Etomidate Group Research Articles

Etomidate versus propofol sedation for complex upper endoscopic procedures: a prospective double-blinded randomized controlled trial

Although a growing body of evidence demonstrates that propofol-induced deep sedation can be effective and performed safely, cardiopulmonary adverse events have been observed frequently. Etomidate is a new emerging drug that provides hemodynamic and respiratory stability, even in high-risk patient groups. The objective of this study was to compare safety and efficacy profiles of etomidate and propofol for endoscopic sedation. A total of 128 patients undergoing EUS were randomized to receive either etomidate or propofol blinded administered by a registered nurse. The primary outcome was the proportion of patients with any cardiopulmonary adverse events. Overall cardiopulmonary adverse events were identified in 22 patients (34.38%) of the etomidate group and 33 patients (51.56%) of the propofol group, without significant difference (P= .074). However, the incidence of oxygen desaturation (4/64 [6.25%] vs 20/64 [31.25%]; P=.001) and respiratory depression (5/64 [7.81%] vs 21/64 [32.81%]; P=.001) was significantly lower in the etomidate group than in the propofol group. The frequency of myoclonus was significantly higher in the etomidate group (22/64 [34.37%]) compared with the propofol group (8/64 [12.50%]) (P=.012). Repeated measure analysis of variance revealed significant effects of sedation group and time on systolic blood pressure (etomidate group greater than propofol group). Physician satisfaction was greater in the etomidate group than in the propofol group. Etomidate administration resulted in fewer respiratory depression events and had a better sedative efficacy than propofol; however, it was more frequently associated with myoclonus and increased blood pressure during endoscopic procedures. (Clinical trial registration number: KCT0001701.).

Variation of hemodynamic response following induction and tracheal intubation: etomidate vs midazolam

Background: Induction and endotracheal intubation are invariably associated with certain cardiovascular changes during anaesthesia practice and can lead to sudden swings of blood pressure, arrhythmias, MI and cardiovascular collapse especially in geriatric and haemodynamically unstable patients. Therefore it is desirable to use a safer agent with fewer adverse effects to minimise these complications. Present prospective randomized study is designed to compare the haemodynamic alterations and various adverse effects following induction with etomidate and midazolam.Methods: Hundred ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving etomidate (0.3mg/kg) and midazolam (0.15mgk/kg) as an induction agent. Vital parameters before and after induction and thereafter at specified time interval following laryngoscopy and intubation were recorded for comparison. Adverse effect viz. pain on injection, apnea and myoclonic activity were also carefully watched.Results: Demographic variables in both the groups were comparable. Patients in both the groups showed little change in mean arterial pressure (MAP) and heart rate (HR) from baseline value (p >0.05). Pain on injection and myoclonic activity were seen in etomidate group while delayed awakening was seen with Midazolam group.Conclusions: This study concludes that both etomidate and midazolam provides haemodynamic stability but Midazolam can be preferred as an induction agent in view of fewer side effects.

Effect of propofol on secretory function of adrenal medullary chromaffin cells of rats

Objective To investigate the effect of propofol on the secretory function of adrenal medullary chromaffin cells of rats. Methods The rat adrenal pheochromocytoma cells cultured in vitro were seeded in 24-well plates at a density of 1×1010 cells/ml and divided into 5 groups (n=12 each ) using a random number table: control group (group C), different concentrations of propofol groups (P1 and P2 groups), and different concentrations of etomidate groups (E1 and E2 groups). Propofol was added with the final concentrations of 30 and 100 μmol/L in P1 and P2 groups, respectively.Etomidate was added with the final concentrations of 4 and 40 μmol/L in E1 and E2 groups, respectively.The cells were then incubated for 10 min in an incubator at 37 ℃.At the end of incubation with drugs, 6 wells in each group were selected, and physiological salt solution 200 μl was added; another 6 wells in each group were selected, and high K+ physiological salt solution was added.[3H]PSS and [3H]K+ -PSS were measured by [3H]norepinephrine release assays. Results Compared with group C, [3H]K+ -PSS and [3H]K+ -PSS/PSS were significantly decreased in P1, P2 and E2 groups (P 0.05). Compared with group P1, [3H]K+ -PSS and [3H]K+ -PSS/PSS were significantly decreased in group P2 (P<0.05). Conclusion Propofol can inhibit the secretory function of adrenal medullary chromaffin cells of rats in a concentration-dependent manner. Key words: Propofol; Adrenal medulla; Chromaffin cells; Neurosecretion

