Impact of Propofol versus Etomidate on Hemodynamic Parameters During Induction in High-Risk Patients
Background: Induction of general anesthesia in high- ‘ risk patients is often associated with significant hemodynamic instability. Propofol and etomidate are commonly used induction agents, but their cardiovascular and endocrine effects differ. Aim: To compare propofol and etomidate with respect to hemodynamic stability, adverse effects, and stress hormone response during induction of anesthesia in high-risk patients. Methodology: This prospective randomized comparative study included 50 ASA II–III patients undergoing elective surgery under general anesthesia. Patients were randomly allocated to receive propofol (n=25) or etomidate (n=25) for induction. Hemodynamic parameters (SBP, DBP, MAP), adverse effects, and serum cortisol levels were recorded at predefined intervals. Results: Demographic characteristics were comparable between groups. Propofol was associated with a significant and sustained reduction in SBP, DBP, and MAP following induction and intubation (p<0.001), with a higher incidence of hypotension (36%). Etomidate maintained better hemodynamic stability but was associated with myoclonus (20%) and significant transient suppression of serum cortisol levels postoperatively (p<0.001), which normalized within 24 hours. Conclusion: Etomidate provides superior hemodynamic stability compared to propofol during induction in highrisk patients, with transient adrenal suppression. It may be preferred when cardiovascular stability is a primary concern.