Etomidate Injection Research Articles

Comparison of priming versus slow injection for reducing etomidate-induced myoclonus: a randomized controlled study.

Etomidate injection is often associated with myoclonus. Etomidate injection technique influences the incidence of myoclonus. This study was designed to clarify which of the two injection techniques-slow injection or priming with etomidate-is more effective in reducing myoclonus. This prospective randomized controlled study was conducted on 189 surgical patients allocated to three study groups. Control group (Group C, n = 63) received 0.3 mg/kg etomidate (induction dose) over 20 s. Priming group (Group P, n = 63) received pretreatment with 0.03 mg/kg etomidate, followed after 1 min by an etomidate induction dose over 20 s. Slow injection group (Group S, n = 63) received etomidate (2 mg/ml) induction dose over 2 min. The patients were observed for occurrence and severity of myoclonus for 3 min from the start of injection of the induction dose. The incidence of myoclonus in Group P (38/63 patients [60.3%], 95% CI [48-71.5%]) was significantly lower than in Group C (53/63 patients [84.1%], 95% CI [72.9-91.3%], P = 0.003) and Group S (49/63 patients [77.8%], 95% CI [66-86.4%], P = 0.034). Myoclonus of moderate or severe grade occurred in significantly more patients in Group C (68.3%) than in Group P (36.5%, P < 0.001) and Group S (50.8%, P = 0.046), but the difference between Groups P and S was not significant (P = 0.106). Priming is more effective than slow injection in reducing the incidence of myoclonus, but their effects on the severity of myoclonus are comparable.

Etomidate and propylene glycol activate nociceptive TRP ion channels.

BackgroundEtomidate is a preferred drug for the induction of general anesthesia in cardiovascular risk patients. As with propofol and other perioperatively used anesthetics, the application of aqueous etomidate formulations causes an intensive burning pain upon injection. Such algogenic properties of etomidate have been attributed to the solubilizer propylene glycol which represents 35% of the solution administered clinically. The aim of this study was to investigate the underlying molecular mechanisms which lead to injection pain of aqueous etomidate formulations.ResultsActivation of the nociceptive transient receptor potential (TRP) ion channels TRPA1 and TRPV1 was studied in a transfected HEK293t cell line by whole-cell voltage clamp recordings of induced inward ion currents. Calcium influx in sensory neurons of wild-type and trp knockout mice was ratiometrically measured by Fura2-AM staining. Stimulated calcitonin gene-related peptide release from mouse sciatic nerves was detected by enzyme immunoassay. Painfulness of different etomidate formulations was tested in a translational human pain model. Etomidate as well as propylene glycol proved to be effective agonists of TRPA1 and TRPV1 ion channels at clinically relevant concentrations. Etomidate consistently activated TRPA1, but there was also evidence for a contribution of TRPV1 in dependence of drug concentration ranges and species specificities. Distinct N-terminal cysteine and lysine residues seemed to mediate gating of TRPA1, although the electrophile scavenger N-acetyl-L-cysteine did not prevent its activation by etomidate. Propylene glycol-induced activation of TRPA1 and TRPV1 appeared independent of the concomitant high osmolarity. Intradermal injections of etomidate as well as propylene glycol evoked severe burning pain in the human pain model that was absent with emulsification of etomidate.ConclusionsData in our study provided evidence that pain upon injection of clinical aqueous etomidate formulations is not an unspecific effect of hyperosmolarity but rather due to a specific action mediated by activated nociceptive TRPA1 and TRPV1 ion channels in sensory neurons.

Pretreatment with Oxycodone Simultaneously Reduces Etomidate-Induced Myoclonus and Rocuronium-Induced Withdrawal Movements During Rapid-Sequence Induction.