Retrospective Review of Propofol versus Etomidate during Rapid Sequence Intubation in the Emergency Department at a Tertiary Academic Center

Background: Etomidate is the standard induction agent used during rapid sequence intubation (RSI) in the emergency department (ED). Etomidate shortages require providers to utilize alternative agents. The purpose of this study is to compare the safety and procedural outcomes of propofol and etomidate for RSI in the ED. Methods: This was a retrospective chart review of adult patients in the ED who received propofol or etomidate for induction during RSI. The main endpoint was hypotension, defined as a systolic blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg, within the first hour of intubation. Time to intubation, intensive care unit length of stay, hospital length of stay, and in-hospital mortality were also evaluated. Results: Two hundred and seventy five patient charts were reviewed. Of the 98 patients included, 43 patients received propofol and 55 patients received etomidate. Propofol was associated with an increased incidence of hypotension within the first hour of intubation (65.1% vs. 25.5%, p < 0.001). No difference was found in the time to intubation: ≤5 minutes (51.2% vs. 34.6%, p = 0.83). The mortality rate was 11.6% in the propofol group and 27.3% in the etomidate group (p = 0.004). There was no difference in hospital or intensive care unit length of stay between the propofol and etomidate groups (7.7 vs. 9.2 days, p = 0.23; 4.2 vs. 6.3 days, p = 0.31). Conclusion: Propofol was a safe and procedurally effective induction agent for RSI. Compared to etomidate, it was associated with an increased rate of hypotension within the first hour of intubation, with no difference in the percent of patients that required an intervention.

Effect of Etomidate on Pneumonia Development in Critically Ill, Nontrauma Patients.

To determine whether etomidate use before intubation increased development of hospital-acquired pneumonia (HAP) in critically ill, nontrauma patients. A single-center, retrospective, cohort study of critically ill, nontrauma patients admitted to the medical intensive care unit (ICU) from 2012 to 2015 and intubated with or without etomidate was conducted. Demographics, comorbidities, primary diagnosis, critical illness scores, concomitant medications, and outcomes were obtained from medical records. Student t, chi-square, and Fisher exact tests were performed as appropriate. Relevant characteristics were modeled using logistic regression techniques to determine whether any predicted HAP independently. Of the 174 patients, 94 (54%) received etomidate and 80 (46%) did not. There was no difference in HAP between etomidate and no etomidate groups (13.8% vs 23.7%, P = .092). Duration of mechanical ventilation (4.4 vs 4.6 days, P = .845), ICU length of stay (7.4 vs 6.9 days, P = .547), ICU mortality (14.9% vs 12.5%, P = .648), and hospital mortality (17% vs 16.2%, P = .892) were similar between the groups. For each 1-day increase in mechanical ventilation duration, the likelihood of HAP development increased by 21%. Patients who received etomidate but no neuromuscular-blocking drug were 80% less likely to develop HAP than those who did not receive etomidate or a neuromuscular-blocking drug (odds ratio: 0.202, 95% confidence interval: 0.045-0.908). Etomidate use was not associated with a difference in HAP development in critically ill, nontrauma patients.

