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PubMed1977

Effect of etomidate on intra-ocular pressure.

Etomidate, a new short-acting non-barbiturate hypnotic, was administered to 40 patients between the ages of 12 years and 65 years. Intra-ocular pressure was measured before and after etomidate injection using a Schiotz tonometer. A significant reduction of intra-ocular pressure was found to follow etomidate injection in spite of the often associated myoclonic movements. The mechanism of reduction of intra-ocular pressure has not been determined in this study. It is suggested that etomidate will be a useful intravenous induction agent where elevation of intra-ocular pressure is undesirable.

Adolescent↗

PubMed1977

Clinical trial of etomidate. Preliminary observations on a new non-barbiturate induction agent.

This is a preliminary report of our clinical experience with etomidate, a new intravenous non-barbiturate anaesthetic agent. Thirty-two patients undergoing minor surgical procedures were anaesthetized, induction being with etomidate 0.3 mg/kg body weight. Induction was fast and smooth. Twenty-eight per cent of the patients complained of pain at site of injection but the pain disappeared on flushing with water for injection. Following etomidate injection, 37.5 per cent of patients developed myoclonic movements which were usually mild and self-limiting. We were impressed by the relative stability of the cardiovascular and respiratory systems. Etomidate looks promising and further work is in progress on other aspects of this drug.

Anesthesia, Intravenous↗

PubMed1978

An investigation of the centrally and peripherally mediated cardiovascular effects of etomidate in the rabbit.

In the decerebrate rabbit etomidate caused dose-related decreases in mean arterial pressure and preganglionic sympathetic nerve activity. There were no significant alterations in heart rate. Etomidate was found to have no effect on the baroreceptor reflex. In pithed animals the effects of etomidate were of short duration and of a lesser magnitude than in the decerebrate animal. It was concluded that the additional effects in the decerebrate rabbit were a result of depression of central cardiovascular control. It was found that etomidate was largely without effect on the cardiovascular system at normal anaesthetic doses (0.5-1 mg-kg-1). However, larger doses (2-8 mg kg-1) produced marked depression of central cardiovascular control, the myocardium and the peripheral vasculature.

Animals↗

PubMed1979

Plasma potassium, sodium and blood sugar following etomidate and suxamethonium.

Changes in plasma potassium, sodium and blood sugar were studied in Nigerian patients following induction of anaesthesia with etomidate and suxamethonium. Healthy patients presenting for elective surgery as well as psychiatric patients presenting for electroconvulsive therapy were studied. Plasma potasium was essentially unaffected by etomidate administration, but rose significantly when suxamethonium was given. This rise was higher than that observed with thiopentone and suxamethonium in a previous study on a similar group of Nigerians. Blood sugar was not significantly increased by the administration of etomidate but rose significantly after suxamethonium was given. This hyperglycaemic response was greater than when thiopentone was used as the induction agent. Administration of ECT was associated with a further increase in blood sugar. It is concluded that thiopentone is preferable to etomidate in situations where increases in plasma potassium and blood sugar are undesirable following administration of suxamethonium.

Adult↗

PubMed1978

Clinical evaluation of etomidate as an induction agent.

A comparative study between Etomidate and Thiopentone was carried out on 100 healthy female patients scheduled for post-partum abdominal sterilization under epidural analgesia. Our results show Etomidate to be a safe and effective induction agent, comparable to Thiopentone in having a rapid onset of action and rapid recovery time. The pulse rates and blood pressures remained relatively stable during the use of Etomidate. However, there was a high incidence of transient respiratory upsets while causing less respiratory depression than Thiopentone. The objectionable features of Etomidate are high incidence of pain on injection and involuntary muscular activity, which account for the low anaesthetist acceptance rate.

Adult↗

PubMed1976

Clinical use of etomidate, influence on blood pressure and heart rate. Comparison with thiopentone and methohexital.

This study deals with blood pressure and heart rate measurements during the use of etomidate after premedication; the injection of etomidate is always preceded by 0.10 mg of fentanyl. Etomidate is compared with thiopentone and methohexitone. There appears to be no gross difference between the drugs as far as the blood pressure is concerned: it is decreased by 15-20%. The influence on the heart rate is typical for each drug: whereas thiopentone causes a rise of 23%, and methohexitone of nearly 40%, the rate remains constant in the etomidate series.

Adolescent↗

PubMed1979

Comparison of the cardiopulmonary effects of etomidate and thiamylal in dogs.

