 patients (9.3%) in the etomidate group and 83 of 950 patients (8.7%) in the propofol group, which met the noninferiority criterion.
• In the etomidate group, mean (SD) cortisol levels were lower at the end of the surgery, and mean (SD) aldosterone levels were lower at the end of surgery and on a postoperative day 1 compared with the propofol group.
• No difference in mortality was observed between the etomidate and propofol groups at postoperative months 6 and 12.
• More patients had pneumonia in the etomidate group than in the propofol group. Results were consistent in the per-protocol population. 

Thus, the researchers concluded that when compared with propofol, etomidate anesthesia did not increase overall major in-hospital morbidity after abdominal surgery in older patients, even though it induced transient adrenocortical suppression. 

For the full article, click here: 10.1001/jamasurg.2022.3338

Lu Z, Zheng H, Chen Z, et al. Effect of Etomidate vs Propofol for Total Intravenous Anesthesia on Major Postoperative Complications in Older Patients: A Randomized Clinical Trial [published online ahead of print, 2022 Aug 10]. JAMA Surg. 2022;10.1001/jamasurg.2022.3338.