Increased incidence of clinical hypotension with etomidate compared to ketamine for intubation in septic patients: A propensity matched analysis

PurposeThis study compared the incidence of clinical hypotension between ketamine and etomidate within a 24 hour period following endotracheal intubation. Materials and methodsThis single-center, retrospective propensity-matched cohort study included septic patients admitted to our medical intensive care unit who received either etomidate or ketamine for intubation. Clinical hypotension was defined as any one of the following: mean arterial pressure (MAP) decrease >40% compared to baseline and MAP <70 mmHg, MAP <60 mmHg, initiation of a vasopressor, or increase to >30% of the initial vasopressor dose. ResultsPatients were matched based on propensity scores determined by demographics and baseline characteristics. A total of 384 (200 etomidate and 184 ketamine) patients were included for analysis with 230 patients (115 in each group) matched. Clinical hypotension was less prevalent in patients who received ketamine as compared to etomidate [51.3% vs. 73% (odds ratio=0.39, 95% confidence interval=0.22-0.67, P=.001]. The etomidate group experienced significantly lower MAPs at time periods 6.1-12 hours (65.1 mmHg vs. 69.3 mmHg, P=.01) and 12.1-24 hours (63.9 mmHg vs. 68.4 mmHg, P=.003). ConclusionsKetamine was associated with a lower incidence of clinical hypotension within the 24 hour period following endotracheal intubation in septic patients.

A randomized clinical trial comparing hemodynamic responses to ketamine-propofol combination (ketofol) versus etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery.

IntroductionAnesthesia induction is often accompanied by a period of hemodynamic instability, which could be a significant problem in patients with compromised ventricular function. The aim of this study is to compare the hemodynamic responses to etomidate versus a combination of ketamine and propofol (ketofol) for anesthetic induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery.Material and methodsIn a double-blind randomized clinical study, a total of 84 patients with ischemic left ventricular dysfunction (EF < 40%) were randomly assigned to two groups (A and B). Patients in group A received etomidate 0.2 mg/kg and a placebo (normal saline); group B received a combination of ketamine (1 mg/kg) and propofol (1.5 mg/kg) at the induction of anesthesia. Two minutes after induction, hemodynamic variables, including systolic, diastolic, mean arterial pressure (SAP, DAP, MAP) and heart rate (HR), were measured immediately before and after the laryngoscopy, and before intubation and post-intubation at 1, 2, and 3 min.ResultsThe decrease in all hemodynamic parameters (SBP, DBP, MAP and HR) from induction time to laryngoscopy was greater in the ketofol group (group B) than in the etomidate group (group A) (p < 0.05). The ephedrine prescription rate due to hemodynamic changes was 24.4% (10 patients) and 5% (2 patients) in group B and group A, respectively (p = 0.03).ConclusionsWe found that etomidate provides superior hemodynamic stability as compared to ketofol in patients with left ventricular dysfunction undergoing CABG surgery under general anesthesia.

Abstract PR447

Background & Objectives: The hemodynamic response to laryngoscopy and intubation is associated with reflex sympathetic response resulting in undesirable increase in heart rate and blood pressure.1 Several techniques have been proposed to attenuate these sympathetic responses. Etomidate is an intravenous anesthetic induction agent remarkable for its minimal cardiovascular effects and rapid onset of action.2 Sevoflurane is relatively cardiostable inhaled anesthetic3 that is pleasant smelling and relatively non irritating to the airways.4 The objective of the study was to compare the effects of Etomidate, a cardiostable intravenous anesthetic induction agent with Sevoflurane, a relatively cardiostable inhaled anesthetic in attenuating the hemodynamic response to laryngoscopy and intubation. Materials & Methods: After obtaining approval from hospital ethics committee and informed consent from the patients, 66 ASA I and II status normotensive patients (n=33 in each group), aged 18 to 60 years scheduled for elective surgical procedures were allocated randomly into 2 groups to receive 4 % sevoflurane / 100% oxygen (S GROUP) or etomidate 0.4mg/kg for induction (E GROUP). 2 micrograms/kg of fentanyl was administered prior to induction and vecuronium for muscle relaxation. Hemodynamic parameters were recorded before induction, post induction, immediately after intubation and 1, 2, 3, 5 minutes from onset of laryngoscopy. Statistical analysis was carried out using Z test for proportions, independent sample t-test and paired t test (two sided). Statistical level of significance was set at P value < 0.05. Results: Demographic profiles of two groups were comparable. Maximum pressor response was observed immediately after intubation. The rise in heart rate, systolic, diastolic and mean arterial blood pressure was statistically significant in etomidate group than in sevoflurane group. The hemodynamic response to laryngoscopy and intubation was effectively decreased by sevoflurane -fentanyl induction and was highly significant on comparison(P<0.001)Conclusion: Sevoflurane inhalational induction is rapidly gaining popularity due to its smooth induction characteristics devoid of airway complications. Sevoflurane induction can be a better alternative to etomidate in attenuating hemodynamic responses to laryngoscopy and intubation in high risk patients with hypertension and coronary artery diseases.

