A comparison of anesthetic regimens using etomidate and propofol in patients undergoing first-trimester abortions: double-blind, randomized clinical trial of safety and efficacy.

Background: This prospective study compared the safety, recovery time and side effects of six distinct general anesthesia regimens for first-trimester surgical abortion.

Study Design: Two hundred forty women scheduled for surgical abortion at 6 to 8 weeks of gestation were randomized into three groups (n=40) of propofol: group P (2 mg/kg propofol alone), group PF (2 mg/kg propofol+1 mcg/kg fentanyl), group PMF (2 mg/kg propofol+1 mcg/kg fentanyl+0.02 mg/kg midazolam) and three groups (n=40) of etomidate: group E (0.2 mg/kg etomidate alone), group EF (0.2 mg/kg etomidate+1 mcg/kg fentanyl) and group EMF (0.2 mg/kg etomidate+1 mcg/kg fentanyl+0.02 mg/kg midazolam). Vital signs including pulse oxygen saturation (SpO2), mean arterial pressure (MAP) and heart rate were recorded as the primary outcomes. The recovery time and side effects were recorded as secondary outcomes.

Results: During induction, SpO2 and MAP decreased significantly in all the three groups of propofol and were significantly lower than those in the groups of etomidate. Mean recovery times to both eye opening and to obeying commands were significantly shorter in group PF than those in groups P and PMF, while there were no significant differences among the three groups of etomidate. Compared with the etomidate groups, the incidence of injection-induced pain was significantly higher, while the scores of myoclonus and postoperative nausea and vomiting were lower, in the three propofol groups. Moreover, myoclonus scores as well as nausea and vomiting scores were lower in group EMF than in groups E and EF.

Conclusions: The results of this study suggest that (a) etomidate is much safer than propofol for first-trimester surgical abortions and (b) using a lower dose of etomidate, supplemented with fentanyl and midazolam, is more beneficial than the use of etomidate with or without fentanyl in reducing adverse effects like myoclonus and postoperative nausea and vomiting.