Induction of anesthesia by titration of eltanolone compared with thiopental and etomidate for coronary artery bypass grafting

Study Objective: To evaluate whether induction of anesthesia with eltanolone in coronary artery bypass graft (CABG) patients is associated with greater hemodynamic stability than either thiopental sodium or etomidate. Design: Randomized, controlled study. Setting: University hospital. Patients: 75 ASA physical status III and IV patients scheduled for elective CABG over 18 years of age, with left ventricular ejection fraction over 30%. Interventions: The participants were prospectively randomized into three groups, each group consisting of 25 patients. Anesthesia was induced by titration of either eltanolone, thiopental sodium, or etomidate. The end point was 'loss of verbal contact.' Measurements and Main Results: Hemodynamic variables were recorded in the awake state, 2 minutes after induction, after administration of fentanyl 0.01 mg/kg, and 2 and 5 minutes after intubation. After induction of anesthesia, cardiac index (CI) decreased from 2.6 ± 0.5 to 2.2 ± 0.5 Lxmin^-1 xm^-2 in the eltanolone group and remained at this value throughout the study period in contrast to the control groups. After fentanyl was given, mean arterial pressure was significantly lower in the case of eltanolone (69 ± 15 mmHg) compared with thiopental (81 ± 19 mmHg) and etomidate (84 ± 18 mmHg). Mean arterial pressure remained significantly lower at the points of measurement after intubation. Two minutes after intubation, CI was likewise significantly lower in the eltanolone group (2.2 ± 0.4 Lxmin^-1 xm^-2) compared with the thiopental group (2.7 ± 0.7 Lxmin^-1 xm^-2). Conclusions: Eltanolone produces more hemodynamic depression compared with etomidate and thiopental when administered in combination with fentanyl 10 μg/kg.