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Cardiovascular effects of various anesthetics in man. Four short-acting intravenous anesthetics: althesin, etomidate, methohexital and propanidid.

Four groups of 15 patients without any cardiovascular or pulmonary pathology received an intravenous injection of one of the 4 studied anesthetics, Althesin (0.07 ml/kg), Methohexital (1.6 mg/kg), Etomidate 0.15 mg/kg) or Propanidid (6 mg/kg). Arterial pressure, heart rate, stroke volume and cardiac output were measured every thirty or sixty seconds. Stroke volume decreased and heart rate increased with all of them, but most of all with Propanidid. The only statistically significant reduction of cardiac output was observed with Althesin. Arterial pressures did not vary. Under the conditions of the present study and at the dose levels mentioned, Etomidate produced the least changes in cardiac parameters.

Adult

[Vasoreactivity of cerebral infarct to barbiturates and other intravenous anesthetics].

The effect of a barbiturate, Sodium thiopental (Nesdonal), on the cerebral circulation in 13 patients with a cerebral ischemic attack is studied. Its action is compared to the action of other intravenous anesthetics (Alfatésine - Etomidate - diazanalgésie) used in neuro-anesthésia. The study is on a total of thirty patients. The regional cerebral blood flow (RCBF) is measured by the intra-carotid injection of Xe133. The anesthetics studied acted like vasoconstrictive agents on the healthy brain. They diminish the RCBF. At the leel of ischemic lesions the response is abolished, even inversed : the flow remains unchanged, even increases. It is the inverse steal syndrome. This action, comparable to the action of hypocapnia, has both a diagnostic and a prognostic value.

Alfaxalone Alfadolone Mixture

[Etomidate: cardiovascular effects of a new intravenous anesthetic agent].

The cardiovascular effects of intravenous Etomidate (0.2 mg/kg) were studied in 14 surgical patients with ages varying from 49 to 90. The anaesthetic induction occurs within 10 seconds and the mean duration of anaesthesia is from 6 to 8 minutes. I.V. Etomidate causes a slight lowering of the mean arterial pressure (8.5 per cent), a negligible increase of the heart rate (2.8 per cent) and an insignificant lowering of the mean pulmonary artery pressure (7 per cent). Cardiac output and stroke volume are respectively lowered by 7.6 per cent and 10 per cent. The peripheral vascular resistance is discreetly reduced by 3.8 per cent. From these results, we believe that Etomidate seems to induce sleep with the lightest hemodynamic disturbances in comparison with other agents commonly used. However, some undesirable side effects appeared in some of our patients which can become somewhat annoying, for example myoclonic movements and pain at the point of injection.

Aged

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

Changes in ventilatory pattern induced by intravenous anesthetic agents in human subjects.

The tidal volume-inspiratory duration relationship was studied during air breathing and rebreathing in conscious and anesthetized human subjects using three different intravenous agents. The results observed have been compared with similar experiments carried out in cats. Its has been shown that anesthesia provokes an increase in breathing rate associated with a decrease in tidal volume in human subjects; an opposite effect on breathing rate was observed in cats. Thus, the tidal volume-inspiratory duration relationship, although very similar in the conscious cat or human subject, is very different under anesthesia. The results were quite consistent in a given species whatever the nature of the drug used. It is suggested that modifications of the breathing rate by anesthesia, related to animal species, are caused by central effects of the drug. These effects are probably mediated by different actions on inputs to the inspiratory "off-switch" mechanisms in the two species.

Alfaxalone Alfadolone Mixture