title: Cardioversion: What to choose? Etomidate or propofol.
abstract: BACKGROUND
  Electrical cardioversion is a short painful procedure to regain normal sinus rhythm requiring anaesthesia for haemodynamic stability, sedation, analgesia and early recovery.
  
  
  OBJECTIVE
  To compare propofol and etomidate as sedatives during cardioversion.
  
  
  METHODS
  Single centred, prospective and randomized single blind study comprising 60 patients.
  
  
  METHODS
  Patients more than 18 years, American Society of Anesthesiologists I/II/III grades undergoing elective cardioversion, randomly divided to receive propofol 1 mg/kg intravenous (IV) bolus followed by 0.5 mg/kg (Group P, n = 30) or etomidate (Group E, n = 30) 0.1 mg/kg followed by 0.05 mg/kg. All patients received IV fentanyl (1 μg/kg) before procedure. Heart rate, blood pressure (BP) (systolic BP [SBP], diastolic BP [DBP], mean arterial pressure), respiratory rate, Aldrete recovery score (ARS) and Ramsay sedation score (RSS) were assessed at 1, 2, 5, 10, 15, 20 and 30 min post cardioversion. Incidence of hypotension, respiratory depression and side effects were compared.
  
  
  METHODS
  Student's unpaired t-test, Chi-square test and Mann-Whitney test. P < 0.05 was taken as significant.
  
  
  RESULTS
  Group P showed significant fall in SBP, DBP, and mean BP at 2 min after cardioversion. Hypotension (33.3% Group P vs. 16.65% Group E) occurred more with propofol (P < 0.05). Group E showed better ARS at 1, 2, 5, 10, 15 and 20 min. Time required to attain RSS = 2 (659.1 s Group P and 435.7 s Group E) indicated longer recovery with propofol. Left atrial size (35.5-42.5 mm) did not affect success rate of cardioversion (80% Group P vs. 83.3% Group E). Incidence of myoclonus (Group E 26.67% vs. Group P 0%) showed significant difference.
  
  
  CONCLUSIONS
  Etomidate/fentanyl is superior over propofol/fentanyl during cardioversion for quick recovery and haemodynamic stability.
authors.affiliation: Department of Anesthesiology, Seth GSMC and KEM Hospital, Parel, Mumbai, Maharashtra, India.
authors.forename: Pushkar M
authors.initials: PM
authors.lastname: Desai
authors.forename: Deepa
authors.initials: D
authors.lastname: Kane
authors.forename: Manjula S
authors.initials: MS
authors.lastname: Sarkar
mesh_terms: D000328:Adult; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D004554:Electric Countershock; D005045:Etomidate; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D015742:Propofol; D011446:Prospective Studies; D056152:Respiratory Rate / Q000187:drug effects
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol; D005045:Etomidate