Comparing the effect of etomidate and propofol on surgical stress responses in elective spine surgery: a randomized clinical trial

The surgical stress response (SSR) alters metabolism, hormones, and inflammation, affecting postoperative outcomes. Etomidate and propofol modulate SSR differently, but their effects in elective spine surgery remain underexplored. We aimed to compare their impact on SSR biomarkers, hemodynamics, and recovery. In this double-blind RCT, 120 ASA I–III patients undergoing elective spine surgery were randomized to receive induction with either etomidate (0.3 mg/kg) or propofol (2 mg/kg); anesthesia was maintained with isoflurane in both groups. Data were analyzed using SPSS v22.0 with Student’s t-tests, ANOVA, and Chi-square/Fisher’s exact tests as appropriate. Primary outcomes were plasma cortisol (at 6 h). Secondary outcomes included IL-6, TNF-α, hypotension incidence, opioid use, hospital stay, and adverse events. Etomidate suppressed cortisol at 6 h (8.3 ± 2.1 vs. 15.6 ± 3.4 µg/dL, P < 0.001), with normalization by 24 h. Propofol reduced IL-6 by 32% at 6 h (P = 0.003), lowered opioid use (36 ± 15 vs. 45 ± 18 MME, P = 0.01), and shortened hospital stays (4.1 vs. 5.3 days, P = 0.02). Etomidate increased adrenal insufficiency (10% vs. 0%, P = 0.03) and myoclonus (15% vs. 0%, P = 0.003); propofol had higher hypotension (28.3% vs. 8.3%, P = 0.004). Etomidate offers hemodynamic stability, but leads to transient adrenal suppression. Propofol attenuates inflammation and aids recovery at the cost of hypotension. Anesthetic choice should be individualized to patient risk and surgical demands.