BackgroundEtomidate and rocuronium are often paired in rapid-sequence anesthesia induction. However, the effect of pretreatment with oxycodone on myoclonic and withdrawal movements has not been previously investigated.The aim of this study was to evaluate the effects of oxycodone on the incidence and severity of etomidate-induced myoclonus and rocuronium-induced nociceptive withdrawal movements during rapidsequence anesthesia induction.Material/MethodsWe randomly divided 120 patients into the saline group (group S) and the oxycodone group (group O) (n=60 in each group). Patients received 0.05 mg/kg oxycodone or saline intravenously 2 min before administration of 0.3 mg/kg etomidate. The occurrence and severity of myoclonus were assessed after administration of etomidate, then rocuronium was injected, followed by evaluation of withdrawal movements.ResultsThe total frequency of involuntary movements following sequential administration of etomidate and rocuronium was significantly lower in Group O than in Group S (28.3% vs. 90%, p<0.001). The total frequency and grade 3 severity of myoclonus following etomidate injection in Group O was significantly lower than in Group S (25.0% vs. 63.3% for total frequency; 0 vs. 10 for grade 3 severity, P<0.001). The total frequency and grade 3 intensity of withdrawal movements were significantly less in Group O than in Group S (6.7% vs. 73.3% for total frequency; 0 vs. 11 for grade 3 intensity, P<0.001).ConclusionsOxycodone is effective for simultaneously preventing etomidate-induced myoclonus and rocuronium-induced withdrawal movements during general anesthesia induction.

Comparison of granisetron and lidocaine on reducing injection pain of etomidate: a controlled randomized study

Background and objectivesReducing pain on injection of anesthetic drugs is of importance to every anesthesiologist. In this study we pursued to define if pretreatment by granisetron reduces the pain on injection of etomidate similar to lidocaine. MethodsThirty patients aged between 18 and 50 years of American Society of Anesthesiologists physical status class I or II, whom were candidates for elective laparoscopic cholecystectomy surgery were enrolled in this study. Two 20 gauge cannulas were inserted into the veins on the dorsum of both hands and 100mL of normal saline was administered during a 10min period from each cannula. Using an elastic band as a tourniquet, venous drainage of both hands was occluded. 2mL of granisetron was administered into one hand and 2mL of lidocaine 2% at the same time into the other hand. One minute later the elastic band was opened and 2mL of etomidate was administered to each hand with equal rates. The patients were asked to give a score from 0 to 10 (0=no pain, 10=severe pain) to each the pain sensed in each hand. ResultsTwo patients were deeply sedated after injection of etomidate and unable to answer any questions. The mean numerical rating score for injection pain of intravenously administered etomidate after intravenous granisetron was 2.3±1.7, which was lower when compared with pain sensed due to intravenously administered etomidate after administration of lidocaine 2% (4.6±1.8), p<0.05. ConclusionThe result of this study demonstrated that, granisetron reduces pain on injection of etomidate more efficiently than lidocaine.

Role of environmental stressors in determining the developmental outcome of neonatal anesthesia

BackgroundThe majority of studies evaluating neurocognition in humans who had procedures under anesthesia early in life found long-term deficits even though the typical anesthesia duration normalized to the human life span is much shorter than that shown to induce developmental abnormalities in rodents. Therefore, we studied whether subsequent environmental stressors contribute to deficiencies programmed by a brief neonatal etomidate exposure. MethodsPostnatal days (P) 4, 5, or 6, Sprague-Dawley rats, pretreated with vehicle or the Na+-K+-2Cl− (NKCC1) inhibitor, bumetanide, received two injections of etomidate resulting in anesthesia for 2h. To simulate stress after anesthesia, the animals were exposed to a single maternal separation for 3h at P10. 3–7days after exposure to etomidate the rats had increased hypothalamic NKCC1 mRNA and corticotropin releasing hormone (CRH) mRNA and decreased K+-2Cl− (KCC2) mRNA levels with greater changes in males. In rats neonatally exposed to both etomidate and maternal separation, these abnormalities persisted into adulthood. These animals also exhibited extended corticosterone responses to restraint stress with increases in total plasma corticosterone more robust in males, as well as behavioral abnormalities. Pretreatment with the NKCC1 inhibitor ameliorated most of these effects. ConclusionsPost-anesthesia stressors may exacerbate/unmask neurodevelopmental abnormalities even after a relatively short anesthetic with etomidate, leading to dysregulated stress response systems and neurobehavioral deficiencies in adulthood. Amelioration by bumetanide suggests a mechanistic role for etomidate-enhanced gamma-aminobutyric acid type A receptor-mediated depolarization in initiating long-lasting alterations in gene expression that are further potentiated by subsequent maternal separation.

Effect of pretreatment with midazolam on etomidate-induced myoclonus: A meta-analysis.

