Cardioversion: What to choose? Etomidate or propofol

Abstract

Context: Electrical cardioversion is a short painful procedure to regain normal sinus rhythm requiring anaesthesia for haemodynamic stability, sedation, analgesia and early recovery.

Aims: To compare propofol and etomidate as sedatives during cardioversion.

Settings and design: Single centred, prospective and randomized single blind study comprising 60 patients.

Subjects and methods: Patients more than 18 years, American Society of Anesthesiologists I/II/III grades undergoing elective cardioversion, randomly divided to receive propofol 1 mg/kg intravenous (IV) bolus followed by 0.5 mg/kg (Group P, n = 30) or etomidate (Group E, n = 30) 0.1 mg/kg followed by 0.05 mg/kg. All patients received IV fentanyl (1 μg/kg) before procedure. Heart rate, blood pressure (BP) (systolic BP [SBP], diastolic BP [DBP], mean arterial pressure), respiratory rate, Aldrete recovery score (ARS) and Ramsay sedation score (RSS) were assessed at 1, 2, 5, 10, 15, 20 and 30 min post cardioversion. Incidence of hypotension, respiratory depression and side effects were compared.

Statistical analysis used: Student's unpaired t-test, Chi-square test and Mann-Whitney test. P < 0.05 was taken as significant.

Results: Group P showed significant fall in SBP, DBP, and mean BP at 2 min after cardioversion. Hypotension (33.3% Group P vs. 16.65% Group E) occurred more with propofol (P < 0.05). Group E showed better ARS at 1, 2, 5, 10, 15 and 20 min. Time required to attain RSS = 2 (659.1 s Group P and 435.7 s Group E) indicated longer recovery with propofol. Left atrial size (35.5-42.5 mm) did not affect success rate of cardioversion (80% Group P vs. 83.3% Group E). Incidence of myoclonus (Group E 26.67% vs. Group P 0%) showed significant difference.

Conclusions: Etomidate/fentanyl is superior over propofol/fentanyl during cardioversion for quick recovery and haemodynamic stability.

Figure 1

Comparison of heart rate (no difference noted)

Figure 2

Comparison of systolic blood pressure (P = 0.004 at 2 min; P = 0.035 at 5 min)

Figure 3

Comparison of diastolic blood pressure (P = 0.032 at 2 min)

Figure 4

Comparison of mean blood pressure (P = 0.017 at 2 min)

Figure 5

Comparison of Ramsay sedation score (P < 0.05 at 1, 5, 10, 15, 20 min denoting profound sedation with propofol)

Figure 6

Comparison of Aldrete recovery score (etomidate showing better recovery at all times)