A comparative study between propofol and etomidate in patients under general anesthesia

Induction of anesthesia is a critical part of anesthesia practice. Sudden hypotension, arrhythmias, and cardiovascular collapse are threatening complications following injection of induction agent in hemodynamically unstable patients. It is desirable to use a safe agent with fewer adverse effects for this purpose. Present prospective randomized study is designed to compare propofol and etomidate for their effect on hemodynamics and various adverse effects on patients in general anesthesia. Hundred ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving propofol (2mg/kg) and etomidate (0.3mg/kg) as an induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded for comparison. Adverse effect viz. pain on injection, apnea and myoclonus were carefully watched. Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) compared to propofol (p>0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.

The pituitary adenylate cyclase-activating polypeptide (PACAP) protects adrenal function in septic rats administered etomidate

BackgroundBoth hyperinflammation during sepsis and etomidate can suppress adrenal function. In this study, we explored whether treatment with pituitary adenylate cyclase-activating polypeptide (PACAP) relieves adrenal suppression in cecal ligation and puncture (CLP)-induced septic rats. Materials and methodsFemale Sprague–Dawley rats were randomly divided into five groups (n=7 per group), including the sham group, sepsis group (CLP group), sepsis and etomidate group (CLP+ETO group), PACAP group, and etomidate alone group (ETO group). Rats were sacrificed on the third day of sepsis, and blood and adrenal gland samples were obtained for further testing. ResultsThe PACAP reduced the apoptosis rate of adrenal cells and peripheral lymphocytes, improving adrenal function, inhibiting the secretion of interferon gamma (IFN-γ) from peripheral lymphocytes, and slightly relieving the suppression of the adrenal function induced by the injection of etomidate in sepsis. ConclusionIn septic conditions, the PACAP protects the adrenal gland by regulating peripheral inflammation, which slightly relieves the toxic effects of etomidate on adrenal function.

Comparison of the Effects of Low-Dose Midazolam, Magnesium Sulfate, Remifentanil and Low-Dose Etomidate on Prevention of Etomidate-Induced Myoclonus in Orthopedic Surgeries.

BackgroundEtomidate is a potent hypnotic agent with several desirable advantages such as providing a stable cardiovascular profile with minimal respiratory adverse effects and better hemodynamic stability compared with other induction agents. This drug is associated, however, with myoclonic movements which is characterized by a sudden, brief muscle contractions as a disturbing side-effect.ObjectivesThe present study was designed to compare the effectiveness of low- dose midazolam, magnesium sulfate, remifentanil and low-dose etomidate to suppress etomidate-induced myoclonus in orthopedic surgery.Patients and MethodsA double-blind clinical trial study was conducted in an academic hospital from September 2014 to August 2015. Two hundred and eighty-four eligible patients, American society of anesthesiologists class I - II, scheduled for elective orthopedic surgery were randomly allocated into four equal groups (n = 71). They received premedication with intravenous low-dose midazolam 0.015 mg/kg, magnesium sulfate 30 mg/kg, remifentanil 1 μg/kg and low-dose etomidate 0.03 mg/kg two minutes before induction of anesthesia with 0.3 mg/kg intravenous etomidate. Then the incidence and intensity of myoclonus were evaluated on a scale of 0 - 3; 0 = no myoclonus; 1 = mild (movement at wrist); 2 = moderate (movement at arm only, elbow or shoulder); and 3 = severe, generalized response or movement in more than one extremity, within ninety seconds. Any adverse effect due to these premedication agents was recorded.ResultsThe incidence and intensity of myoclonus were significantly lower in the low-dose etomidate group. The incidence rates of myoclonus were 51 (71.85%), 61 (85.9%), 30 (42.3%) and 41 (57.7%), and the percentages of patients who experienced grade III of myoclonus were 30 (58.8%), 32 (52.5%), 9 (30%) and 14 (34.1%) in the midazolam, magnesium sulfate, etomidate and remifentanil groups, respectively. The incidence and intensity of myoclonus were significantly lower in the low-dose etomidate group (P = 0.0001). No notable adverse effect was detected in our patients during the study period.ConclusionsIntravenous etomidate 0.03 mg/kg prior to induction can effectively reduce the incidence and severity of myoclonus linked to etomidate.

