A comparative study of the effect of anesthesia induction with the use of four drug combinations including “propofol,” “etomidate-propofol,” “thiopental,” and “midazolam-thiopental” on hemodynamic changes during the insertion of laryngeal mask in eye surgery

Document Type : Original Article


1 Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: This study aimed to compare the efficacies of four anesthetic induction drugs (thiopental, propofol, midazolam-thiopental, and etomidate-propofol) on cardiovascular response during laryngeal mask airway (LMA) placement in eye surgery. Materials and Methods: The present clinical trial study included 128 patients who were candidates for ophthalmic surgery in four groups. Patients in the first group were given a combination of midazolam (0.04 mg/kg) with thiopental (2.5 mg/kg) (Group T + M). We administered propofol alone (2.5 mg/kg) to patients in the second group (Group P). The third group received a combination of etomidate (0.1 mg/kg) with propofol (1 mg/kg) (ET + P group) and patients in the fourth group received thiopental drug (5 mg/kg) alone (Group T). Then, the stability of patients' hemodynamic parameters before anesthesia was evaluated and compared immediately after anesthesia, 1, 3, and 5 min after LMA placement. Results: There was no significant difference between the four groups in changes in oxygen saturation level (P > 0.05). Furthermore, the difference between decreased systolic blood pressure and diastolic blood pressure over time was not significant in 5 min in both Groups T + M and T (P > 0.05). In addition, the stability of these two groups was higher than the other two groups (P < 0.05) and the most unstable group was Group P. The changes pulse rate in the P group were significant (P < 0.05). Conclusion: According to the results of the current study, thiopental and Midazolam can be used as an effective induction compound to facilitate LMA insertion with higher hemodynamic stability compared to propofol alone, propofol and etomidate, and thiopental alone.


Khodadoust K, Ardalan M, Ghabili K, Golzari SE, Eknoyan G. Discourse on pulse in medieval Persia-the Hidayat of Al-Akhawayni (?–983AD). Int J Cardiol 2013;166:289-93.  Back to cited text no. 1
Golzari SE, Khan ZH, Ghabili K, Hosseinzadeh H, Soleimanpour H, Azarfarin R, et al. Contributions of medieval Islamic physicians to the history of tracheostomy. Anesth Analg 2013;116:1123-32.  Back to cited text no. 2
Aghamohammadi D, Eydi M, Hosseinzadeh H, Amiri Rahimi M, Golzari SE. Assessment of Mini-dose succinylcholine effect on facilitating laryngeal mask airway insertion. J Cardiovasc Thorac Res 2013;5:17-21.  Back to cited text no. 3
Mahmoodpoor A, Golzari SE, Hamidi M, Parish M, Soleimanpour H, Mirinezhad M. Comparison of three methods for laryngeal mask airway insertion in adults: Standard, lateral and rotational. J Clin Analytical Med 2015;6:53-6.  Back to cited text no. 4
Alipour M, Derakhshan A, Pourmazar R, Abrishami M, Ghanbarabadi VG. Effects of propofol, etomidate, and thiopental on intraocular pressure and hemodynamic responses in phacoemulsification by insertion of laryngeal mask airway. J Ocul Pharmacol Ther 2014;30:665-9.  Back to cited text no. 5
Hagberg C, Georgi R, Krier C. Complications of managing the airway. Best Pract Res Clin Anaesthesiol 2005;19:641-59.  Back to cited text no. 6
Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller's Anesthesia e-Book. Philadelphia: Elsevier Health Sciences; 2014.  Back to cited text no. 7
