Propofol, Etomidate, and Brugada

December 6, 2019

Written by Clay Smith

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A propofol bolus for induction did not induce ECG changes compared to etomidate, nor did either agent induce arrhythmias upon induction.

Why does the matter?
BrugadaDrugs.org recommends against using propofol in these patients, given its sodium channel blocking properties. However, no RCT data exists to prove or disprove whether or not it is harmful.

Propofol doesn’t skip a beat
This was a double-blinded RCT including 80 patients with Brugada syndrome who were scheduled to undergo anesthesia. They were randomized to either etomidate 0.3mg/kg or propofol 2-3mg/kg for induction, with a primary endpoint of change in the ST segment, QRS interval, or arrhythmia upon induction. There was no difference in ST elevation, depression, or QRS prolongation between the groups. No patients had arrhythmia upon induction. Bear in mind, this was a relatively small study. Since the most common change was zero, this caused extreme skewness of the data. Regardless, for bolus induction, propofol appeared safe. This does not consider the effects of prolonged propofol infusion.

Source
Electrocardiographic Effects of Propofol versus Etomidate in Patients with Brugada Syndrome. Anesthesiology. 2019 Nov 13. doi: 10.1097/ALN.0000000000003030. [Epub ahead of print]

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