Plasma concentrations of etomidate have been measured in six patients who required intermittent positive pressure ventilation following surgery. There was an approximately linear relationship between the plasma concentration and the rate of infusion of etomidate. The drug exhibited linear pharmacokinetics over a 10-fold variation in plasma concentration. The decrease in the plasma concentration after discontinuing the infusion was consistent with a three-compartment pharmacokinetic model. The plasma terminal half-life was found to be about 5.5 h, and the clearance calculated to be 0.025 litre kg-1 min-1.
Summary
A technique is described for sedation of ventilated patients. Six patients who underwent major maxillofacial surgery were given low dose infusions of etomidate and fentanyl for postoperative sedation. Measurements of respiratory function were recorded before and during the period of intermittent positive pressure ventilation. Plasma etomidate levels were estimated.
After initial stabilisation an almost constant rate of infusion was used to provide a reproducible level of sedation from which the patients were easily aroused. All patients maintained an adequate minute volume when disconnected from the ventilator. All measured and derived respiratory indices remained within normal limits. Patients exhibited amnesia throughout the period of infusion. All patients found this method of sedation pleasant. This technique may be recommended as an alternative to conventional methods of sedation for ventilated patients.
A technique is described for the management of post-operative patients who have undergone major craniofacial surgery. Under supervision on the Intensive Care Unit, the patients breathe humidified, oxygen-enriched air through a naso-tracheal tube. Sedation and analgesia are provided by continuous infusions of etomidate (variable rate) and fentanyl (fixed rate), administered by volumetric infusion pumps (IMED 922). Six patients have been studied in detail and our results are presented. In conjunction with fentanyl, a mean infusion rate of 3.72 micrograms . kg-1 . min-1 of etomidate provided good sedation and analgesia, without clinically significant respiratory depression. The patients found the technique very acceptable and no side-effects were noted.
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