ObjectiveTo investigate the effect of pretreatment with midazolam on myoclonus induced by etomidate injection.MethodsA meta-analysis was performed using Review Manager software, version 5.2. Two researchers independently searched PubMed, Cochrane Library, and Embase® databases for randomized controlled trials involving patients who underwent etomidate induced general anaesthesia with or without midazolam pretreatment, published between 1990 and 2016. Outcome measures comprised overall myoclonus incidence rate and incidence rate classified by degree of myoclonus following etomidate injection. Data were assessed using a fixed effects model.ResultsFive studies, comprising 302 patients, were included for analysis. Overall incidence rate of etomidate injection-induced myoclonus was significantly lower in the pooled midazolam group versus controls (relative risk [RR] 0.34, 95% confidence interval [CI] 0.26, 0.44); Results subgrouped by degree of myoclonus showed significantly lower incidence in midazolam groups versus control groups for mild myoclonus (RR 0.56, 95% CI 0.39, 0.80); moderate myoclonus (RR 0.20, 95% CI 0.10, 0.41); and severe myoclonus (RR 0.12, 95% CI 0.04, 0.39).ConclusionMidazolam can effectively prevent etomidate-induced myoclonus, and alleviate the degree of etomidate-induced myoclonus.

Contrasting Effects of the γ-Aminobutyric Acid Type A Receptor β3 Subunit N265M Mutation on Loss of Righting Reflexes Induced by Etomidate and the Novel Anesthetic Barbiturate R-mTFD-MPAB.

Previous studies have shown that etomidate modulates γ-aminobutyric acid type A receptors by binding at the β-α subunit interface within the transmembrane domain of receptors that incorporate β2 or β3 subunits. Introducing an asparagine-to-methionine (N265M) mutation at position 265 of the β3 subunit, which sits within the etomidate-binding site, attenuates the hypnotic effect of etomidate in vivo. It was reported recently that the photoactivatable barbiturate R-mTFD-MPAB also acts on γ-aminobutyric acid type A receptors primarily by binding to a homologous site at the γ-β interface. Given this difference in drug-binding sites established by the in vitro experiments, we hypothesized that the β3-N265M-mutant mice would not be resistant to the anesthetic effects of R-mTFD-MPAB in vivo, whereas the same mutant mice would be resistant to the anesthetic effects of R-etomidate. We measured the effects of IV injection of etomidate and R-mTFD-MPAB on loss and recovery of righting reflex in wild-type mice and in mice carrying the β3-N265M mutation. Etomidate-induced hypnosis, as measured by the duration of loss of righting reflex, was attenuated in the N265M knock-in mice, confirming prior results. By contrast, recovery of balance and coordinated movement, as measured by the ability to maintain all 4 paws on the ground, was unaffected by the mutation. Neither hypnosis nor impairment of coordinated movement produced by the barbiturate R-mTFD-MPAB was affected by the mutation. The findings confirmed our hypothesis that mutating the etomidate-binding site would not alter the response to the barbiturate R-mTFD-MPAB. Furthermore, we confirmed previous studies indicating that etomidate-induced hypnosis is mediated in part by β3-containing receptors. We also extended previous findings by showing that etomidate-impaired balance and coordinated movement are not mediated by β3-containing receptors, thus implicating β2-containing receptors in this end point.

Intracarotid Etomidate Decreases the Interhemispheric Synchronization in Electroencephalogram (EEG) During the Wada Test.

The Wada test is a diagnostic method to anesthetize 1 cerebral hemisphere and assess the language and memory functions of awake contralateral hemisphere before temporal lobectomy in patients with epilepsy. The effects of an ipsilateral injection of etomidate on the functional properties of contralateral hemisphere are not known. Our aim was to characterize the electroencephalographic (EEG) effects after intracarotid injection of etomidate and to determine the changes in synchronization between the ipsilateral and contralateral hemispheres. We retrospectively analyzed EEG data from 15 patients who underwent Wada test with etomidate. Continuous EEG data from 4 electrodes (2 anterior [F3, F4] and 2 posterior [P3, P4]) were analyzed. After artifact rejection, we measured the amplitudes of delta (1 to 4 Hz) and alpha (7 to 13 Hz) waves and the changes in the interhemispheric synchronization before, during, and after etomidate injection. Ipsilateral injection of etomidate causes EEG changes in both hemispheres with increased amplitude of delta waves anteriorly and the alpha waves posteriorly. However this effect of etomidate is not uniform. Although there was a decrease in the interhemispheric synchronization of delta waves, there was no change in the synchronization of the alpha waves. Our study showed that the EEG effects of intracarotid ipsilateral injection of etomidate is not uniform in both hemispheres. Decrease in the interhemispheric synchronization of delta waves might serve as an indicator of ipsilateral effect of etomidate on the brain. Additional studies are needed to confirm our findings.

