Etomidate and thiopental-based anesthetic induction: Comparisons between different titrated levels of electrophysiologic cortical depression and response of laryngoscopy

Study Objective: To determine whether etomidate-based induction can provide better hemodynamics than a standard thiopental sodium-based anesthetic induction. Design: Prospective, single-blind clinical trial. Setting: Multicenter university neurosurgical operating room. Patients: 66 ASA physical status II and III inpatients undergoing neurosurgical procedures for intracranial tumor or other pathology. Interventions: Patients were divided into two groups for anesthetic induction. The first group (control) was divided into two subgroups, with the first subgroup receiving 'low-dose' etomidate (LET) 0.4 to 0.6 mg/kg titrated to an electroencephalographic (EEG) spectral edge frequency (SEF) of 10 to 12 Hz. The second subgroup received thiopental sodium (THIO) 3 to 6 mg/kg titrated to the same EEG endpoint. The study group was given high-dose etomidate (HET) 0.5 to 1.7 mg/kg titrated to an early burst suppression pattern. Measurement and Main Results: Baseline (awake) measurements of mean arterial pressure (MAP) heart rate (HR), and SEF were obtained prior to anesthetic induction that was accomplished using a small bolus plus an infusion of the induction drug titrated to the EEG target, MAP, HR, and SEF were recorded just prior to laryngoscopy and intubation (TI), 30 seconds after laryngoscopy and intubation (T2), and 90 seconds after (T3) laryngoscopy and intubation. Times to reach EEG endpoint, along with total dose of anesthetic given, were also recorded. Compared with baseline values, the THIO group had the highest increase in both HR (22.9 ± 4.4 bpm,) and MAP (16.8 ± 4.2 mmHg) (p < 0.05) after laryngoscopy and intubation. The LET group also had significant increases compared with the HET group that demonstrated the least hemodynamic variability. No correlations could be made between age and dose of induction drug. Conclusions: Etomidate-based anesthetic induction, titrated to EEG burst suppression, produced stable hemodynamics during laryngoscopy and intubation as compared with lower dose, more 'classic' inductions with etomidate or thiopental.