Etomidate, but not thiopental, decreases serum cortisol concentration in morbidly obese patients. A randomized controlled trial.

The effect of etomidate administration on the adrenal cortex in obese patients is still unclear. The objective of the study was to determine the influence of a single dose of etomidate on cortisol secretion in the morbidly obese. 127 healthy patients were enrolled into the study. Data from 82 patients scheduled for elective laparoscopic surgery were analyzed. 62 of them were morbidly obese, while 20 had normal body mass. The participants were divided equally into etomidate and thiopental groups, depending on the kind of intravenous anaesthetic used for the induction of anaesthesia. Each patient's serum cortisol concentration was measured five times: on the day before surgery (sample A), two hours after the induction of anaesthesia (sample B), after a short tetracosactide test (sample C), 24 hours after the induction of anaesthesia (sample D), and after a second short stimulation test (sample E). The mean cortisol concentration in obese patients in the etomidate group was lower two hours after the induction of anaesthesia (sample B, P < 0.001), and 30 minutes after the first tetracosactide test (sample C, P < 0.001) compared to obese patients in the thiopental group. There were no differences between the groups in sample A (P = 0.833), D (P = 0.614) and E (P = 0.769). We found no changes in haemodynamic parameters between both groups. Etomidate decreased serum cortisol concentration and decreased reactivity to tetracosactide both in morbidly obese and in normal weight patients. This effect was reversible within 24 hours.

Propofol, but not etomidate, increases corticosterone levels and induces long-term alteration in hippocampal synaptic activity in neonatal rats

Animal studies provide strong evidence that general anesthetics (GAs), administered during the early postnatal period, induce long-term cognitive and neurological abnormalities. Because the brain growth spurt in rodents is delayed compared to that in humans, a fundamental question is whether the postnatal human brain is similarly vulnerable. Sevoflurane and propofol, GAs that share positive modulation of the gamma-aminobutyric acid type A receptor (GABAAR) function cause marked increase in corticosterone levels and induce long-term developmental alterations in synaptic activity in rodents. If synaptogenesis is affected, investigation of mechanisms of the synaptic effects of GAs is of high interest because synaptogenesis in humans continues for several years after birth. Here, we compared long-term synaptic effects of etomidate with those of propofol. Etomidate and propofol both positively modulate GABAAR activity, but in contrast to propofol, etomidate inhibits the adrenal synthesis of corticosterone.Postnatal day (P) 4, 5, or 6 rats received five injections of etomidate, propofol, or vehicle control during 5h of maternal separation. Endocrine effects of the anesthetics were evaluated by measuring serum levels of corticosterone immediately after anesthesia or maternal separation. The frequency and amplitude of miniature inhibitory postsynaptic currents (mIPSCs) in hippocampal CA1 pyramidal neurons were measured at P24-40 and P≥80.Only propofol caused a significant increase in serum corticosterone levels (F(4.26)=17.739, P<0.001). In contrast to increased frequency of mIPSCs in the propofol group (F(4.23)=8.731, p<0.001), mIPSC activity in the etomidate group was not different from that in the vehicle groups.The results of this study together with previously published data suggest that anesthetic-caused increase in corticosterone levels is required for GABAergic GAs to induce synaptic effects in the form of a long-term increase in the frequency of hippocampal mIPSCs.

