Ambulatory electrical external cardioversion with propofol or etomidate.

Study Objective: To compare, in pairwise fashion, the effects of propofol and etomidate during ambulatory cardioversion and early recovery.

Design: Clinical, prospective, randomized, blinded, monocenter, pairwise, comparative study

Setting: OR and recovery area of the electrophysiological department, University Hospital Ghent, Belgium.

Patients: 34 patients with atrial arrhythmia who were scheduled for repetitive electrical cardioversion, of whom 25 patients completed the study.

Interventions: Nonpremedicated patients received during the first cardioversion either propofol (1 mg/kg) or etomidate (0.2 mg/kg) until loss of consciousness, followed by electrical external cardioversion. If after restoration of sinus rhythm for at least 1 day, atrial arrhythmia reoccurred, a second session was performed a week later, using the other induction drug.

Measurements: Systolic and diastolic blood pressure values taken before drug administration, at loss of consciousness, 60 seconds after cardioversion, and awake; the number of shocks, the total amount of energy, the number of patients in which we failed to restore sinus rhythm, the time before opening eyes, answering simple questions and be able to sit, were all noted. Aldrete scores and the Steward postanesthetic recovery scores were noted every minute until 10 minutes after the external cardioversion. Recovery tests were performed and evaluated 5, 10, 15, and 20 minutes after energy delivery.

Main Results: Number of shocks, amount of energy, and blood pressure values were comparable in both groups. Recovery times and Aldrete and Steward postanesthetic recovery scores showed a faster awakening in patients who were induced with propofol. Overall performance of the psychomotor test was better in the propofol group, and most pronounced at 10 and 15 minutes.

Conclusions: Etomidate and propofol are both useful during ambulatory external electrical cardioversion. The described doses maintain stable hemodynamic conditions in nonpremedicated patients. Recovery scores and psychomotor test indicate a faster recovery in the propofol group. However, no intergroup differences were noted at 20 minutes after the cardioversion. A safe discharge of all patients from the critical care unit or postanesthesia care unit to the ward can be considered after 30 minutes.