COMPARATIVE STUDY OF HAEMODYNAMIC CHANGES AND BLOOD SUGAR LEVELS BEFORE AND AFTER INDUCTION OF GENERAL ANAESTHESIA WITH ETOMIDATE AND PROPOFOL

Dr. Shakti Singhal. Senior resident department of anaesthesia and critical care,dr baba saheb ambedkar medical college and hospital,New Delhi. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


Inclusion criteria:-
Patients those were included in the study -1. Age 15 to 45 yrs of both sexes 2. ASA grade I and II 3. Not known allergic to mentioned anaesthetic drugs 4. Non diabetic patient 5. Haemodynamically stable patients Exclusion criteria:-1. Patient not fulfilling inclusion criteria 2. Lake of patient consent 3. Hypothyroid and hyperthyroid patients 4. Heart block 5. Active disease of CNS In order to randomize computer generated randomization table was used.
PAC and informed written consent was taken to all patients.
All statistical analyses was performed using the SPSS version 18.0 (SPSS Inc., chicago , IL, USE ). Quantitative data was presented as means and standard deviation (mean ±sd) and qualitative data as frequency and 95% confidence interval (CI).Age, weight and sex will be analyzed using frequencies test. Systolic, diastolic and mean arterial pressure, as well as heart rate was analyseusing unpair student's t test and analysed with chi-2 or student's t test. Significance defined as p<0.05.

Observations And Results:-
There is not significant about demographic characteristic.

Statistical significance:-
The two-tailed P value is less than 0.0001 By conventional criteria, this difference is considered to be extremely statistically significant. Tailed paired t-test was applied in both groups. There was a stastically significant (p<0.0001) found between both groups.

Discussion:-
Propofol caused hypotension is due to the reduction of heart's preload and after load, which is not synchronized with heart's compensatory responses such as increased cardiac output and increased HR as seen by Schmidt C et al in their study [8].
In the study of Hug et al that was conducted on 25000 patients showed that Propofol would lead to bradycardia in 4.2% of patients and hypotension in 15.7% of patients. [10] At 5 and 10 minutes after induction HR was decreased significantly which was similar with the findings seen [11,12,13] in the study by Ko YK et al. [14] In the previous studies done by Shah [15,16 PONV scores were significantly higher in Group IIE compared to the other groups. [19].
In conclusion the results of present study confirmed the other few human studies that propofol prevent increasing in blood glucose during the surgery in comparison to isoflurane anesthesia in our study RBS level is also affected in both propofol and etomidate group. [20] A.Ramakrishna Rao et al found that in non-diabetic patients, RBS decrease at 5 min after intubation when induced with Propofol and also showed that response to surgical stress in surgeries of less than 2 hrs duration in non diabetics and controlled diabetics can be minimized by using opioids like fentany l and induction agents like Propofol. [21 in our study we also found low level of RBS from base line in patients of Propofol group.
A propofol infusion technique for maintenance of anesthesia for cardiac surgery where serum lipids and glucose may be of concern could be recommended as an alternative to midazolam. [ 23] in our study in both the groups RBS was a statically significant difference (P<0.0001) with t value 9.1595 in E group and t valuein 9.7314 in P group .
Another study in contrast to our study by Ram Prasad Kaushal et al who studied for Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass. There was significant increase in blood glucose value during bypass and when weaning off CPB in both groups compared to baseline andbetween the two groups [24].

Conclusions:-
From our results and comparison with other studies we conclude that; 1. Etomidate is hemodynamically more stable as an induction agent than propofol.
2. Blood sugar levels were found to be slightly increased after 5mins of induction than the baseline level in Etomidate group. 3. Blood sugar levels were found to be slightly decreased after 5mins of induction than the baseline level in propofol group. 4. Both Etomidate and Propofol affect blood sugar levels after induction but this affect is slightly more marked in Etomidate group as compared to Propofol group.