Evaluation of Etomidate for Seizure Duration in Electroconvulsive Therapy

The optimum induction agent for anesthesia for electroconvulsive therapy (ECT) has been long debated. Ideal agent should be short acting with minimal suppression of seizure potentials. Recent studies have suggested longer seizure duration with etomidate in comparison to propofol, thiopental, and methohexital. The aim of the present meta-analysis was to pool data available from studies comparing systematically the efficacy of etomidate against other induction agents in terms of seizure duration (both electroencephalography (EEG) and motor). We searched the PubMed, Embase, and Cochrane registry for trials evaluating etomidate against methohexital, propofol, or thiopental for duration of EEG or motor seizure in patients undergoing ECT. Specific adverse effects reported were also identified. Seventeen trials were identified involving 704, 84, 2491, and 258 setting of ECT using etomidate, methohexital, thiopental, and propofol, respectively. In the etomidate group, pooled EEG seizure duration was longer by 2.23 seconds (95% confidence interval [CI], -3.62 to 8.01; P = 0.456) than methohexital, longer by 17.65 seconds (95% CI, 9.72-25.57; P < 0.001) than propofol, and longer by 11.81 seconds (95% CI, 4.26-19.35; P = 0.003) than thiopental. Pooled motor seizure duration was longer in etomidate group by 1.45 seconds (95% CI, -4.79 to 7.69; P = 0.649) than methohexital, longer by 11.13 seconds (95% CI, 6.64-15.62; P < 0.001) than propofol, and longer by 3.60 seconds (95% CI, 2.15-5.06; P < 0.001) than thiopental. Myoclonus (6 trials) and painful injection (4 trials) were commonest adverse effects with etomidate. Etomidate is clearly better in terms of seizure duration potential (both motor and EEG) than propofol and thiopental. Superiority/inferiority over methohexital could not be demonstrated with the presently available literature.

Comparative Study On Haemodynamic Responses During Intubation Using Etomidate Propofol And Thiopentone In Laparoscopic Cholecystectomy Surgeries

DOI:http://dx.doi.org/10.15520/ij mhs.2015.vol5.iss4.80.150-158 Tracheal intubation provides a patent airway. Direct laryngoscopy and intubation are noxious stimuli. Significant hypertension and tachycardia are associated with tracheal intubation under light anaesthesia. Nowdays, prevention of hemodynamic response by use of premedications & induction agents, thereby increasing the depth of anaethesia. During laparoscopic cholecystectomy, haemodynamic changes occur to a greater extent than other non laproscopic surgeries. In my study Ninety (90) patients of ASA I & II physical status of either sex schedule for elective laparoscopic cholecystectomy surgeries. All the patients were preoxygenated with O2 followed by Inj. Nalbuphine 0.1 mg / Kg & midazolam 0.05mg / Kg i.v. followed by induction agent either thiopentone, propofol or etomidate doses of 5mg/kg,2mg/kg,0.3mg/kg respectively & muscle relaxant rocuronium 1mg/kg was given. Laryngoscopy and intubation were done after complete jaw relaxation. Injection glycopyrolat 4 mg/ Kg IM, injection ranitidine 50mg and injection metoclopamide 10mg were given IV to the patients 45 minute before surgery. Haemodynamic parameters at pre induction, post induction and after intubation at 0min,1min,3min,5min & 10min were taken into account for evaluation obtained from each group were analyzed statistically and compared by Average Standard Deviation and t test . p value less than 0.05 was considered significant and more than 0.0.5 was considered not significant. The finding of study, no significant change in HR,SBP,DBP,MAP in post induction and after intubation in etomidate group.

Cyclopropyl-methoxycarbonyl Metomidate: Studies in a Lipopolysaccharide Inflammatory Model of Sepsis.

