Does etomidate increase postoperative nausea? A double-blind controlled comparison of etomidate in lipid emulsion with propofol for balanced anaesthesia

St.Pierre, Michael; Dunkel, M.; Rutherford, A.; Hering, W.

doi:10.1046/j.1365-2346.2000.00747.x

Cited by 22 publications

(10 citation statements)

References 22 publications

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“…Early investigators reported that post-operative nausea and vomiting incidence after induction with etomidate is around 40%, 50,55 comparable to that following barbiturates, 43,56 and higher than that following propofol. 63 More recently, the incidence of nausea after induction with etomidate in lipid emulsion was reported to be similar to that associated with propofol, 64,65 while the incidence of vomiting was higher with etomidate. 65 …”

Section: Clinical Pharmacologymentioning

confidence: 92%

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Clinical and Molecular Pharmacology of Etomidate

2011

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This review focuses on the unique clinical and molecular pharmacology of etomidate. Among general anesthesia induction drugs, etomidate is the only imidazole, and it has the most favorable therapeutic index for single bolus administration. It also produces a unique toxicity among anesthetic drugs-- inhibition of adrenal steroid synthesis that far outlasts its hypnotic action and that may reduce survival of critically ill patients. The major molecular targets mediating anesthetic effects of etomidate in the central nervous system are specific γ-aminobutyric acid type A receptor subtypes. Amino acids forming etomidate binding sites have been identified in transmembrane domains of these proteins. Etomidate binding site structure models for the main enzyme mediating etomidate adrenotoxicity have also been developed. Based on this deepening understanding of molecular targets and actions, new etomidate derivatives are being investigated as potentially improved sedative-hypnotics or for use as highly selective inhibitors of adrenal steroid synthesis.

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Section: Clinical Pharmacologymentioning

confidence: 92%

“…63 More recently, the incidence of nausea after induction with etomidate in lipid emulsion was reported to be similar to that associated with propofol, 64,65 while the incidence of vomiting was higher with etomidate. 65 …”

Section: Clinical Pharmacologymentioning

confidence: 92%

Clinical and Molecular Pharmacology of Etomidate

2011

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“…Etomidate is a hydrophobic compound associated with pain on injection but this effect has been reduced by formulation in a lipid emulsion. Myoclonic movements, trismus and post-operative nausea and vomiting are said to be more frequent with etomidate [20-23]. The main concern, however, has been the inhibition of steroid synthesis produced by etomidate.…”

Section: Con: Etomidate Is Not Safe In Hemodynamically Unstable Critimentioning

confidence: 99%

Pro/con debate: Is etomidate safe in hemodynamically unstable critically ill patients?

Flynn

Shehabi

2012

Crit Care

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Etomidate is an induction agent known for its smooth intubating conditions and cardiovascular stability. Studies, however, have shown that a single dose of etomidate can result in a prolonged adrenal insufficiency. The impact of this in patients with sepsis has been a matter for debate. This review presents a pro/con case for using etomidate in hemodynamically unstable critically ill patients and provides guidance for alternative induction techniques and when the use of etomidate might be justified despite these concerns.

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“…A variety of antiemetics acting via different mechanisms are used for prevention and treatment of PONV. In general, clinicians choose among these agents based upon side effect profile, personal experience, cost, and formulary considera-tions (20)(21)(22). Previous study suggested that commonly used antiemetics reduce the risk of PONV by approximately 25 percent (23).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Different Antiemetics on the Nausea in Early Postoperative Period After Laparoscopic Holecystectomy

Marijanović

Radunovic

2021

Serbian Journal of Experimental and Clinical Research

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Postoperative nausea and vomiting (PONV) is a patient-important outcome; patients often rate PONV as worse than postoperative pain. This clinical study was aimed to asses the efficiency of standard aniemetics administration separately or in combination in prevention of PONV in patients who underwent to the same surgical procedure - laparoscopic cholecystectomy. Also, this article could provide a novel information about the best choice for prevention and treatment of PONV. This study included 87 patients divided into four groups according to the postoperative phramacological treatment: First group was control group without treatment, Second group was group of patients with ondasetron treatment in postoperative period, Third group was group of patients with ondasetron+dexamethasone treatment, and fourth group was group of patients with dexamethasone treatment in postoperative period for nausea. PONV was distributed in Ondansetron+Dexamethasone group in the lowest percent (4.5%), which means that this conbination of antiemetics was very effective. Than, Dexamethasone group was in relation with low incidence of PONV (14.3%), and after that were Ondansetron and Control groups. Also smokers and males has lower incidence of PONV, especially in combination with Ondansetron+Dexamethasone treatment. The incidence of PONV is lower in male smokers patients who were underwent to combination of two antiemetics, ondansetron and dexamethasone compared to monotherapy and female non-smokers. Preventive strategies for PONV must include risk stratification followed by prophylactic approach and also testing the newer antiemetics. Because of the high incidence of postoperative nausea and vomiting as a patient-important outcome, the preventive strategies should be considered as serious condition which requires multimodal approach.

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Does etomidate increase postoperative nausea? A double-blind controlled comparison of etomidate in lipid emulsion with propofol for balanced anaesthesia

Cited by 22 publications

References 22 publications

Clinical and Molecular Pharmacology of Etomidate

Clinical and Molecular Pharmacology of Etomidate

Pro/con debate: Is etomidate safe in hemodynamically unstable critically ill patients?

The Impact of Different Antiemetics on the Nausea in Early Postoperative Period After Laparoscopic Holecystectomy

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