Comparison of bispectral index-guided infusion of propofol, etomidate, and etomidate-propofol combination for supraglottic airway device insertion in paediatric patients: A randomised clinical trial

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• Picked for Otorhinolaryngology (top studies of the week, 4 October 2026): Randomised clinical trial, paediatric anaesthetic induction

Abstract

BACKGROUND AND AIMS: The use of supraglottic airway devices (SADs) in paediatrics has considerably increased. Focusing haemodynamics at anaesthetic induction, the study evaluated change in mean arterial pressure (MAP) amongst propofol (P), etomidate (E), and etomidate-propofol combination(etofol, EP) groups at the attainment of bispectral index (BIS) 50 for SAD insertion. METHODS: A total of 132 patients of either gender between 6 and 10 years of age were randomly allocated as groups P, E, and EP with n = 44/group. Induced with a group-specific anaesthetic agent at 50 mL/h infusion, SAD was inserted at a BIS of 50. The primary outcome was change in MAP from baseline (∆MAP) at BIS 50, and secondary outcomes included change in heart rate (∆HR), time to attain BIS 50, SAD-related parameters (1st attempt success, time to insertion, insertion summed score), and drug-related side effects. RESULTS: ∆MAP was maximum in group P opposed to groups E and EP (9.14 ± 1.5 versus 4.32 ± 0.98 and 4.75 ± 1.50 mmHg, P < 0.001). With comparable ∆ MAP between E and EP groups, ∆HR was comparable across the study groups. The 1st attempt success and insertion summed score were significantly better for P and EP groups compared to group E (90.9% and 81.8% versus 68.2%; P = 0.033 and 6.59 ± 0.97 and 6.84 ± 1.27 versus 7.80 ± 1.58; P < 0.001) albeit statistically insignificant when analysed between groups P and EP. Groups P and EP had lower SAD-insertion times with the EP group displaying attenuation of pain on injection and myoclonus in contrast to groups P and E, respectively. CONCLUSION: Etomidate-propofol combination (etofol) demonstrated superior haemodynamic stability in BIS-guided paediatric anaesthetic induction, an added advantage to propofol use for ensuring favourable SAD insertion alongside better side-effect profile.

Abstract as published, via PubMed.