Cyclopropyl-methoxycarbonyl metomidate (CPMM) is a rapidly metabolized etomidate analog that is currently in clinical trials. The goal of this study is to assess CPMM's potential value as an anesthetic agent for use in patients with sepsis by defining its actions in an acute inflammatory model of sepsis. Escherichia coli lipopolysaccharide (1 mg/kg) was injected intravenously into Sprague-Dawley rats. Thirty minutes later, CPMM, etomidate, or vehicle (n = 8 per group) was infused for 1 h. Plasma adrenocorticotropic hormone, corticosterone, and cytokine (interleukin-1β, interleukin-6, interleukin-10, and tumor necrosis factor-α) concentrations were measured before, during, and after infusion. After lipopolysaccharide injection, adrenocorticotropic hormone concentrations changed similarly over time in all three groups. Compared with vehicle group rats, CPMM group rats had significantly lower corticosterone concentrations at only a single study time point during infusion and no significant differences in cytokine concentrations at any time during the study period. Compared with etomidate group rats, CPMM group rats had significantly higher corticosterone concentrations (up to nine-fold) during and after hypnotic infusion. Cytokine concentrations in CPMM group rats and vehicle group rats were not significantly different, but they were significantly lower than those in etomidate group rats. Postinfusion mortality was 40% in etomidate group rats and 0% in CPMM and vehicle group rats. Compared with etomidate, CPMM produces less adrenocortical suppression, lower plasma cytokine concentrations, and improved survival in a lipopolysaccharide inflammatory model of sepsis. These results suggest that CPMM may be a safer alternative to etomidate in patients with sepsis.

Effect of etomidate combined with dezocine in middle aged and old women in painless curettage

Objective To observe the effect of etomidate combined with dezocine used in elderly women painless curettage effect and safety. Methods All postmenopausal uterine bleeding patients meet to following conditions:American Society of Anesthesiologists score I-II,age of 50-74 years,weight of 41-72kg.60 patients were randomly divided into the two groups,propofol group(group P)and etomidate group(group E),30 cases in each group;slowly injection of dezocine(0.04g/kg)in two groups,5min after intravenous injection of propofol in group P(0.8-1mg/kg);intravenous injection of etomidate in group E(0.1-0.3mg/kg).Each patients cannula for oxygen,retain spontaneous breathing.The mean arterial pressure(MAP),electrocardiogram (ECG),heart rate(HR),respiratory rate(RR)and blood oxygen saturation(Sp O2),the etomidate and propofol dosage during induction of anesthesia.injection pain,muscle spasm,intraoperative respiratory repression,low blood pressure,ephedrine,atropine dosage and body movement,operation physicians and anesthesiologists satisfaction,before anesthesia,intraoperative minimum diastolic blood pressure,heart rate,respiration,blood oxygen saturation,from the room time,nausea,vomiting,dizziness and other complications after operation were recorded between the two groups. Results The two groups during anesthesia induction time,injection pain,muscle spasm,body movement,operation physician satisfaction had no significant difference(P>0.05).The patients in the group E of respiratory depression,hypotension,ephedrine,atropine dosage respectively 0 cases,1 cases,0 cases,2 cases,P group 12 cases,respectively 24 cases,19 cases,7 cases,two groups of the differences were statistically significant(χ2=15.000,23.976,6.648,0.000,3.268,all P<0.05);group E of anesthesiologists satisfaction rate of 96.7%,higher than 20%in the group P,the difference between the two groups was statistically significant(χ2=12.346,P<0.05);group E of postoperative nausea and vomiting complication rate was 60.0%,50.0%,3.3%and 0.0%higher than those of group P,the difference between the two groups had statistical significance(χ2=6.405,20.000,all P<0.05));group E after operation from the room time for(30.6 ±5.2)min,longer than those of the group P(21.4±3.3)min(t=7.118,P<0.05). Conclusion Effect of etomidate combined with dezocine anesthesia while postoperative nausea,dizziness and other complications,but the effects on respiration,circulation is small,suitable for middle aged and old women painless curettage. Key words: Etomidate; Dezocine; Curettage

