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

Parsa Afghaniyan; Maryam Farhadian; Masoud Tarbiat; Mohammad Hossein Bakhshaei; Seyed Ahmadreza Salimbahrami

doi:10.18502/jthc.v19i2.16197

Parsa Afghaniyan Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Maryam Farhadian Research Center for Health Sciences, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
Masoud Tarbiat Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Mohammad Hossein Bakhshaei Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Seyed Ahmadreza Salimbahrami Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.

DOI: https://doi.org/10.18502/jthc.v19i2.16197

Keywords: Coronary artery bypass; Etomidate; Midazolam; Propofol

Abstract

Background: Hemodynamic disorders during anesthesia lead to complications. To reduce hemodynamic complications, this study was conducted to compare midazolam, etomidate, and propofol following anesthesia induction in patients undergoing coronary artery bypass grafting surgery (CABG).

Methods: A double-blind, randomized clinical trial was conducted involving 90 patients with coronary artery disease. These patients were randomly assigned to 1 of 3 groups receiving propofol, etomidate, or midazolam. Hemodynamic variables, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP), and heart rate (HR), were measured at baseline, before intubation, and 1 and 5 minutes after intubation.

Results: Ninety patients with coronary artery disease (mean age: 60.83 y) were included in the study. Women and men comprised 74.4% and 25.6% of the study population. HR, SBP, DBP, and MABP exhibited significant decreases in all 3 groups after intubation. The etomidate group demonstrated the least change in SBP (P<0.001) and MABP (P<0.001), followed by the midazolam group. Concerning HR, the least change was observed in the midazolam group, followed by the propofol group (P=0.688). After intubation, blood pressure increased almost equally in the etomidate and midazolam groups compared with the levels during intubation. In contrast, the propofol group exhibited a downward trend in blood pressure during intubation, a significant difference across all 3 groups (P<0.001).

Conclusion: This study, conducted on candidates for CABG, demonstrated that anesthesia induction with etomidate and midazolam resulted in less variation in hemodynamic variables compared with propofol.