Two Forgotten Induction Agents ; Etomidate versus Thiopental Sodium with Rocuronium for Rapid Sequence Induction

Objective: To assess the effect on intubating conditions and haemodynamic response on intubation of two different induction agents etomidate and thiopental sodium with rocuronium during rapid sequence induction. Methods: This prospective quasi experimentalstudy was conducted in Department Of Anaesthesia, SICU and Pain Management, Dow Medical College, Civil Hospital Karachi and Abbasi Shaheed Hospital Karachi Medical and Dental College over a period of one year. Total 120 American Society of Anaesthesiologists (ASA) physical class I and II, adult patients of either gender, aged between 18 to 60 years, undergoing elective surgery were allocated randomly into two equal groups to receive either intravenous thiopental sodium (Group NTR) or etomidate(Group NER) for rapid sequence induction. Group NER was given nalbuphine 0.1mg/kg, induction agent etomidate 3 mg/kg with muscle relaxant rocuronium 1.0 mg/kg while in group NTR induction agent thiopental sodium was given in the dose of 4 mg/kg with nalbuphine and rocuronium in the same doses. After sixty seconds, laryngoscopy was done. Intubating condition was assessed using the criteria of Cooper and colleagues: ease of intubation, condition of vocal cords and response to intubation. Cardiovascular response on intubation in terms of systolic and diastolic blood pressure and heart rate was evaluated at 0,1, 3 and 5 minutes. Results: Demographic data were comparable between the groups. Intubating conditions which were assessed in terms of ease of laryngoscopy, condition of vocal cords at intubation and intubation response coughing, bucking and diaphragmatic movement were significantly better in the group NER (p<0.05). Similarly, arterial blood pressure remained close to base line in NER group but there was significant fall in both systolic and diastolic blood pressure in group NTR. However, there was no significant difference in change in the heart rate in the groups. Conclusion: Etomidate-rocuronium is better than thiopental-rocuronium in terms of intubating conditions and haemodynamic stability during rapid sequence induction in non-septic surgical patients in emergency department.