Hemodynamic Responses to Etomidate on Induction of Anesthesia in Pediatric Patients

Abstract

Etomidate is often used for inducing anesthesia in patients who have limited hemodynamic reserve. Using invasive hemodynamic monitoring, we studied the acute effects of a bolus of etomidate during induction of anesthesia in children. Twelve children undergoing cardiac catheterization were studied (mean age, 9.2 +/- 4.8 yr; mean weight, 33.4 +/- 15.4 kg); catheterization procedures included device closure of secundum atrial septal defects (n = 7) and radiofrequency catheter ablation procedures for supraventricular tachycardia (n = 5). Using IV sedation, a balloon-tipped pulmonary artery catheter was placed to measure intracardiac and pulmonary artery pressures and oxygen saturations. Baseline measurements were recorded and then repeated after a bolus of IV etomidate (0.3 mg/kg). For the entire group, no significant changes in right atrial, aortic, or pulmonary artery pressure, oxygen saturations, calculated Qp:Qs ratio or systemic or pulmonary vascular resistance were detected after the bolus dose of etomidate. The lack of clinically significant hemodynamic changes after etomidate administration supports the clinical impression that etomidate is safe in children. Further research is needed to determine the hemodynamic profile of etomidate in neonates and in pediatric patients with severe ventricular dysfunction and pulmonary hypertension.

Cortisol Lowering Action and Cardiovascular Stability of Etomidate: A Comparison With Propofol in Controlled Hypertensives

“…[ Table 4] DISCUSSION: Etomidate has been compared to other induction agents in various studies and has been known to preserve the haemodynamics whereas propofol does not. 8,9,10,11 Various mechanisms are proposed for these differences in haemodynamic response of these drugs. Propofol has been shown to decrease preload, 12 afterload, 13 and myocardial contractility.…”

A Comparative Study of Effect of Propofol, Etomidate and Propofol Plus Etomidate Induction on Hemodynamic Response to Endotracheal Intubation: A RCT

“…It is short acting drug, used for induction and maintenance of anesthesia [7]. The most important side effects of Etomidate are nausea and vomiting that may lead to aspiration in patients [8][9][10]. Intravenous Injection of Etomidate would cause a burning sensation.…”

“…One of the most important, but rare side effects of this drug is the suppression of steroids production by reversible inhibition of 11betahydroxylase enzyme [10,11]. Induction of anesthesia by Etomidate would lead to a stable hemodynamic condition for performing laryngoscopy and endotracheal intubation [9,10,12].…”

Comparision of Etomidate versus Propofol for Anaesthesia in Short Case Surgical Procedures

“…Weisenberg M et al found in their study that the mechanisms of arterial hypotension following IV anesthetic induction were multifactorial. The hemodynamic stability seen with etomidate may be due to its unique lack of effect on both the sympathetic nervous system and baroreceptor function and capacity to bind and stimulate peripheral alpha-2B adrenergic receptors with a subsequent vasoconstriction 3 . Decrease in systemic blood pressure after bolus injection of propofol is dependent on both vasodilation with reduced preload and after load and myocardial depression (negative inotropic action).…”