Abstract:Three formulations of etomidate were evaluated in unpremedicated patients undergoing minor gynaecological procedures. There was a high frequency of pain on injection (up to 50%) and excitatory phenomena (up to 95%) with all formulations. The frequency of excitatory phenomena was significantly greater than that after methohexitone. Recovery was rapid, but emetic sequelae were frequent and significantly more marked than after methohexitone.
“…53–55 Pain on injection was found to be worse with etomidate in aqueous solutions in comparison to the formulation in 35% propylene glycol. 56 Formulation into medium chain-length lipids or cyclodextrins appears to further decrease the incidence of injection pain and hemolysis. 9,57 Myoclonus has been shown to increase with etomidate dose and can be attenuated by split-dose induction 58 or premedication with benzodiazepines, 59 thiopental, dexmedetomidine 60 , and/or opioids.…”
Section: Clinical Pharmacologymentioning
confidence: 99%
“…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.…”
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.
“…53–55 Pain on injection was found to be worse with etomidate in aqueous solutions in comparison to the formulation in 35% propylene glycol. 56 Formulation into medium chain-length lipids or cyclodextrins appears to further decrease the incidence of injection pain and hemolysis. 9,57 Myoclonus has been shown to increase with etomidate dose and can be attenuated by split-dose induction 58 or premedication with benzodiazepines, 59 thiopental, dexmedetomidine 60 , and/or opioids.…”
Section: Clinical Pharmacologymentioning
confidence: 99%
“…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.…”
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.
“…3,4 However, the frequency of reactions differs from one study to another. In our knowledge, there is no study to evaluate the venous complications of 6 different iv anesthetic agents.…”
ÖZETAmaç: Çalışmamızda, genel anestezide kullanılan %1 Propofol, %2 Propofol, Ketamin, Pentotal, Etomidat ve Etomidat-Lipuro'nun venöz endotel üzerine olan etkileri karşılaştırılmıştır.
“…Although etomidate has been used widely as an induction agent, it has the disadvantage of causing pain on injection and excitatory movements (Miller, Hendry and Lees, 1978;Zacharias et al, 1978) when given as a bolus. However, because of its lack of cumulation (Kay, 1976) it can be used as an infusion to maintain anaesthesia.…”
A two-stage infusion technique of etomidate with a separate infusion of fentanyl was compared with thiopentone and halothane or morphine, plus nitrous oxide in oxygen, for the induction and maintenance of anaesthesia in 200 patients. Cardiovascular and respiratory indices and recovery times were found to be similar in the two groups.
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