The development of ventricular fibrillation due to etomidate for anesthetic induction: a very rare side effect, case report

Karcioglu, Murat; Davarcı, Işıl; Kirecci, Nuray; Akçay, Adnan Burak; Turhanoglu, Selim; Tuzcu, Kasım; Hakimoğlu, Sedat; Akküçük, Seçkin; Aydogan, Akin

doi:10.1016/j.bjane.2013.06.009

Cited by 3 publications

(6 citation statements)

References 9 publications

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“… 23 In addition to these known side-effects of etomidate, it has been reported that occasionally ventricular tachycardia and fibrillation may be seen. 24 …”

Section: Discussionmentioning

confidence: 99%

Haemodynamic Responses to Tracheal Intubation Using Propofol, Etomidate and Etomidate-Propofol Combination in Anaesthesia Induction

Yağan

Taş

Küçük

et al. 2015

J Cardiovasc Thorac Res

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Introduction: The aim of this study was to measure the haemodynamic responses to a etomidate-propofol combination used for anaesthesia induction and to compare the haemodynamic responses with the separate use of each drug. Methods: The patients were randomly divided into three groups as group P (n = 30, propofol 2.5 mg kg-1), group E (n = 30, etomidate 0.3 mg kg-1) and group PE (n = 30, propofol 1.25 mg kg-1 + etomidate 0.15 mg kg-1). For each patient, the times of measurement of the heart rate (HR) and mean arterial pressure values were defined as baseline, after the induction, before the intubation, immediately after the intubation and 1, 2, 3, 4, 5 and 10 minutes after the intubation. Results: In all 3 groups, a significant decrease in MAP values were seen at T2 and T3 compared to the baseline values, and this decrease was greater in group P compared to that in group E and PE (P < 0.001, P < 0.01). A significant increase was seen in all 3 groups in the mean arterial pressure (MAP) value at T4 after the intubation. When the groups were compared with each other, this increase was greater in group E than in the other two groups (with group P, P < 0.001; with group PE, P < 0.01). Conclusion: Etomidate-propofol combination may be a valuable alternative when extremes of hypotensive and hypertensive responses due to propofol and etomidate are best to be avoided.

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“… 23 In addition to these known side-effects of etomidate, it has been reported that occasionally ventricular tachycardia and fibrillation may be seen. 24 …”

Section: Discussionmentioning

confidence: 99%

Haemodynamic Responses to Tracheal Intubation Using Propofol, Etomidate and Etomidate-Propofol Combination in Anaesthesia Induction

Yağan

Taş

Küçük

et al. 2015

J Cardiovasc Thorac Res

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“…16,17 Propofol leads to haemodynamic instablity as it decreases systemic vascular resistance causing hypotension. 9 It also leads to respiratory depression and pain on injection. 18,19 Etomidate is devoid of any effect on sympathetic nervous system or baroreceptor regulatory system and causes minimal respiratory depression.…”

Section: Discussionmentioning

confidence: 99%

“…22 But increased chance of emesis which may cause aspiration, myoclonus, thrombophlebitis and adrenal insufficiency with decreased cortisol are its side adverse effects. 4,9,23,24 It causes reversible inhibition of 11-β-hydroxylase, hence preventing the conversion of 11-deoxy cortisol to cortisol. Single-dose etomidate inhibits 11-β-hydroxylase in 5-8 hours postoperatively .…”

Section: Discussionmentioning

confidence: 99%

“…It also may cause ventricular tachycardia and fibrillation may be seen. 9 Neither propofol nor etomidate is the preferred induction agent for hypertensives, elderly patients and patients of ASAIII and IV or MAP<70 mmHg. If etomidate is used in such patients, it also does not blunt laryngoscopic sympathetic response.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 and has been known to occasionally cause ventricular tachycardia and fibrillation. 9 Such haemodynamic changes are well tolerated in normal individuals but may be life threatening in cardiac patients and patients of increased intracranial pressue.…”

mentioning

confidence: 99%

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To Evaluate the Haemodynamic Effects of Etomidate and a Combination of Etomidate and Propofol as Induction Agents in Elective Surgeries

Puri¹,

Dwivedi²,

Arora³

et al. 2019

jemds

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BACKGROUND Haemodynamic changes during laryngoscopy and intubation are the major concern during induction under general anaesthesia. Our study aims to compare the haemodynamic changes between etomidate versus a combination of etomidate and propofol. MATERIALS AND METHODS Sixty patients in age group of 18-50 years of ASA grade I and II were divided randomly into two groups of thirty patients each. Haemodynamic data was observed and compared. Sample size was taken for convenience. RESULTS Statistically significant difference was found in heart rate (p=0.000 at induction; p=0.0001 at 1 min after intubation) and MAP in both the groups at 0 min (p=0.0008) and after 1 minute (p=0.004) of induction with haemodynamic parameters significantly higher in etomidate group than the etofol group. There was no statistically significant difference at 2 mins, 5 mins, 10 mins, 20 mins, 30 mins and 60 mins between the two groups. CONCLUSION The combination of etomidate and propofol is an alternative to etomidate alone in patients where laryngoscopic response to haemodynamic parameters is a concern.

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Etomidate Shows Prospect as an Anti-Arrhythmic Drug Conferring Safe Sedation and Sinus Conversion Simultaneously

et al. 2020

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This case is of a 76-year-old man with a known history of hypertension, type 2 diabetes mellitus, and ischemic heart disease, who presented to our department with chest pain and palpitations. His electrocardiogram showed a ventricular tachycardia (VT), but fortunately our patient was hemodynamically stable. A trial of adenosine was given to convert the patient’s heart back to sinus rhythm, but was unsuccessful and the rhythm remained as VT. Soon after, the patient suddenly became hemodynamically unstable as his blood pressure acutely declined; thus, the decision to perform a direct current cardioversion was taken. Bearing in mind that the patient was still awake, he was given 10 mg of intravenous etomidate as a pre-procedural sedative. During the time it took to prepare for the procedure, the patient’s rhythm reverted from VT to a regular sinus rhythm, raising his blood pressure back to normal and achieving hemodynamic stablility, negating the need of any electrical or chemical cardioversion. Our patient was then handed over to the cardiology team for an emergency percutaneous coronary intervention procedure and an implantable cardioverter-defibrillator procedure, both of which were successful. Etomidate was used in this case for the purpose of sedation, and as luck would have it, it seems that it had also incidentally reverted the arrhythmia back to normal.

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The development of ventricular fibrillation due to etomidate for anesthetic induction: a very rare side effect, case report

Cited by 3 publications

References 9 publications

Haemodynamic Responses to Tracheal Intubation Using Propofol, Etomidate and Etomidate-Propofol Combination in Anaesthesia Induction

Haemodynamic Responses to Tracheal Intubation Using Propofol, Etomidate and Etomidate-Propofol Combination in Anaesthesia Induction

To Evaluate the Haemodynamic Effects of Etomidate and a Combination of Etomidate and Propofol as Induction Agents in Elective Surgeries

Etomidate Shows Prospect as an Anti-Arrhythmic Drug Conferring Safe Sedation and Sinus Conversion Simultaneously

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