Original Article

Comparing the Hemodynamic Effects of Midazolam, Etomidate, and Propofol during Coronary Artery Bypass Graft Surgery: A Double-Blind Randomized Clinical Trial

Abstract

Background: This study aimed to assess and compare the hemodynamic responses to propofol, etomidate, and midazolam following the induction of anesthesia and intubation in patients undergoing coronary artery bypass graft (CABG) surgery.

Materials and Methods: A double-blind randomized clinical trial was conducted involving 90 patients with coronary artery disease. These patients were randomly assigned to one of three groups receiving either propofol (1.5 mg/kg), etomidate (0.2 mg/kg), or midazolam (0.15 mg/kg). Hemodynamic variables, including systolic and diastolic blood pressure (SBP and DBP), mean arterial blood pressure (MABP), and heart rate (HR), were measured at baseline, before intubation, and one and five minutes after intubation.

Results: HR, SBP, DBP, and MABP all exhibited significant decreases in all three groups after induction and during intubation. The etomidate group demonstrated the least extent of change in SBP (P<0.001), MABP (P<0.001), and DBP (P=0.056), followed by the midazolam group. As for HR, the least change was observed in the midazolam group, followed by the propofol group (P=0.688). Following intubation, blood pressure increased almost equally in the etomidate and midazolam groups compared to during intubation. In contrast, the propofol group exhibited a downward trend in blood pressure post-intubation, a significant difference across all three groups. The propofol group also required additional drugs to manage hemodynamic changes to a greater extent, which was statistically significant.

Conclusion: This study, conducted on candidates for coronary artery surgery, demonstrated that the induction of anesthesia with etomidate and midazolam resulted in less variation in hemodynamic variables compared to propofol.

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Keywords
Coronary Artery Bypass Etomidate Hemodynamic Changes Midazolam Propofol
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1.
Afghaniyan P, Farhadian M, Tarbiat M, Bakhshaei MH, Salim Bahrami SAR. Comparing the Hemodynamic Effects of Midazolam, Etomidate, and Propofol during Coronary Artery Bypass Graft Surgery: A Double-Blind Randomized Clinical Trial. J Tehran Heart Cent. 2024;.