Abbasivash R, Aghdashi MM, Sinaei B, Kheradmand F. The effects of propofol-midazolam-ketamine co-induction on hemodynamic changes and catecholamine response. J Clin Anesth 2014;26:628-33.  Back to cited text no. 8
Hosseinzadeh H, Eidy M, Golzari SE, Vasebi M. Hemodynamic Stability during Induction of Anesthesia in ElderlyPatients: Propofol+Ketamine versus Propofol+Etomidate. J Cardiovasc Thorac Res 2013;5:51-4.  Back to cited text no. 9
Seyedhejazi M, Eydi M, Ghojazadeh M, Nejati A, Ghabili K, Golzari SE, et al. Propofol for laryngeal mask airway insertion in children: Effect of two different doses. Saudi J Anaesth 2013;7:266-9.  Back to cited text no. 10
Hosseinzadeh H, Golzari SE, Torabi E, Dehdilani M. hemodynamic changes following anesthesia induction and LMA insertion with propofol, etomidate, and propofol+etomidate. J Cardiovasc Thorac Res 2013;5:109-12.  Back to cited text no. 11
Pandey AK, Makhija N, Chauhan S, Das S, Kira U, Bisol AK, et al. The Effects of Etomidate and propofol Induction on Hemodynamic and Endocrin Respanse in patients undergoing coronary Artery Bypass Graft surgery on Cardiopulmonary Bypass. World J Cardiovasc Surg 2012;2:48-53.  Back to cited text no. 12
Martinon C, Duracher C, Blanot S, Escolano S, de Agostini M, Périé-Vintras AC, et al. Emergency tracheal intubation of severely head-injured children: Changing daily practice after implementation of national guidelines. Pediatr Crit Care Med 2011;12:65-70.  Back to cited text no. 13
Yeung JK, Zed PJ. A review of etomidate for rapid sequence intubation in the emergency department. CJEM 2002;4:194-8.  Back to cited text no. 14
Meuldermans WE, Heykants JJ. The plasma protein binding and distribution of etomidate in dog, rat and human blood. Arch Int Pharmacodyn Ther 1976;221:150-62.  Back to cited text no. 15
Bhaskar P, Malik A, Kapoor R, Kohli M, Agarwal J, Harjai M. Effect of midazolam premedication on the dose of propofol for laryngeal mask airway insertion in children. J Anaesthesiol Clin Pharmacol 2010;26:503-6.  Back to cited text no. 16
[PUBMED]  [Full text]  
Arnett-Chinn ER, Hadfield CA, Clayton LA. Review of intramuscular midazolam for sedation in reptiles at the National Aquarium, Baltimore. J Herpetol Med Surg 2016;26:59-63.  Back to cited text no. 17
Adinehmehr L, Shetabi H, Moradi Farsani D, Salehi A, Noorbakhsh M. Comparison of the sedation quality of Etomidate, Propofol, and midazolam in combination with fentanyl during phacoemulsification cataract surgery: A double-blind, randomized, controlled, clinical trial. Anesth Pain Med 2019;9:e87415.  Back to cited text no. 18
Sinha R, Shende D, Garg R. Comparison of propofol (1%) with admixture (1:1) of thiopentone (1.25%) and propofol (0.5%) for laryngeal mask airway insertion in children undergoing elective eye surgery: Double-masked randomized clinical trial. Indian J Anaesth 2010;54:104-8.  Back to cited text no. 19
Basunia SR, Mukherjee K, Dutta SS, Biswas SK, Ray S, Mandal P, et al. A comparative evaluation of midazolam-thiopentone with propofol on laryngeal mask airway insertion condition. J Evolut Med Dent Sci 2014;3:10643-52.  Back to cited text no. 20
Saricaoglu F, Uzun S, Arun O, Arun F, Aypar U. A clinical comparison of etomidate-lipuro, propofol and admixture at induction. Saudi J Anaesth 2011;5:62-6.  Back to cited text no. 21
Moosavi Tekye SM, Pashang SM. Comparison of the hemodynamic effects of Etomidate versus propofol, Rapid Sequence Intubation, on none surgical patients. Med J Mashhad Univ Med Sci 2014;57:602-8.  Back to cited text no. 22
