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Invited Commentary
August 10, 2022

Expanding Options for Total Intravenous Anesthesia—The Etomidate vs Propofol for In-Hospital Complications Trial

Author Affiliations
  • 1University of Nebraska Medical Center, Omaha
JAMA Surg. 2022;157(10):896. doi:10.1001/jamasurg.2022.3339

Using a randomized clinical trial design, the authors compared the ability of etomidate to provide total intravenous (IV) anesthesia with propofol.1 Propofol is the most common IV anesthesia medication used for general anesthesia in combination with analgesia and neuromuscular blockade. But propofol is far from perfect with an adverse effect profile having significant effect on cardiovascular parameters, including reduced blood pressure and elevated heart rate. In contrast, etomidate maintains cardiovascular stability with administration. Yet, etomidate has adverse effects, too, which until the current trial were considered possibilities as conflicting evidence suggested significant effect on cortisol and aldosterone levels and potential lung effect with increased risk of pneumonia based on single-dose administration.

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