Comparison of pre treatment with Ondansetron and Lignocaine over Pain on Etomidate Injection. A double blind prospective non randomised study

Background: Etomidate is the preferred induction agent in patient with Cardiac disease due to its cardiac vascular stability. It can cause severe pain during IV administration which can produce increased stress response. Various methods have been tried to reduce the pain of etomidate injection with variable success. Lignocaine pre-treatment which is extensively used to reduce the pain of propofol injection is also used to reduce the pain of etomidate injection. Materials And Methods: This nonrandomised double blind, study was done after getting ethical clearance from university ethical committee. After informed consent 40 patients of both sexes aged between 18 to 65 years of ASA physical status 1, 2 & 3, who were posted for various elective surgical procedure planned under general anaesthesia were enrolled for the study.. They were not given any premedication. On arriving to Operating room (OR) 20G IV cannula inserted on dorsum of both hands and both flushed with100ml of normal saline. Venous drainage was occluded with elastic band in the both hands at midarm. In one hand 2ml of 1% lignocaine followed by 1 ml (2 mg ) of Etomidate is Injected and pain is assessed by Verbal rating scale(VRS). After one minute in other hand 2 ml (8mg) ondansetron injected followed by 1 ml (2 mg ) of Etomidate and pain is assessed. Statistical analysis: Non-Parametric test-Wilcoxon Sign Ranks Test is used to compare both drugs .Analysis is perfomed using SPSS Version22. Results: A total number of 40 patients (male=57.50%, female=42.50%).The mean age of patient was 42.85, The mean VRS pain score of etomidate after pre-administration of intravenous lignocaine (Drug A) was 1.58, which was lower compared to pre-administration of ondansetron(Drug )2.43. Conclusion: This study illustrates that pre-treatment with intravenous lignocaine significantly reduces the pain on injection of etomidate compare to ondansetron. (P value<0.001).

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.

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.

Underlying Mechanisms of Memory Deficits Induced by Etomidate Anesthesia in Aged Rat Model: Critical Role of Immediate Early Genes.

Background:Etomidate (R-1-[1-ethylphenyl] imidazole-5-ethyl ester) is a widely used anesthetic drug that had been reported to contribute to cognitive deficits after general surgery. However, its underlying mechanisms have not been fully elucidated. In this study, we aimed to explore the neurobiological mechanisms of cognitive impairments that caused by etomidate.Methods:A total of 30 Sprague-Dawley rats were used and divided into two groups randomly to receive a single injection of etomidate or vehicle. Then, the rats’ spatial memory ability and neuronal survival were evaluated using the Morris water maze test and Nissl staining, respectively. Furthermore, we analyzed levels of oxidative stress, as well as cyclic adenosine 3’,5’-monophosphate response element-binding (CREB) protein phosphorylation and immediate early gene (IEG, including Arc, c-fos, and Egr1) expression levels using Western blot analysis.Results:Compared with vehicle-treated rats, the etomidate-treated rats displayed impaired spatial learning (day 4: 27.26 ± 5.33 s vs. 35.52 ± 3.88 s, t = 2.988, P = 0.0068; day 5: 15.84 ± 4.02 s vs. 30.67 ± 4.23 s, t = 3.013, P = 0.0057; day 6: 9.47 ± 2.35 s vs. 25.66 ± 4.16 s, t = 3.567, P = 0.0036) and memory ability (crossing times: 4.40 ± 1.18 vs. 2.06 ± 0.80, t = 2.896, P = 0.0072; duration: 34.00 ± 4.24 s vs. 18.07 ± 4.79 s, t = 3.023, P = 0.0053; total swimming distance: 40.73 ± 3.45 cm vs. 27.40 ± 6.56 cm, t = 2.798, P = 0.0086) but no neuronal death. Furthermore, etomidate did not cause oxidative stress or deficits in CREB phosphorylation. The levels of multiple IEGs (Arc: vehicle treated rats 100%, etomidate treated rats 86%, t = 2.876, P = 0.0086; c-fos: Vehicle treated rats 100%, etomidate treated rats 72%, t = 2.996, P = 0.0076; Egr1: Vehicle treated rats 100%, etomidate treated rats 58%, t = 3.011, P = 0.0057) were significantly reduced in hippocampi of etomidate-treated rats.Conclusion:Our data suggested that etomidate might induce memory impairment in rats via inhibition of IEG expression.

