Cardiorespiratory Changes Following Induction of Anaesthesia With Etomidate in Patients With Cardiac Disease

Colvin, M. P.; Savege, T. M.; Newland, P E; Weaver, E. J. M.; Waters, A.; Brookes, Jocelyn; Inniss, Rona

doi:10.1093/bja/51.6.551

Cited by 71 publications

(17 citation statements)

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“…Values only became significantly lower than the control values during the 2nd minute after the induction, [30] which may have resulted in an increase of approximately 15% of PaCO 2 but unchanged PaO 2 . [31] In this trial, as the dosage of propofol increased, the probability of respiratory and cardiovascular depression also increased, which was similar to a previous study. [32] Numerous studies have found that propofol can reduce blood pressure by suppressing sympathetic activity, inhibiting myocardial contractility, and dilating blood vessels.…”

Section: Discussionsupporting

confidence: 89%

Propofol decreases etomidate-related myoclonus in gastroscopy

Liu

Meng

et al. 2017

Medicine

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Objective:Myoclonus, a common complication during intravenous induction with etomidate, is bothersome to both anesthesiologists and patients. This study explored the preventive effect of pretreatment with propofol on etomidate-related myoclonus.Methods:This was a prospective, double-blind, clinical, randomized controlled study. Totally, 363 patients who were scheduled for a short-duration, painless gastrointestinal endoscopy were divided into 5 groups. Four groups received 0 mg/kg (E group), 0.25 mg/kg (LPE group), 0.50 mg/kg (MPE group), or 0.75 mg/kg (HPE group) propofol pretreatment before etomidate anesthesia. Another group only received 1 to 2 mg/kg of propofol (P group) as anesthesia. The incidence and severity of myoclonus, patient circulation and respiratory status, and intraoperative and postoperative complications were recorded.Results:The incidence of myoclonus in the LPE group (26.8%), MPE group (16.4%), HPE group (14.9%), and P group (0) was lower than the E group (48.6%, P < .05). The incidence of grade 1, 2, and 3 of myoclonus in the LPE group, MPE group, HPE group, and P group was significantly lower than the E group, and that in the P group was lower than the LPE group (P < .05). The incidence of hypoxemia in the P group was higher than the E group, and the incidence of adverse events in the HPE group and P group was lower than the E group (P < .05).Discussion:Pretreatment with propofol was feasible for preventing etomidate-related myoclonus. Furthermore, as propofol dosage increased, its effect on reducing the incidence and severity of myoclonic movements induced by etomidate increased.

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Section: Discussionsupporting

confidence: 89%

Propofol decreases etomidate-related myoclonus in gastroscopy

Liu

Meng

et al. 2017

Medicine

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“…Studies confirm that reduction of stress response in paediatric patients undergoing cardiac surgery helps improve postoperative morbidity. Etomidate [7][8][9] and ketamine are well known anaesthetic agents routinely used for induction of anaesthesia for paediatric cardiac surgeries. Hence, the study was conducted to compare the effect of anaesthetic induction with single dose etomidate versus ketamine, in paediatric patients undergoing Patent ductus arteriosus (PDA) ligation, on serum cortisol levels.…”

Section: Introductionmentioning

confidence: 99%

The Variation in Plasma Cortisol Levels in Response to Anaesthetic Induction with Etomidate and Ketamine in Paediatric Patients Undergoing Patent Ductus Arteriosus Ligation

2016

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Background:To compare the effect of anaesthetic induction with single dose etomidate versus ketamine on serum cortisol levels in paediatric patients posted for patent ductus arteriosus (PDA ) ligation surgery. Methods: A total of 60 paediatric patients in the age group of 2 to 8 yrs posted for PDA correction in the department of cardiothoracic surgery in a tertiary care centre, was selected for prospective randomized control study trial and allocated randomly into 2 groups-group E and K. Anaesthetic induction was done using single dose etomidate (group E) and ketamine (group K) and serum cortisol levels were compared in paediatric patients posted for PDA ligation surgery.Statistical analysis done using SPSS 20 software. Baseline continuous variables were compared using student 't' test for independent samples. The primary outcome (serum cortisol ) was compared using Wilcoxon Signed Ranks Test and student 't' test. The value less than 0.05 was considered significant. Results: The serum cortisol in group E was found to be significantly low 4 hour postoperatively compared to group K. However, serum cortisol increased 24 hour postoperatively in both groups and the increase was not found to be significant between the groups. Conclusion: Etomidate can be used for induction in paediatric cardiac surgery in patients without serious cortisol suppression lasting more than twenty four hours.

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“…1–5 It produces sedation and hypnosis by enhancing the function of γ-aminobutyric acid type A (GABA A ) receptors in the brain, an action that is highly dependent upon the receptor’s subunit composition 6 ; GABA A receptor’s containing β 2 or β 3 subunits are substantially more sensitive to the actions of etomidate than those containing β 1 subunits. 7 Among clinical anesthetics, such high selectivity is unusual and may account for distinguishing aspects of etomidate’s pharmacology, potentially including its tendency to produce myoclonus and lower seizure thresholds or maintain cardiovascular stability.…”

Section: Introductionmentioning

confidence: 99%

Analogues of Etomidate

Pejo

Santer

Jeffrey³

et al. 2014

Anesthesiology

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Background R-etomidate possesses unique desirable properties, but potently suppresses adrenocortical function. Consequently, efforts are being made to define structure-activity relationships with the goal of designing analogues with reduced adrenocortical toxicity. We explored the pharmacological impact of modifying etomidate’s chiral center utilizing R-etomidate, S-etomidate and two achiral etomidate analogues (cyclopropyl etomidate and dihydrogen etomidate). Methods The γ-aminobutyric acid type A (GABAA) receptor modulatory potencies of drugs were assessed in oocyte-expressed α1(L264T)β3γ2L and α1(L264T)β1γ2L GABAA receptors (for each drug, n=6 oocytes per subtype). In rats, hypnotic potencies and durations of action were measured using a righting reflex assay (n = 26 – 30 doses per drug) and adrenocortical potencies were quantified using an adrenocorticotropic hormone stimulation test (n = 20 experiments per drug). Results All four drugs activated both GABAA receptor subtypes in vitro and produced hypnosis and suppressed adrenocortical function in rats. However, drug potencies in each model ranged by 1–2 orders of magnitude. R-etomidate had the highest GABAA receptor moulatory, hypnotic, and adrenocortical inhibitory potencies. Respectively, R-etomidate, S-etomidate and cyclopropyl etomidate were 27.4-fold, 18.9-fold, and 23.5-fold more potent activators of receptors containing β3 subunits than β1 subunits; however, dihydrogen etomidate’s subunit selectivity was only 2.48-fold and similar to that of propofol (2.08-fold). S-etomidate was 1/23rd as potent an adrenocortical inhibitor as R-etomidate. Conclusion The linkage between the structure of etomidate’s chiral center and its pharmacology suggests that altering etomidate’s chiral center may be used as part of a strategy to design analogues with more desirable adrenocortical activities and/or subunit selectivities.

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Cardiorespiratory Changes Following Induction of Anaesthesia With Etomidate in Patients With Cardiac Disease

Cited by 71 publications

References 0 publications

Propofol decreases etomidate-related myoclonus in gastroscopy

Propofol decreases etomidate-related myoclonus in gastroscopy

The Variation in Plasma Cortisol Levels in Response to Anaesthetic Induction with Etomidate and Ketamine in Paediatric Patients Undergoing Patent Ductus Arteriosus Ligation

Analogues of Etomidate

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