The Comparison Of The Effect Of Etomidate And Propofol On Serum Cortisol Level

Abstract

Background: The choose of anesthetic agent not only based on primary effect as an ideal anesthetic for surgical procedure, but also took attention for their effect to various organ system. Etomidate is known as an ideal anesthetic agent because its hemodynamic stability, minimally respiratory effect and neuroprotection properties, but become not popular as it suppress cortisol synthesis although it significant clinical effect remain controversy.

Purpose: To analyze the different effect etomidate and propofol on serum cortisol concentration in patient underwent elective surgery in general anesthesia.

Method: This double blind, Randomized Controlled Trial with 34 subjects which divided into two groups (n=17), control group and treatment group which received either intravenous propofol 2,5mg/kgBW or etomidate 0,2mg/kgBW pre-operation respectively. Each group was then examined for serum cortisol concentration pre-anesthesia, 2 hours post induction, and 8 hours post induction. Wilcoxon Signed Rank Test and Paired T Test were performed to compare cortisol serum concentration in each group. Mann Whitney and Independent Sample T Test were used to compare between control and treatment group.

Results: There were significant different of cortisol serum level between pre-anesthesia and 2 post induction in etomidate group [244,15(181,39-382,75)] vs [195,07(119,96-236,35)]. It showed that decrement of etomidate dosage into 0,2mg/kgBW still decrease cortisol serum production significantly from 2 to 8 hours. It proved that propofol did not decrease cortical synthesis. Compared with propofol, etomidate significantly suppress serum cortisol level at 2 hours post induction.

Conclusion: Etomidate 0,2mg/kgBW decrease serum cortisol concentration at 2 hours post induction, but return to its normal level at 8 hours post induction. Propofol 2,5mg/kgBB did not decrease serum cortisol concentration.

Keywords : Etomidate, Propofol, General anesthesia, CortisolABSTRAK

Latar belakang penelitian: Pemilihan suatu obat anestesi tidak hanya didasarkan pada efek utamanya sebagai anestesi yang ideal untuk suatu prosedur pembedahan, melainkan turut pula mempertimbangkan efeknya terhadap berbagai sistem organ. Etomidat diketahui memiliki sifat obat anestesi yang ideal baik dari segi hemodinamik, respirasi, maupun neuroproteksi, akan tetapi menjadi kurang populer akibat efeknya terhadap fungsi adrenal meski konsekuensi klinis nyata dari efek hambatan ini masih kontroversi.

Tujuan: Membuktikan adanya perbedaan pengaruh pemberian etomidat 0,2mg/kgBB intravena dan propofol 2,5mg/kgBB intravena terhadap penurunan kadar kortisol serum.

Metode: Merupakan penelitian Randomized Clinical Control Trial pada 34 pasien yang menjalani anestesi umum, dibagi menjadi 2 kelompok (n=17), etomidat dan propofol. Masing-masing kelompok diperiksa kadar kortisol serum sebelum induksi, 2 dan 8 jam setelah induksi. Uji statistik Wilcoxon Signed Rank Test dan Paired T Test digunakan untuk membandingkan kadar kortisol di masing- masing kelompok. Sedangkan uji statistik Mann Whitney U Test dan Independent Sample T-Test digunakan untuk membandingkan antar kelompok perlakuan.

Hasil: Terdapat perbedaan bermakna kadar kortisol sebelum dan 2 jam pasca induksi pada kelompok etomidat (mean 244,15 vs 195,07), tetapi tidak pada 8 jam pasca induksi. Hal ini menunjukkan bahwa pengurangan dosis etomidat sampai 0,2mg/kgBB masih menurunkan kadar kortisol secara signifikan sampai < 8 jam pasca induksi. Pada kelompok propofol terdapat peningkatan bermakna kadar kortisol 2 jam pasca induksi (p=0,013). Hal ini membuktikan bahwa propofol tidak memiliki efek menurunkan síntesis kortisol.

Kesimpulan: Pemberian etomidat 0,2mg/kgBB menurunkan síntesis kortisol pada 2 jam pasca induksi namun kembali normal 8 jam pasca induks i. Pemberian propofol 2,5 mg/kgBB tidak menyebabkan penurunan kadar kortisol serum.