Comparative study evaluating efficacy of sufentanil versus midazolam in preventing myoclonic movements following etomidate.

Background and Aims:Myoclonus is a major side-effect following etomidate injection requiring use of medical intervention.Material and Methods:In this double-blinded clinical trial, 50 consecutive patients, randomly received sufentanil 0.2 μg/kg or midazolam 0.015 mg/kg, 90 s before induction of anesthesia with etomidate (0.3 mg/kg). Then, the patients were monitored for any myoclonic movements during anesthesia.Results:The incidence of myoclonus was 28% in the sufentanil group and 84% in the midazolam group. The frequency and intensity of myoclonus were significantly higher in the midazolam group, compared to the sufentanil group (P < 0.001). Myoclonus duration in the sufentanil and midazolam groups were 5.8 ± 13.2 and 69 ± 47.8 s, respectively (P < 0.0010).Conclusion:The frequency, intensity and duration of myoclonus in the midazolam group, were significantly more prevalent than the sufentanil group.

Effect of gabapentin pretreatment on myoclonus after etomidate: a randomized, double-blind, placebo-controlled study

AimTo evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection. MethodOne hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I–II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2h before the operation were given oral capsules of placebo (Group P, n=25), 400mg gabapentin (Group G400, n=25), 800mg gabapentin (Group G800, n=25) or 1200mg gabapentin (Group G1200, n=25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3mgkg−1 etomidate was administered for 10s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2μgkg−1 fentanyl and 0.8mgkg−1 rocuronium were administered for tracheal intubation. ResultsDemographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two-hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient. ConclusionPretreatment with 800mg and 1200mg gabapentin 2h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.

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

Anesthesia for stem cell transplantation in autistic children: A prospective, randomized, double-blind comparison of propofol and etomidate following sevoflurane inhalation.

The objective of the present study was to comparatively investigate the feasibility and safety of etomidate and propofol use following sevoflurane inhalation in autistic children during the intrathecal transplantation of stem cells. The patients selected were 60 autistic children with American Society of Anesthesiologists physical status I, who were aged between two and 12 years and scheduled for stem cell transplantation. The children received an inhalation induction of 8% sevoflurane, followed by intravenous injection of etomidate (0.2 mg/kg) in group E and propofol (2 mg/kg) in group P (n=30/group). Supplemental doses of 0.1 mg/kg etomidate or 1 mg/kg propofol were used until a deep sedation was obtained. The heart rate (HR), mean arterial pressure, oxygen saturation, respiratory rate, Ramsay sedation score (RSS) and recovery time were monitored continuously. Following anesthesia, blood pressure and HR measurements were significantly decreased in group P compared with the baseline (P<0.01) and group E values at the same time-points (P<0.05). The occurrence of adverse effects, such as respiratory depression, bradycardia, hypotension and pain on injection, was significantly higher in group P than that in group E, whereas the incidence of myoclonus in group E was significantly higher than that in group P (P<0.01). No significant differences in anesthesia induction, surgery duration, recovery time, RSS and physician satisfaction were observed between the two groups. In conclusion, sevoflurane-etomidate combinations resulted in more stable hemodynamic responses and relatively fewer adverse effects compared with propofol injection following sevoflurane inhalation and may therefore be more suitable for the induction of short-term anesthesia in autistic children during stem cell transplantation.

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.

Magnesium sulfate versus Lidocaine pretreatment for prevention of pain on etomidate injection: A randomized, double-blinded placebo controlled trial.

Objective:Etomidate is an imidazole derivative and formulated in 35% propylene glycol. When given without a rapid lidocaine injection, etomidate is associated with pain after injection. Magnesium (Mg) is a calcium channel blocker and influences the N-methyl-D-aspartate receptor ion channel. The aim of the study is to evaluate the efficiency of preemptive injection of magnesium sulfate and lidocaine on pain alleviation on etomidate intravenous injection.Methods:In a randomized, double-blinded trial study, 135 adult patients scheduled for elective outpatient or inpatient surgery were divided into three groups. Group M received 620 mg magnesium sulfate, Group L received 3 ml lidocaine 1% and Group S received normal saline, all in a volume of 5 mL followed by a maximal dose of 0.3 mg/kg of 1% etomidate. Pain was assessed on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain and 3 = severe pain at the time of pretreatment and etomidate injection.Findings:About 60% of patients in the control group had pain during etomidate injection as compared to 22.2% and 40% in the lidocaine and magnesium sulfate groups, respectively. There was difference in induction pain score between three treatment groups, significantly (P = 0.01) and observed differences in pain scores between “normal saline and lidocaine group” (P < 0.001) and “normal saline and magnesium sulfate groups” were statistically meaningful (P = 0.044).Conclusion:Intravenous magnesium sulfate and lidocaine injection are comparably effective in reducing etomidate-induced pain.

