Effect of Etomidate vs Propofol for Total Intravenous Anesthesia on Major Postoperative Complications in Older Patients

This randomized clinical trial compares the in-hospital morbidity, clinical outcomes, and mortality associated with use of etomidate vs propofol during abdominal surgery in older patients in China.


Cardiovascular complication (severe arrhythmia, acute heart failure or myocardial infarction)
Heart failure: signs and symptoms of left or right heart failure, effective treatment, or cardiac ultrasound findings of left ventricular ejection fraction less than 35%, suggesting left ventricular impairment.
Acute infarction: myocardial enzyme profile suggestive of at least one index (commonly cardiac troponin [cTn]) more than 5 times the 99% recommended upper limit and meeting one of the following indicators: ischemic symptoms; ECG changes indicating new ischemia (new ST-T changes or left bundle branch block [LBBB]); cardiac imaging suggestive of new myocardial loss or new ventricular wall motion abnormalities; coronary angiography; or autopsy suggestive of intracoronary thrombus.
Late infarction: ST-segment elevation or T-wave changes; pathological Q waves on more than two ECG leads; new LBBB on ECG; cTn exceeding the recommended upper limit.

Pulmonary complications (hypoxemia, need for non-invasive or invasive mechanical ventilation, ARDS, pneumonia)
Hypoxemia was defined as a PaO2 <60 mmHg or SpO2 <90% on room air.
Noninvasive ventilation: Noninvasive ventilation will be considered in case of presence and persistence for more than 30 minutes of hypoxemia (as defined above) and at least one of the following: a) Respiratory rate higher than 30/min b) Clinical signs suggestive of intense respiratory muscle work and/or labored breathing, such as use of accessory respiratory muscles, paradoxical motion of the abdomen, or intercostal retraction.
Pneumonia: Pneumonia was suspected upon the presence of new and/or progressive pulmonary infiltrates on chest radiograph plus two or more of the following criteria: a) Fever ≥38.5°C or hypothermia <36°C b) Leukocytosis ≥12000 WBC/mm 3 or leukopenia <4000 WBC/mm 3

Neurologic complications (stroke or altered consciousness)
Postoperative altered consciousness was determined clinically by the treating physician, and defined as a Glasgow Coma Scale (GCS) score of 14 or less (SOFA sub-score of 1 point or more in the neurologic component). Additionally, whenever possible, the Digital Symbol Substitution Test (DSST) score was recorded.
Acute ischemic stroke was defined as an acute new focal neurologic deficit with confirmation by CT scan and/or MRI.

Gastrointestinal complications (liver failure, gastrointestinal bleeding or perforation)
Liver failure: total plasma bilirubin >180 mmol/L, glutathione and glutamic oxalacetic transaminase more than 2 times the 99% recommended upper limit, reduced plasma cholinesterase, elevated blood ammonia levels, hepatic encephalopathy.

Infectious complications (surgical site infection, urinary tract infection, sepsis, severe sepsis and septic shock)
Sepsis was defined as: a) defined focus of infection and b) at least two systemic inflammatory response syndrome (SIRS) criteria. Defined focus of infection was indicated by either an organism grown in blood or sterile site, or an abscess or infected tissue (e.g. pneumonia, peritonitis, urinary tract, vascular line infection, soft tissue, etc.).