PubMed · 7426269
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N T Jack. 1980. Etomidate.. https://doi.org/10.1093/bja%2F52.8.843-a
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The effects of etomidate in an alcoholic vehicle and in a lipid-emulsion as well as those of propofol on N-formyl-methionyl-leucyl-phenylalanine (FMLP-) and zymosan-induced oxygen radical production of neutrophils were examined and compared with the effects of their respective vehicles. Furthermore free-radical scavenging capacities of these medications were investigated. The dose-response effects of etomidate, propofol and their respective vehicles on neutrophil function were tested by FMLP- and zymosan-induced chemiluminescence of neutrophils and, in addition, in a cell-free chemiluminescence system. Effects of commercial preparations of etomidate were generally not drug-specific but due to the vehicles and/or to unphysiologic osmolality values. Propofol impaired chemiluminescence of neutrophils in a drug-specific manner, even in the therapeutic concentration range. Free-radical scavenging contributed to this depression of chemiluminescence of neutrophils by propofol. Different composition of the lipid-emulsions of etomidate and propofol resulted in either a stimulation or suppression of chemiluminescence of neutrophils. Propofol but not etomidate impairs chemiluminescence of neutrophils drug-specifically. Besides a potential interaction with the neutrophils, free-radical scavenging accounts for this suppression.
Clinical observations during anaesthesia and intubation of emergency patients are presented showing a differentiated impact of etomidate (Hypnomidate) on upper airway reflexes: a blockade of pharyngeal reflexes with sustained but possibly delayed laryngeal reflexes and a certain protection against laryngospasm and vomiting. In addition etomidate enables, preferably in combination, difficult intubation with sustained spontaneous breathing due to its low respiratory depressant effect. These features were confirmed in a small foreshortened clinical study using thiopentone (Trapanal) or etomidate without muscle relaxants, whereby the difference in high risk patients became obvious. The impact of anaesthetics on airway reflexes is generally concealed by muscular relaxants, and observations on this matter are difficult to make subject to quantifiable parameters and controlled studies; accordingly such observations are scarcely found in newer anaesthetic literature. In the development of new techniques for intubation and anaesthesia without muscle relaxation, these methodical problems deserve attention.
For comparison of the induction effects of domestic etomidate on hemodynamics with gamma-OH, each group of thirty patients undergoing either repair of ASD or MVR was randomly selected. Certain hemodynamic parameters involving CI, SI, IC, MAP, HR and SVR (cardiac index, stroke volume index, index of contractility, mean artery pressure, heart rate and systemic vascular resistance) were followed throughout the course of induction. The results showed that HR decreased in gamma-OH 2 minutes after intravenous injection (P less than 0.05) but not in etomidate. MAP and SVR decreased 5 minutes after the administration of drugs (P less than 0.05), while the others showed no significant changes. We conclude that etomidate is superior to gamma-OH in patients for cardiac operations during induction.