Effectiveness of Midazolam in the Prevention of Etomidate Induced Myoclonus

Introduction: Etomidate, the imidazole derivative, is an intravenous anaesthetic induction agent, having stable hemodynamic profile, minimal respiratory side effects and histamine release. It is extremely useful in hemodynamically compromised patients. But the most common problem associated with its induction is myoclonus. Objective: To determine the effect of pretreatment with midazolam on the frequency of myoclonus after etomidate induction. Methods: Two hundred and fifty patients fulfilling the inclusion and exclusion criteria, scheduled for elective surgical procedures, were included. After all monitoring and intravenous access, the patients were given intravenous midazolam 0.05 mg/kg and after ninety seconds anesthesia induction was done with etomidate, and the myoclonic movements were noted for a minute after etomidate injection. The movement were recorded and graded on a scale of 0 to 3. Results: Myoclonus was developed in 15.45% (38/246) cases while in 84.55% (208/246) patients abnormal muscle movements was not observed after etomidate injection. Mild myoclonus (grade 1) was observed in 23 (9.3%) cases, moderate myoclonus (grade 2) in 11 (4.5%) and severe (grade 3) in 4 (1.6%) cases. Summary: The incidence of myoclonus was lowered significantly (15.45%) after 0.05mg/kg midazolam pretreatment.

Haemodynamic effects of etomidate, propofol and electrical shock in patients undergoing implantable cardioverter-defibrillator testing.

Anaesthetic drugs and internal electrical shock may alter the haemodynamic status of patients undergoing implantable cardioverter-defibrillator (ICD) testing. Comparative data on the mechanisms of etomidate and propofol-induced changes in haemodynamic parameters are inconsistent. Also the effects of ICD shock on haemodynamics have not been extensively studied. To compare the haemodynamic effects of etomidate and propofol as well as electrical shock during ICD testing in a prospective, randomised trial. The study group consisted of 63 consecutive patients (mean age 66 ± 10 years, 51 males) who underwent ICD testing. Haemodynamic parameters were measured using impedance cardiography (Task Force Monitor Systems, CNSystems, Austria) before and after injection of etomidate (n = 30) or propofol (n = 33) as well as immediately after internal defibrillation of ventricular fibrillation (VF). Parameters measured included heart rate, systolic (sBP), diastolic (dBP) and mean (mBP) blood pressure, stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR). Propofol significantly decreased the values of all measured parameters (sBP: 123.4 ± 17.1 vs. 106.3 ± 18 mm Hg, p < 0.0001; dBP: 83.7 ± 12.2 vs. 74.1 ± 13.8 mm Hg, p < 0.0001; mBP: 93.9 ± 13.1 vs. 81.1 ± 16.1 mm Hg, p < 0.0001; SV: 61.1 ± 19.3 vs. 56.4 ± 15.7 mL, p < 0.003; CO: 4.51 ± 1.07 vs. 4.17 ± 0.73 L/min, p < 0.003; and TPR: 1,735.8 ± 532.6 vs. 1,573.9 ± 390.5 dyn×s/cm⁵), whereas the only significant change following etomidate infusion was a decrease in SV (60.6 ± 11 vs. 56.8 ± 10 mL, p < 0.022). The propofol-induced changes were similar in patients with reduced (< 40%) vs. preserved (≥ 40%) left ventricular ejection fraction (LVEF) and in patients in heart failure NYHA class 0-II vs. class III-IV. Induction of VF and internal electrical shock did not cause major haemodynamic changes apart from significant, albeit very modest, drops in dBP and mBP (77 ± 2 vs. 72.9 ± 18 mm Hg, p < 0.002, and 85.2 ± 17 vs. 81.8 ± 20 mm Hg, p < 0.017, respectively). There were no complications during ICD testing. Propofol significantly decreased BP probably by both reducing CO and causing vasodilatation, whereas etomidate only slightly decreased dBP and mBP without affecting other parameters. Propofol-induced changes were independent of LVEF or NYHA class. Induction of VF and internal defibrillation did not cause clinically significant changes apart from very modest drops in dBP and mBP values.