Comparative evaluation of propofol and etomidate for laryngeal mask airway insertion and hemodynamic stability: A randomized controlled trial.

Dr. Haritha  Gundeboyina; Dr.Harikrishna  Gulipalli; Dr. Pigilam  Siddarth

doi:10.51168/sjhrafrica.v6i9.2121

Authors

Dr. Haritha Gundeboyina Assistant Professor, Department of Anaesthesiology, Visakha Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India
Dr.Harikrishna Gulipalli Assistant Professor, Department of Anaesthesiology, Visakha Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India
Dr. Pigilam Siddarth Senior Consultant Orthopaedic Surgeon and Limb Reconstructive Specialist , KIMS ICON Hospital, Visakhapatnam, Andhra Pradesh, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i9.2121

Keywords:

Propofol, Etomidate, Laryngeal Mask Airway, Hemodynamics, Airway Insertion, Anesthesia

Abstract

Background

The laryngeal mask airway (LMA) is widely used in modern anesthesia practice, and successful insertion requires adequate suppression of airway reflexes with minimal hemodynamic disturbances. Propofol is considered the standard induction agent but is associated with hypotension, whereas Etomidate offers cardiovascular stability, though insertion conditions may be suboptimal.

Aim: To compare the ease of LMA insertion and hemodynamic responses following induction with intravenous Propofol and Etomidate.

Methods

This prospective randomized double-blind study included 62 ASA I–II patients aged 18–50 years, undergoing elective surgeries at CARE Hospitals, Visakhapatnam. Participants were randomly assigned to receive either Propofol (2 mg/kg; n=31) or Etomidate (0.3 mg/kg; n=31) for induction. Ease of LMA insertion was evaluated using predefined parameters (mouth opening, gagging, coughing, head/limb movements, and laryngospasm). Hemodynamic variables (heart rate, systolic and diastolic blood pressure) were recorded at baseline and 30 seconds post-induction.

Results

The mean age was 32.1 ± 8.0 years; both groups were comparable in gender (Propofol 58% male vs. Etomidate 55% male), weight (61.2 ± 9.6 kg vs. 60.4 ± 8.8 kg), and ASA status (Grade I: 67.7%, Grade II: 32.3%). Propofol achieved better insertion conditions with higher adequate mouth opening (93.5% vs. 71.0%, p=0.02), absence of gagging (90.3% vs. 61.3%, p=0.01), and first-attempt success (93.5% vs. 74.2%, p=0.04). However, Propofol caused significant post-induction hypotension (SBP 124 → 98 mmHg; p<0.001), while Etomidate maintained stable hemodynamics.

Conclusion

Propofol provides better ease of LMA insertion with higher first-attempt success but is associated with significant hypotension. Etomidate, although hemodynamically stable, offers less favorable insertion conditions. The choice between the agents should therefore balance airway insertion ease against cardiovascular safety.

Recommendations

Propofol is preferred for healthy patients; Etomidate is recommended in cardiovascularly vulnerable individuals to balance airway management and hemodynamic stability.

Author Biographies

Dr. Haritha Gundeboyina, Assistant Professor, Department of Anaesthesiology, Visakha Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India

completed her MBBS from Narayana Medical College, Nellore (2003–2009) and DNB in Anaesthesiology from CARE Hospitals, Visakhapatnam (2012–2015). She has served as Senior Resident in the Department of Anaesthesiology at Andhra Medical College (2015–2016) and Consultant Anaesthesiologist at CARE Hospitals, Visakhapatnam (2016–2018). Subsequently, she worked as a Senior Resident and later as an Assistant Professor in Anaesthesiology at GITAM Medical College (2018–2022). Since January 2022, she has been serving as an Assistant Professor in the Department of Anaesthesiology at Visakha Institute of Medical Sciences, Visakhapatnam. Her clinical expertise spans advanced trauma, cardiac, neonatal, and transplant anaesthesia, with significant experience in managing multi-specialty and super-specialty cases. ORCID ID: https://orcid.org/0009-0006-7643-1300

Dr.Harikrishna Gulipalli, Assistant Professor, Department of Anaesthesiology, Visakha Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India

is an experienced anaesthesiologist with more than 18 years in cardiac anaesthesia and critical care. He earned his MBBS from Andhra Medical College, Visakhapatnam (2000) and Diploma in Anaesthesia (2006), followed by DNB Anaesthesia (2019) and an MBA in Health Care Services (2017). He has worked extensively in tertiary care hospitals, including Manipal Hospitals, My Cure Hospital, Care Hospitals, and ANU Institute of Neuro and Cardiac Sciences, Visakhapatnam. Currently, he is an Assistant Professor of Anaesthesiology at Visakha Institute of Medical Sciences and Consultant Anaesthesiologist at Vrindaa Super Specialty Hospital, Visakhapatnam. His expertise covers cardiac, thoracic, vascular, paediatric, and transplant anaesthesia, as well as advanced airway management, invasive procedures, and perioperative critical care. ORCID ID: https://orcid.org/0009-0001-3533-951X

Dr. Pigilam Siddarth, Senior Consultant Orthopaedic Surgeon and Limb Reconstructive Specialist , KIMS ICON Hospital, Visakhapatnam, Andhra Pradesh, India

obtained his MBBS from Narayana Medical College, Nellore (2001–2006) and MS in Orthopaedics from Dr. Pinnamaneni Siddhartha Medical College, Vijayawada (2009–2012), where he was awarded the Dr. NTR Health University Prof. Ethili Raju Orthopaedic Gold Medal. He subsequently completed a fellowship in Limb Reconstructive Surgery and Trauma at Ganga Hospital, Coimbatore, under Dr. MGR University. He has held positions as Senior Registrar and Orthopaedic Consultant at Ganga Hospital, Senior Resident at ASRAM Medical College, Eluru (2012–2017), and currently serves as Senior Consultant Orthopaedic Surgeon and Limb Reconstructive Specialist at KIMS ICON Hospital, Visakhapatnam (since 2017). His clinical interests include limb reconstruction, deformity correction, polytrauma, upper limb surgery, and navigation-assisted joint replacement. ORCID ID: https://orcid.org/0009-0002-3690-5226

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