Anesthetic Induction With Etomidate in Cardiac Surgical Patients: A PRISMA-Compliant Systematic Review and Meta-Analysis

Yao, Yun-Tai; He, Li-Xian; Fang, Nan; Ma, Jie

doi:10.1053/j.jvca.2020.11.068

Cited by 18 publications

(13 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the current issue of the Journal of Cardiothoracic and Vascular Anesthesia, Yao et al presented a meta-analysis to assess the impact of etomidate on morbidity and mortality in patients undergoing cardiac surgery. 1 Despite etomidate's use in cardiac surgery across centers worldwide for decades, a comprehensive systematic review of its hemodynamic effects and side effects when used as an induction agent for cardiac surgery is lacking. The authors utilized 18 previously published randomized clinical trials totaling 1,241 patients to evaluate the consequences of using a single bolus of etomidate to induce anesthesia.…”

Section: Financial Disclosures: Aad Consults For Edwards Lifesciencesmentioning

confidence: 99%

Etomidate and Adrenocortical Suppression: Should We Take the Concerns to Heart?

Dalia

Raines

2021

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Section: Financial Disclosures: Aad Consults For Edwards Lifesciencesmentioning

confidence: 99%

Etomidate and Adrenocortical Suppression: Should We Take the Concerns to Heart?

Dalia

Raines

2021

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

show abstract

“…However, propofol has a strong circulatory inhibitory effect, which often causes a significant drop in blood pressure, which is more pronounced in geriatric patients or patients with insufficient effective circulating blood volume. Because etomidate has little effect on circulation [ 7 , 8 ], it is often used for induction in geriatric patients, but etomidate does not inhibit the upper airway reflex, and it can make LMA insertion very difficult when used alone, so it needs to be combined with opioids. Among the opioids used, sufentanil is often used for anesthesia in the elderly.…”

Section: Introductionmentioning

confidence: 99%

Determination of the median effective dose of sufentanil for inhibiting the laryngeal mask insertion response in geriatric patients: a prospective, double-blinded, dose–response trial

Wang

Xiao

et al. 2022

BMC Anesthesiol

View full text Add to dashboard Cite

Background Laryngeal mask airway(LMA) have been widely used in clinical practice. Irritation to the patient during the insertion of a laryngeal mask can cause hemodynamic fluctuations, which is particularly unsafe for geriatric patients. We used probit regression analysis to determine the median effective dose of sufentanil to inhibit the response to LMA insertion in geriatric patients. Methods A total of 90 patients were selected for the study using the following inclusion criteria: age ≥ 65 years old, ASA grade I–III, and scheduled to undergo intravenous general anesthesia with LMA insertion. Each patient received a dose of sufentanil for anesthesia induction in one of six levels: 0.05, 0.1, 0.15, 0.2, 0.25, or 0.3 μg kg−1. LMA insertion was scored with a 3-point, 6-category scale, with scores ≥ 16 indicating effective LMA insertion, and < 16 indicating ineffective LMA insertion. Mean arterial blood pressure (MAP), heart rate (HR), and bispectral index (BIS) were recorded 1 min before induction (T1), 1 min after induction (T2), 1 min after LMA insertion (T3), and 5 min after LMA insertion (T4) in each group. In addition, the plasma norepinephrine (NE) levels and adverse reactions were measured at T2 and T3 in each dosage group. Results Probit regression analysis showed that the ED50 of sufentanil inhibiting the response to LMA insertion in geriatric patients was 0.18 μg kg−1 (95% CI: 0.16–0.21 μg kg−1), and the ED95 was 0.31 μg kg−1 (95% CI: 0.27–0.38 μg kg−1), and the probit(p) = -2.34 + 12.90 × ln(Dose)($$\chi^{2}$$ χ 2 = 0.725, p = 0.948). Among all the patients, the number of effective LMA insertions was 57 (group A), and the number of ineffective LMA insertions was 33 (group B). The MAP, HR, and NE in group B were significantly higher than in group A at T3. Conclusions Sufentanil can effectively inhibit the patient’s response to LMA insertion, with stable hemodynamics and small stress response. The ED50 and ED95 were 0.18 μg kg−1 (95% CI: 0.16–0.21 μg kg−1) and 0.31 μg kg−1(95% CI: 0.27–0.38 μg kg−1), respectively. Trial registration This study was registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2100051827) on October 6, 2021.

show abstract

“…However, midazolam has been reported to be associated with a high incidence of hypotension in patients with cardiac disease and undergoing colonoscopy [ 16 , 17 ]. Etomidate is another alternative sedative for patients with cardiovascular diseases due to its remarkably stable cardiorespiratory profile [ 18 , 19 ]. However, etomidate can result in lower cortisol levels and higher adrenal insufficiency incidence compared with midazolam or propofol [ 18 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of remimazolam for non-obese patients during anesthetic induction in cardiac surgery: study protocol for a multicenter randomized trial

et al. 2022

Trials

View full text Add to dashboard Cite

Background Valvular heart disease remains common in both developed and developing countries, and it requires timely surgical treatment when necessary. However, the stability of hemodynamics during anesthesia induction in patients undergoing valve replacement surgery is difficult to maintain due to their impaired cardiac function. Remimazolam, a novel and ultrashort-acting intravenous sedative-hypnotic, may be beneficial to stable hemodynamics, but the evidence is limited. Therefore, this study aims to evaluate the effect of remimazolam induction on hemodynamics compared with midazolam and etomidate in patients undergoing valve replacement surgery. Methods This is a prospective, multicenter randomized controlled trial (RCT). Three hundred and sixty-three non-obese adult patients aged 45 to 80 years old undergoing valve surgery with cardiopulmonary bypass will be randomly allocated to receive remimazolam tosilate, midazolam, or etomidate during anesthetic induction. The primary outcome is the incidence of hypotension within 20 min after the administration of investigated drugs. The hypotension is defined as systolic blood pressure (SBP) < 90 mmHg or a 30% reduction in SBP from baseline or the application of vasoactive drugs. Secondary outcomes include incidence of successful sedation, time to successful sedation, incidence of delirium and postoperative low cardiac output syndrome within 7 days after surgery, hospital mortality, mechanical ventilation time, ICU length of stay, and hospital length of stay. Discussion To our knowledge, this is the first prospective RCT to investigate the efficacy and safety of remimazolam induction in adult cardiac surgery compared with midazolam and etomidate. This study will provide important information on the application of remimazolam in cardiac surgery in the future. Trial registration Chinese Clinical Trial Registry chictr.org.cn ChiCTR2100050122. Registered on August 16, 2021.

show abstract

Anesthetic Induction With Etomidate in Cardiac Surgical Patients: A PRISMA-Compliant Systematic Review and Meta-Analysis

Cited by 18 publications

References 50 publications

Etomidate and Adrenocortical Suppression: Should We Take the Concerns to Heart?

Etomidate and Adrenocortical Suppression: Should We Take the Concerns to Heart?

Determination of the median effective dose of sufentanil for inhibiting the laryngeal mask insertion response in geriatric patients: a prospective, double-blinded, dose–response trial

Efficacy and safety of remimazolam for non-obese patients during anesthetic induction in cardiac surgery: study protocol for a multicenter randomized trial

Contact Info

Product

Resources

About