Comparison between Propofol and Etomidate in Anesthetic Induction of Hypovolemic Patients

Abstract

Introduction: Anesthetic induction in hypovolemic patients is challenging due to hemodynamic instability caused by reduced circulating blood volume. This condition is common in emergency scenarios such as trauma and hemorrhage, where choosing the appropriate induction agent is crucial to minimize the risk of hypotension and ensure patient safety. Objective: The aim of this study is to critically review the literature on the comparison between the use of propofol and etomidate in the induction of anesthesia in hypovolemic patients, aiming to improve anesthetic practices. Methodology: An exploratory and qualitative literature review was performed in databases such as PubMed, SciELO, LILACS and Google Scholar. The descriptors used included "Propofol", "Etomidate", "Hypovolemia" and "Anesthetic Induction". The search covered publications from 2019 to 2023, selecting studies that directly addressed the effects of the agents on hemodynamic stability in hypovolemic patients. After applying inclusion and exclusion criteria, nine studies were selected for detailed analysis. Results and Discussion: Propofol, despite being widely used due to its rapid onset of action, presents significant risks of hypotension, especially in hypovolemic patients. Etomidate, on the other hand, offers greater hemodynamic stability, but with the risk of adrenal suppression. Analysis of the studies shows that, while propofol increases the risk of adverse clinical outcomes due to its propensity to cause hypotension, etomidate, although more hemodynamically stable, may complicate the management of critically ill patients due to the possible suppression of cortisol production. Final Considerations: The choice between propofol and etomidate should not be based on a fixed protocol, but rather on a careful assessment of the specific conditions of the patient. Both agents have their merits and risks, and the decision should consider the hemodynamic and endocrine needs, as well as the clinical situation of the patient. The development of robust evidence-based guidelines is essential to optimize the safety and efficacy of anesthetic induction in hypovolemic patients, thereby increasing positive clinical outcomes.