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Pro: Etomidate Is the Ideal Induction Agent for a Cardiac Anesthetic

  • Arne O. Budde
    Correspondence
    Address reprint requests to Arne O. Budde, MD, Department of Anesthesiology, Penn State University College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033
    Affiliations
    Department of Anesthesiology, Penn State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
    Search for articles by this author
  • Berend Mets
    Affiliations
    Department of Anesthesiology, Penn State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
    Search for articles by this author
Published:November 05, 2012DOI:https://doi.org/10.1053/j.jvca.2012.08.024
      POSTINDUCTION HYPOTENSION has been associated with increased morbidity and mortality.
      • Reich D.L.
      • Hossain S.
      • Krol M.
      • et al.
      Predictors of hypotension after induction of general anesthesia.
      Patients who experienced ≥1 5-minute episode of hypotension after induction of general anesthesia had a 13.3% increase in hospital length of stay and an 8.6% increase of death. Hypotension has been defined as a decrease in mean arterial pressure <60 mmHg or by >40% decrease from baseline. In a recent study
      • Alcock R.F.
      • Kouzios D.
      • Naoum C.
      • et al.
      Perioperative myocardial necrosis in patients at high cardiovascular risk undergoing elective non-cardiac surgery.
      in patients treated with antiplatelet agents for cardiovascular comorbidities undergoing major noncardiac surgery, intraoperative hypotension was identified as 1 of 3 independent predictors of intraoperative myocardial ischemia and necrosis assessed using postoperative troponin T levels. Given the high risk of poor outcome after postinduction and intraoperative hypotension, the ideal induction agent would avoid any major deviation from baseline hemodynamic parameters.

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