European Journal of Biomedical and Pharmaceutical Sciences

COMPARISON OF HEMODYNAMIC CHANGES FOLLOWING PROPOFOL VS. ETOMIDATE INDUCTION IN GENERAL ANESTHESIA: A RETROSPECTIVE STUDY

*Wisam AL-Sukkar, Yazan Alzubi, Saja Awaimreen, Firas AL-khalaileh, Hamza Alwreikat, Moh’d Obeidat

ABSTRACT

Background: Induction agents differ in their cardiovascular effects. Propofol is widely used but frequently causes hypotension, while etomidate offers greater hemodynamic stability. Quantifying these differences can guide individualized anesthetic planning. Aim: This study compared the incidence and predictors of post-induction hypotension following propofol versus etomidate in adult surgical patients. Methods: We conducted a retrospective study of adult patients undergoing general anesthesia at King Hussein Medical Center between January 2021 and December 2023. Patients who received either propofol or etomidate as the sole induction agent were included. Data were extracted from anesthesia records. The primary endpoint was post-induction hypotension, defined as a ≥20% decrease in mean arterial pressure (MAP) within 10 minutes of induction. Baseline characteristics were compared using the Wilcoxon rank-sum and chi-squared tests, and multivariable logistic regression identified independent predictors of hypotension. Results: Among over 6000 patients, baseline MAP was lower in those receiving etomidate than propofol (89 vs. 93 mmHg, p = 0.001). Propofol recipients were more often ASA I–II (79% vs. 63%, p < 0.001) and on ACEi/ARBs (42% vs. 31%, p = 0.006). Post-induction hypotension occurred more frequently after propofol, which was independently associated with a fourfold increased risk compared to etomidate (OR 4.65, 95% CI: 3.09–7.13, p < 0.001). Other predictors included older age (OR 1.02 per year, p = 0.021), hypertension (OR 1.92, p = 0.001), ASA III status (OR 1.89, p = 0.004), and ACEi/ARB use on the day of surgery (OR 1.93, p < 0.001). Conclusion: Propofol was strongly associated with intraoperative hypotension compared to etomidate, especially in older, hypertensive, and ACEi/ARB-treated patients. Careful agent selection and dose titration may reduce risk.

Keywords: Propofol, Etomidate, Hypotension, Induction, Anesthesia.