Sunneta Dutta, Abhijit Saikia, Deba Gopal Pathak


Aim and objective: The aim of this study was to compare the effect of  Propofol and Etomidate separately and in a combination with  reduced doses of the two drugs in attenuating the hemodynamic response following laryngoscopy and intubation.

Methods: After taking ethical committee clearance, A prospective randomized double blinded study involving 90 patients aged 18-60 years of either sex and ASA physical status I or II scheduled for elective surgery under general anesthesia were randomly placed into three groups. Group A induced with Inj.Propofol (2.5 mg/kg), Group B with Inj.Etomidate (0.3 mg/kg) and Group C with Inj.Propofol (1.5 mg/kg) plus Inj.Etomidate (0.15 mg/kg). Heart rate (HR), mean arterial pressure (MAP) were recorded at baseline, after induction, before intubation, immediately after intubation and then at 1min, 3 min, 5 min and 10 min. ANNOVA and chi-square test were used for statistical analysis.

Result: Heart rate in all study groups decreases after induction and it was more in group A compared to group C (p<0.045) and after intubation HR increases in all three groups but this increase was greater in group B than A and C (p˂0.000, p˂0.001). MAP among all three groups decreases after induction and it was more in group A than group B and C (p˂0.000, p˂0.000). MAP was increased after intubation in all groups, more in group B than A and C(p˂0.000,p˂0.010).

Conclusion: The combination of propofol plus Etomidate has better hemodynamic stability than propofol and etomidate alone.


Propofol, Etomidate, hemodynamic response, mean arterial pressure, heart rate, laryngoscopy

Full Text:



Reid & Brace: Irritation of respiratory tract and its reflex effect on heart Surgery Gynaecology Obstetrics. 1940;70:157.

Tomori Z, Widdicombe J G. muscular, bronchomotor and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract. J. physiol. 1969;200;25-49.

King BD: Harris L, Greifenstein F, Elder J, Dripps RD. Reflex circulatory responses to direct laryngoscopy and intubation under general anaesthesia. Anaesthesiology. 1951;12:556-66.

Karl et al-Insertion of LMA in place of endotracheal intubation to attenuate the cardiovascular response. IJA, 1999;43:30-35.

Divatia JV, Bhowmick K. Complications of endotracheal intubation and other airway management procedures. Ind J Anaesth 2005; 49(4): 308-18.

Kumar et al-Blocking Glossopharyngeal & superior laryngeal nerves to attenuate the cardiovascular response to laryngoscopy & endotracheal intubation.IJA, 1993;41:2025.

King BD: Harris L, Greifenstein F, Elder J, Dripps RD. Reflex circulatory responses to direct laryngoscopy and intubation under general anaesthesia. Anaesthesiology. 1951;12:556-66.

Donlinger, JK Ellison N, Ominsky AJ. Effects of intrathecal lidocaine on circulatory responses to tracheal intubation. Anaesthesiology. 1974;41:409-12.

Stoelting RK. Blood pressure and heart rate changes during short duration laryngoscopy for tracheal intubation: influence of viscous or intravenous lignocaine. Anaesthesia Analgesia 1978;57:197-9.

Stoelting RK. Circulatory changes during direct laryngoscopy and tracheal intubation: Influence of duration of laryngoscopy with or without prior lignocaine. Anaesthesiology 1977;47:381.

Dahlgreen N, Messeter K. Treatment of the stress response to laryngoscopy and intubation with Fentanyl. Anaesthesia. 1981;36:1022.91.

Martin DE, Rosenberg H, Aukburg SJ, Bartkowski RR, Edwards MW Jr, Greenhow DE, Klineburg PL. Low dose Fentanyl blunts circulatory responses to tracheal intubation. Anaesthesia Analgesia. 1982 Aug;61(8):680-4.

Ebert JP, Pearson JD, Gelman S, Harris C, Bradley EL. Circulatory response to laryngoscopy. The comparative effects of Placebo, Fentanyl and Esmolol. Canadian Journal of Anaesthesia. 1989;36:301-6.

Prys-Roberts C, Foex P, Biro GP. Studies of anaesthesia in relation to hypertension versus adrenergic β receptor blockade. Br J Anaesth 1973; 45:671-80.

Mc Cammon RL, Hilgenberg JC, Stoelting RK. Effect of Propranolol on circulatory responses to induction of diazepam-nitrous oxide anesthesia and to endotracheal intubation. Anesthesia Analgesia 1981 Aug;60(8):579-83.

Chung KS, Sinatra RS, Chung JH. The effect of an intermediate dose of Labetalol on heart rate and blood pressure responses to laryngoscopy and intubation. Journal of Clinical Anaesthesia 1992 Jan-Feb;4(1):11-5.

Puri GD, Batra YK. Effect of Nifedepine on cardiovascular response to laryngoscopy and intubation. Br J Anaesth. 1988;60:579-81.

Nishikawa T, Naiki A. Attenuation of the pressor response to laryngoscopy and tracheal intubation with IV Verapamil. Act Anaesthesiologica Scandinavica 1989;33:232-5.

Fuji Y, Tanaka H, Saitoh Y, Toyooka H. Effects of Calcium channel blockers on circulatory response to tracheal intubation in hypertensive patients: Nicardipine vs Diltiazem. Canadian Journal of Anaesthesia. 1995;42:785-8.92.

Stoelting RK. Attenuation of blood pressure response to laryngoscopy and tracheal intubation with Sodium Nitroprusside. Anesthesia Analgesia. 1979; 58:116-9.

Fossoulaki A, Kaniasis P. Intranasal administration of Nitroglycerine attenuates the pressor response to laryngoscopy and intubation of the trachea. Br J Anaesth. 1983;55:49-52.

Stoelting RK, Itravenous sedatives and hypnotics. Anesthesia. 2017;5:160-97

Meena K, Meena R, Nayak SS, Prakash S, Kumar A (2016) A Comparative Study of Effect of Propofol, Etomidate and Propofol PlusEtomidate Induction on Hemodynamic Response to Endotracheal Intubation: A RCT. J AnesthClin Res 7: 622.

Yağan Ö, Taş N, Küçük A, Hancı V, Yurtlu BS. Haemodynamic Responses to Tracheal Intubation Using Propofol, Etomidate and Etomidate-Propofol Combination in Anaesthesia Induction. J Cardiovasc Thorac Res. 2015;7(4):134-40.

Saricaglu F, Uzun S, Arun O, Arun F, Aypar U. A clinical comparison of etomidate-lipuro, propofol and admixture at induction. Saudi J Anaesth. 2011;5(1):62-66.


  • There are currently no refbacks.