The cardiopulmonary effects of etomidate, a nonbarbiturate, short-acting, IV anesthetic, were compared and contrasted with those of thiamylal sodium in chronically instrumented conscious dogs. Etomidate, when administered IV at dosages of 1.5 and 3.0 mg/kg of body weight, produced anesthesia lasting from 8 +/- 5 and 21 +/- 9 minutes, respectively. Heart rate, aortic blood pressure, left ventricular peak pressure, left ventricular end diastolic pressure, left ventricular contractile force, and myocardial oxygen consumption were unchanged after administration of either dose of etomidate; however, the dosage of 1.5 mg/kg produced significant (P less than 0.05) increases in respiratory rate and decreases in tidal volume. The minute volume remained unchanged from base-line values. Significant (P less than 0.05) decreases in tidal volume, arterial pH, and partial pressure of oxygen were produced, and minute volume remained unchanged when 3.0 mg of etomidate/kg of body weight was administered. Thiamylal sodium (8.0 mg/kg of body weight; given IV) produced anesthesia lasting for 14 +/- 5 minutes. Significant increases (P less than 0.05) in heart rate, arterial blood pressure, left ventricular peak pressure, and myocardial oxygen consumption were observed after IV administration. Left ventricular contractility was significantly (P less than 0.05) decreased. Respiratory rate was not significantly (P less than 0.05) affected by thiamylal although tidal volume and minute volume were decreased. These respiratory alterations resulted in significant (P less than 0.05) increases in the arterial partial pressure of carbon dioxide and decreases in pH and the partial pressure of oxygen. On the basis of cardiopulmonary function, etomidate offered rapid, safe, short duration anesthesia superior to that of thiamylal sodium.

Animals↗

PubMed1977

Total intravenous anesthesia with etomidate. III. Some observations in adults.

An investigation was undertaken to determine the dosage of etomidate required to maintain sleep in adults undergoing surgery under regional local anesthesia. Premedication of diazepam 10 mg and atropine 0.5 mg was given, and sleep was induced and maintained by intermittent intravenous injections of etomidate 0.1/mg/kg, given whenever the patient would open his eyes on request. A mean overall dose of etomidate 17.4 microgram/kg/min. was required to maintain sleep, but great individual variation occurred, with older patients requiring less drug. The investigation was discontinued after 18 patients because of the frequency and intensity of side-effects, particularly pain and myoclonia, which caused the technique to be abandoned in two cases. It is considered unlikely that etomidate will prove to be the hypnotic of choice for a totally intravenous anesthetic technique in adults because of the high incidence of myoclonia after prolonged administration. In several patients uncontrollable muscle movements persisted for many minutes after complete recovery of consciousness.

Adolescent↗

PubMed1977

The effects of etomidate on arterial pressure, pulse rate and preganglionic sympathetic activity in cats.

We have studied the effects of etomidate on preganglionic cervical sympathetic activity, arterial pressure, and pulse rate. Normal and baroreceptor-denervated animals were studied. On the basis of findings it is concluded that etomidate exerts a minimal direct depressant action on the cardiovascular system. A profound depression of sympathetic tone was observed in spite of unaffected arterial pressure. Etomidate was also shown to possess a mild vagolytic action.

Animals↗

PubMed1979

Etomidate for induction of anaesthesia at caesarean section: comparison with thiopentone.

Thirty mothers undergoing elective Caesarean section received thiopentone 3.5 mg kg-1 and 30 received etomidate 0.3 mg kg-1 for induction of anaesthesia. Subsequent management of anaesthesia was identical in both groups. Maternal to fetal base excess differences and the degree of biochemical correlation between mother and infant were more favourable following etomidate than following thiopentone. The clinical status of the newborn was considered superior with etomidate.

Adult↗

PubMed1979

Effect of etomidate on intracranial pressure and cerebral perfusion pressure.

Ten patients with intracranial lesions, anaesthetized with thiopentone and nitrous oxide (70%) in oxygen (30%) received etomidate 0.2 mg kg-1 i.v. Ventilation was controlled in each patient. Intracranial pressure (i.c.p.) and mean arterial pressure (m.a.p.) were recorded. I.c.p. decreased significantly in all patients (0.01 greater than P greater than 0.001). Although PaCO2 decreased during the period of measurement, the extent and time-course of this change suggested that it was not mainly responsible for changes in i.c.p. M.a.p. decreased in most patients, but the decrease was statistically significant only at 3 and 4 min after the administration of etomidate (0.05 greater than P greater than 0.02). The changes in cerebral perfusion pressure (c.p.p.) and heart rate were not clinically or statistically significant. We conclude that etomidate can be used for the induction of anaesthesia in patients with intracranial space-occupying lesions without increasing i.c.p. or seriously reducing c.p.p.

Adult↗

PubMed1979

Cardiorespiratory changes following induction of anaesthesia with etomidate in patients with cardiac disease.

The cardiorespiratory effects of etomidate were measured in two groups of six patients with aortic or mitral valve disease. The induction of anaesthesia with etomidate 0.3 mg kg-1 was followed by a second dose 10 min later. After the first dose, a 19% decrease in systemic arterial pressure was associated with a decrease in systemic vascular resistance and left ventricular heart work. Cardiac index, pulmonary artery pressure and wedge pressure all decreased slightly. Central venous pressure and heart rate did not change. A slight increase in respiratory frequency failed to prevent an increase in PACO2. Changes after the second dose were similar. The two groups of patients did not differ significantly in their response to etomidate. No patient complained of pain during injection, nor did myoclonic movements occur.

Aged↗

PubMed1978

Pharmacokinetics of etomidate, a new intravenous anesthetic.