A comparative study between propofol and etomidate in patients under general anesthesia

Background and objectivesInduction of anesthesia is a critical part of anesthesia practice. Sudden hypotension, arrhythmias, and cardiovascular collapse are threatening complications following injection of induction agent in hemodynamically unstable patients. It is desirable to use a safe agent with fewer adverse effects for this purpose. Present prospective randomized study is designed to compare propofol and etomidate for their effect on hemodynamics and various adverse effects on patients in general anesthesia. MethodsHundred ASA I and II patients of age group 18–60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving propofol (2mg/kg) and etomidate (0.3mg/kg) as an induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded for comparison. Adverse effect viz. pain on injection, apnea and myoclonus were carefully watched. ResultsDemographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) compared to propofol (p>0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. ConclusionsThis study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.

Etomidate is associated with longer seizure duration, lower stimulus intensity, and lower number of failed trials in electroconvulsive therapy compared with thiopental.

Induction agents used for electroconvulsive therapy (ECT) may alter seizure parameters. In this study, we aimed to investigate the effects of etomidate and thiopental on seizure-related variables. Registries of patients who received ECT between 2010 and 2013 in a tertiary psychiatry clinic were evaluated retrospectively. The information of patients who were on the same induction agent and muscle relaxant during the whole treatment course was assessed. Primary outcome measures were total number of ECT sessions, mean peripheral and central seizure duration, cumulative stimulus intensity, and the number of adequate seizures per total number of stimuli. Secondary measures were maximum systolic-diastolic and mean blood pressure, peak heart rate, and the frequency of antihypertensive drug use during the sessions. Although the total number of ECT sessions is similar between the etomidate (n = 43) and thiopenthal (n = 31) groups, the mean seizure duration per stimuli was significantly longer whereas the cumulative stimulus intensity was lower in the etomidate group. The number of adequate seizures obtained in relation with the number of stimuli was also significantly higher, indicating increased probability of eliciting an adequate seizure with etomidate. During threshold determination, the number of stimuli needed to provide an adequate seizure was marginally less with etomidate. No group difference was observed in hemodynamic changes and the frequency of antihypertensive use. Etomidate use, compared with thiopental as an induction agent, is associated with longer seizure duration with less cumulative intensity. The use of etomidate reduces the number of failed trials and may prevent the application of unnecessary electrical stimuli with a possibly safe hemodynamic profile.

English

BACKGROUND: Patients undergoing coronary artery bypass grafting are susceptible to haemodynamic labiality during anaesthesia induction. AIMS AND OBJECTIVE: To evaluate the hemodynamic effects of etomidate in comparison to that of propofol during induction of general anaesthesia. SETTINGS AND DESIGN: The study was conducted in the department of anaesthesia of a tertiary care medical college setting over a period of one year from October 2013 to October 2014 on patients undergoing elective coronary artery bypass surgery under general anaesthesia. MATERIAL AND METHODS: 40 adult patients who are aged 35–65 years belonging to American Society Anaesthesia grades 1 and 2 undergoing elective surgery under general anaesthesia, were divided randomly into two groups of 20 patients each. By using bispectral index of 50 as a goal for induction, group a patients were given intravenous propofol injection, and group B were given etomidate injection. STASTICAL ANALYSIS: Data is presented as mean and standard deviation. The statistical analysis was performed using SPSS 15.0, Stata 8.0, medicals 9.0.1 and Systat 11.0. A “p” value of less than 0.05 was taken as significant. RESULTS: Our results in both (P and E respectively) groups showed significant reduction in arterial pressure (30%-22%), SVRI (31%-23%), and LVSWI (38%32%) after anaesthesia induction. However, the heart rate (3%-10%) and cardiac index did not change significantly. SVRI significantly increased in the etomidate group after intubation. CONCLUSION: Propofol can produce a larger reduction in contractility, arterial pressure, and after load when compared to etomidate as an induction agent in patients with coronary artery disease. Etomidate is less effective in preventing stress response to intubation.