Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1293
Peer-review started: November 10, 2020
First decision: December 8, 2020
Revised: December 17, 2020
Accepted: December 27, 2020
Article in press: December 27, 2020
Published online: February 26, 2021
The choice of anesthetic strategy in patients with coronary heart disease (CHD) undergoing major noncardiac surgery is becoming an increasingly important issue as the population ages.
Perioperative cardiac complications including myocardial infarction have been reported in around 15% of patients with CHD who undergo noncardiac surgery. It is thus essential to utilize strategies that maintain hemodynamic stability, adequate oxygenation, and a good analgesic effect while minimizing the risk of perioperative ischemia, and this requires a multidisciplinary approach.
To compare hemodynamic function and cardiovascular event rate between etomidate- and propofol-based anesthesia in patients with CHD.
This prospective, randomized clinical trial enrolled consecutive patients with stable CHD undergoing major noncardiac surgery. The patients were randomly allocated to receive either etomidate/remifentanil-based or propofol/remifentanil-based general anesthesia.
The final analysis included 40 patients in each group. The incidences of bradycardia, hypotension, ST-T segment changes, and ventricular premature beats during anesthesia were significantly higher in the propofol group than in the etomidate group (P < 0.05 for all).
In patients with CHD undergoing noncardiac major surgery, etomidate-based anesthesia was associated with fewer cardiovascular events and smaller hemodynamic changes than propofol-based anesthesia.
In the future, a large prospective randomized study will definitively address the effect of etomidate on postoperative outcomes in patients with coronary heart disease undergoing major noncardiac surgery.