To compare efficacy and safety between etomidate and fentanyl-midazolam as an induction agents in patients undergoing adult valvular open heart surgeries

Background: Valvular Heart disease patients are always have other system involvement due to their complications, In such kind of high risk patients if haemodynamic instability occurs during induction, intubation then it will be hazardous to the patients .Hence the ideal anesthetic induction agents if used will be be helpful to these patients. Hence we decided to study effects of etomidate and Fentanyl –Midazolam combination as induction agents as well as their effects on stress response of Intubation and cardiopulmonary bypass. Aim: To study the effects of induction dose of etomidate and Fentanyl Midazolam on stress response of intubation and Cardiopulmonary Bypass in adult cardiac valvular surgeries Materials and methods: After approval from the institutional review board, 60 patients undergoing cardiac valvular surgeries using cardiopulmonary bypass were enrolled in the study. Patients were randomized to receive either Etomidate or fentanyl-midazolam for induction of anaesthesia. Anaesthesia was maintained in both the groups with fentanyl 2 mcg/kg/hr, midazolam 0.02 mg/kg/hr, vecuronium 0.05 mg/kg/hr and Desflurane till the end of surgery. Results: Baseline demographic and hemodynamic variables and cortisol levels were comparable in both the groups. Cortisol and blood sugar levels decreased in etomidate group on cardiopulmonary bypass and significant difference was found between etomidate and fentanyl-midazolam group. Cortisol levels 24 hours after the surgery showed no significant difference. Conclusion: Etomidate induction results in significantly decreased cortisol and blood sugar levels on cardiopulmonary bypass as compared to fentanyl-midazolam group, and thus, decreasing the stress response elicited by cardiopulmonary bypass. 24 hours after surgery cortisol levels in both the groups were comparable without any untoward effects.