Etomidate sulfate, 0.3 mg/kg, was administered intravenously to eight patients and venous blood samples were drawn at intervals for the subsequent 10 hours. Plasma etomidate was determined by mass fragmentography. Plasma concentrations were fitted to a triexponential equation consistent with a three-compartment open pharmacokinetic model. Mean (+/-SD) variables were: initial t1/2, 2.6 +/- 1.3 min; intermediate t1/2, 28.7 +/- 14.0 min; apparent elimination t1/2, 4.6 +/- 2.6 hours; volume of the central compartment, 23.2 +/- 11.41; total apparent volume of distribution, 4.5 +/- 2.21/kg; fraction of drug in the central compartment, 7 per cent; total plasma clearance, 860 +/- 230 ml/min. Total blood clearance was estimated to be 754 ml/min and hepatic clearance, 739 ml/min. The large apparent volume of distribution indicates considerable tissue uptake. The hepatic clearance, being about 50 per cent of hepatic blood flow, indicates that changes in hepatic blood flow or hepatic metabolism will have only moderate effects on etomidate disposition.

Adolescent↗

PubMed1977

Etomidate in electroconvulsive therapy. A within-patient comparison with alphaxalone/alphadalone.

In a group of 31 patients undergoing electroconvulsive therapy, there was no significant difference between the times of return of eyelash reflex, swallowing and respiration following a single induction dose of 0.2 mg/kg of etomidate as compared with an induction dose of 0.036 ml/kg of alphaxalone/alphadalone. The incidence of involuntary movements and increased muscle tone was significantly greater after etomidate than following alphaxalone/alphadalone; but the involuntary movements were never marked. The overall incidence of pain on injection was 15% after etomidate. There was a low incidence of venous sequelae following either drug.

Adolescent↗

PubMed1978

Experience with etomidate: a hypnotic for induction of anaesthesia.

The authors report on their experience with combined etomidate anaesthesia in 500 varied surgical procedures including thoracic and neurosurgery. Specific indications for the new short-term hypnotic etomidate are dealt with, including anaesthesia in poor-risk patients, conditions of shock, spastic bronchitis, and bronchial asthma. When used for the induction of neuroleptic analgesia, etomidate offers certain benefits. Since it induces few side-effects, it is suggested that this preparation is the drug of choice for ambulatory anesthesia, Casesarean section, etc.

Adolescent↗

PubMed1976

[Hemodynamic effects of Etomidate].

Hemodynamic variations due to Etomidate administration were studies in 10 patients submitted to artificial ventilation. Etomidate was given at a 0.37 mg/kg B.W. dosage. Cardiac rate, mean arterial B.P., C.V.P., mean arteial pulmonary pressure, mean pulmonary capillary pressure and cardiac output were investigated. From values found, systolic output, systemic vascular resistance, and pulmonary arteriolar resistance were calculated. Results show that Etomidate has little effect on hemodynamics. There is only a 5 p. 100 increase in cardiac rate, a 16p. 100 decrease in cardiac output, 1 18 p. 100 decrease in systolic output and a 12p. 100 decrease in mean arterial B.P. Variations of mean capillary pressure, of systemic vascular resistance and of pulmonary arteriolar resistance are not significant.

Adult↗

PubMed1978

[An experimental study of the effect of etomidate on central sympathetic activity, respiration and circulation (author's transl)].

The effect of Etomidate on central sympathetic activity, respiration and circulation were studied in animals at rest and under asphyctic conditions. The doses used were 0.15, 0.3 and 0.6 milligrams/kilogram bodyweight. Injection of the drug into animals at rest caused excitation lasting for about 10 seconds and then lowering of sympathetic activity by about 15-30 per cent. With doses of 0.6 mg the depression lasted for about 15 minutes. Central stimulation by asphyxia often a more pronounced dose-dependent depression of sympathetic activity by about 15-40% of the original level was observed. Activity of the phrenic nerve was affected only with doses of 0.6 mg; the reduction by about 30% lasted for up to 15 min. Injection of 0.6 mg was followed within one minute by a short-lasting fall in blood pressure by about 10%. The heart rate remained unchanged at rest but during asphyctic conditions the heart rate was less slowed down than would normally occur with vagal stimulation. Etomidate apparently also depressed the vagal centres. Similarities and differences in action between Etomidate and propanidid are discussed.

Animals↗

PubMed1978

Anaesthetic induction for caesarean section with etomidate compared with thiopentone.

Anaesthesia for caesarean section demands a technique that provides perfect narcosis without neonatal depression. To date, no ideal induction agent has been found for obstetric anaesthesia, although thiopentone is still considered the safest. A new agent, etomidate (0,3 mg/kg) has been studied in a group of parturients who underwent elective caesarean section in the left lateral tilt position. The results obtained are compared with those from a similar series, in which the management was identical, except that anaesthesia was induced with thiopentone 3,5 mg/kg. The infants in the present series were usually extremely lively after delivery, and generally sustained respiration in a shorter time than those after thiopentone. In addition, maternal-to-fetal base excess gradients were narrower with etomidate than with thiopentone. Thus etomidate may offer some advantage over thiopentone for anaesthetic induction at elective caesarean section, and appears worthy of further trial.

Anesthesia, Intravenous↗