Bjelland TW, Klepstad P, Haugen BO, Nilsen T, Salvesen O, Dale O. Concentrations of remifentanil, propofol, fentanyl, and midazolam during rewarming from therapeutic hypothermia. Acta Anaesthesiol Scand 2014;58:709-15.  Back to cited text no. 23
Crawford ME, Carl P, Andersen RS, Mikkelsen BO. Comparison between midazolam and thiopentone-based balanced anaesthesia for day-case surgery. Br J Anaesth 1984;56:165-9.  Back to cited text no. 24
Lim YS, Kang DH, Kim SH, Jang TH, Kim KH, Ryu SJ, et al. The cardiovascular effects of midazolam co-induction to propofol for induction in aged patients. Korean J Anesthesiol 2012;62:536-42.  Back to cited text no. 25
Boisson-Bertrand D, Taron F, Laxenaire MC. Etomidate vs. propofol to carry out suspension laryngoscopies. Eur J Anaesthesiol 1991;8:141-4.  Back to cited text no. 26
Shetabi H, Honarmand A, Adinehmehr L, Kaviani R. Comparison of the effect of thiopental sodium-midazolam combination on the hemodynamic response between tracheal intubation and laryngeal mask airway insertion: A clinical trial study. Sci J Kurdistan Univ Med Sci 2019;24:99-110.  Back to cited text no. 27
Sivilotti M, Ducharme J. Randomized, double-blind study on sedatives and hemodynamics during rapid-sequence intubation in the emergency department: The SHRED study. Ann Emerg Med 1998;31:313-24.  Back to cited text no. 28
Lebowitz PW, Cote ME, Daniels AL, Ramsey FM, Martyn JA, Teplick RS, et al. Comparative cardiovascular effects of midazolam and thiopental in healthy patients. Anesth Analg 1982;61:771-5.  Back to cited text no. 29
Gelissen HP, Epema AH, Henning RH, Krijnen HJ, Hennis PJ, den Hertog A. Inotropic effects of propofol, thiopental, midazolam, etomidate, and ketamine on isolated human atrial muscle. Anesthesiology 1996;84:397-403.  Back to cited text no. 30
Aghdaii N, Ziyaeifard M, Faritus SZ, Azarfarin R. Hemodynamic responses to two different anesthesia regimens in compromised left ventricular function patients undergoing coronary artery bypass graft surgery: Etomidate-midazolam versus propofol-ketamine. Anesth Pain Med 2015;5:e27966.  Back to cited text no. 31
Yoon JR, Kim YS, Kim TK. Thiopental-induced burst suppression measured by the bispectral index is extended during propofol administration compared with sevoflurane. J Neurosurg Anesthesiol 2012;24:146-51.  Back to cited text no. 32
Bellante F, Legros B, Depondt C, Créteur J, Taccone FS, Gaspard N. Midazolam and thiopental for the treatment of refractory status epilepticus: A retrospective comparison of efficacy and safety. J Neurol 2016;263:799-806.  Back to cited text no. 33
Stoelting RK. Stoelting's Anesthesia and co-Existing Disease. Philadelphia: Elsevier Health Sciences; 2012.  Back to cited text no. 34
Scherzer D, Leder M, Tobias JD. Pro-con debate: Etomidate or ketamine for rapid sequence intubation in pediatric patients. J Pediatr Pharmacol Ther 2012;17:142-9.  Back to cited text no. 35
Eftekhari J, Kazemi Haki B, Tizro P, Alizadeh V. A comparison to facilitate insertion of the laryngeal mask: Term of recovery and postoperative nausea and vomiting after anesthesia with propofol- atracurium and thiopental-atracurium. Acta Med Iran 2015;53:117-21.  Back to cited text no. 36
Uzun S, Gözaçan A, Canbay O, Ozgen S. Remifentanil and etomidate for laryngeal mask airway insertion. J Int Med Res 2007;35:878-85.  Back to cited text no. 37
Gholipour Baradari A, Firouzian A, Zamani Kiasari A, Aarabi M, Emadi SA, Davanlou A, et al. Effect of etomidate versus combination of propofol-ketamine and thiopental-ketamine on hemodynamic response to laryngoscopy and intubation: A randomized double blind clinical trial. Anesth Pain Med 2016;6:e30071.  Back to cited text no. 38