A comparative study of two infusion doses of etomidate for induction vs standard induction dose of etomidate

Prakash, M. V. S. Satya; Gnanasekar, Rajiv; Panneerselvam, Sakthirajan; Adole, Prashant Shankarrao

doi:10.1007/s00228-019-02681-6

Cited by 6 publications

(6 citation statements)

References 11 publications

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“…The anesthesia literature does offer data suggesting that the stimulant effects of higher‐dose ketamine may counterbalance any deleterious impacts from sedation 30 . Anesthesia literature similarly supports the notion that the hemodynamic impacts of etomidate are stable across the range of etomidate doses typically used in clinical practice 31 . That said, these studies were of stable patients undergoing elective procedures.…”

Section: Discussionmentioning

confidence: 86%

“…30 Anesthesia literature similarly supports the notion that the hemodynamic impacts of etomidate are stable across the range of etomidate doses typically used in clinical practice. 31 That said, these studies were of stable patients undergoing elective procedures. The generalizability of these data to patients undergoing emergency airway management, many of whom are hemodynamically unstable is unclear.…”

Section: Discussionmentioning

confidence: 99%

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Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study

April

Araña

Schauer

et al. 2020

Academic Emergency Medicine

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Background: The hemodynamic impact of induction agents is a critically important consideration in emergency intubations. We assessed the relationship between peri-intubation hypotension and the use of ketamine versus etomidate as an induction agent for emergency department (ED) intubation. Methods: We analyzed ED intubation data for patients aged >14 years from the National Emergency Airway Registry performed in 25 EDs during 2016 through 2018. We excluded patients with preintubation hypotension (systolic blood pressure <100 mm Hg) or cardiac arrest prior to intubation. The primary outcome was periintubation hypotension. Secondary outcomes included interventions for hypotension (e.g., intravenous fluids or vasopressors). We report adjusted odds ratios (aOR) from multivariable logistic regression models controlling for patient demographics, difficult airway characteristics, and intubation modality. Results: There were 738 encounters with ketamine and 6,068 with etomidate. Patients receiving ketamine were more likely to have difficult airway characteristics (effect size difference = 8.8%, 95% confidence interval [CI] = 5.3% to 12.4%) and to undergo intubation with video laryngoscopy (8.1%, 95% CI = 4.4% to 12.0%). Periintubation hypotension incidence was 18.3% among patients receiving ketamine and 12.4% among patients receiving etomidate (effect size difference = 5.9%, 95% CI = 2.9% to 8.8%). Patients receiving ketamine were more likely to receive treatment for peri-intubation hypotension (effect size difference = 6.5%, 95% CI = 3.9% to 9.3%). In logistic regression analyses, patients receiving ketamine remained at higher risk for peri-intubation hypotension (aOR = 1.4, 95% CI = 1.2 to 1.7) and treatment for hypotension (aOR = 1.8, 95% CI = 1.4 to 2.0). There was no difference in the aOR of hypotension between patients receiving ketamine at doses ≤1.0 mg/kg versus >1.0 mg/kg or patients receiving etomidate at doses ≤0.3 mg/kg versus >0.3 mg/kg. Conclusions: Pending additional data, our results suggest that clinicians should not necessarily prioritize ketamine over etomidate based on concern for hemodynamic compromise among ED patients undergoing intubation.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study

April

Araña

Schauer

et al. 2020

Academic Emergency Medicine

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“…It was found that the serum corticosterone concentration decreased significantly and lasted for more than 3 h after 120 min of etomidate infusion in rats 9 . Clinical studies found that when intravenous infusion of etomidate was used for anesthesia induction, the levels of plasma cortisol were suppressed in the first 6 h after induction by intravenous infusion of etomidate, and returned to pre anesthesia levels 24 h later 10 . The serum cortisol concentration of patients anesthetized with etomidate for electroconvulsive therapy for several times was decreased significantly at 24 h after each anesthesia, and returned to the preoperative level 48 h after anesthesia 11 .…”

Section: Discussionmentioning

confidence: 99%

Effects of etomidate combined with dexmedetomidine on adrenocortical function in elderly patients: a double-blind randomized controlled trial

Wang

Zheng

Zeng

et al. 2022

Sci Rep

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Etomidate has been advocated to be used in anesthesia for the elderly and the critically ill patients due to its faint effect on cardiovascular system. But the dose-dependent suppression of etomidate on adrenal cortex function leads to the limitation of its clinical application. Clinical research showed that dexmedetomidine could reduce the dose requirements for intravenous or inhalation anesthetics and opioids, and the hemodynamics was more stable during the operation. The objective was to observe the effect of etomidate combined with dexmedetomidine on adrenocortical function in elderly patients. 180 elderly patients scheduled for elective ureteroscopic holmium laser lithotripsy were randomly allocated to PR group anesthetized with propofol-remifentanil, ER group anesthetized with etomidate-remifentanil, and ERD group anesthetized with dexmedetomidine combined with etomidate-remifentanil. Patients in each group whose operation time was less than or equal to 1 h were incorporated into short time surgery group (PR1 group, ER1 group and ERD1 group), and whose surgical procedure time was more than 1 h were incorporated into long time surgery group (PR2 group, ER2 group and ERD2 group). The primary outcome was the serum cortisol and ACTH concentration. The secondary outcomes were the values of SBP, DBP, HR and SpO2, the time of surgical procedure, the dosage of etomidate and remifentanil administered during surgery, the time to spontaneous respiration, recovery and extubation, and the duration of stay in the PACU. The Serum cortisol concentration was higher at t1~2 in ERD1 group compared to ER1 group (P < 0.05). The Serum cortisol concentration at t1~3 was higher in ERD2 group than in ER2 group (P < 0.05). The Serum ACTH concentration was lower at t1~2 in ERD1 group compared to ER1 group (P < 0.05). The Serum ACTH concentration at t1~3 was lower in ERD2 group compared to ER2 group (P < 0.05). The SBP at T1 and T3 were higher in ER2 and ERD2 group than in PR2 group (P < 0.05). The DBP in ER1 and ERD1 group were higher at T1 compared to PR1 group (P < 0.05). The dosage of etomidate was significantly lower in ERD1 group and ERD2 group than in ER1 group and ER2 group (P < 0.05), respectively. The administration of dexmedetomidine combined with etomidate can attenuate the inhibition of etomidate on adrenocortical function in elderly patients and maintain intraoperative hemodynamic stability.

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“…Furthermore, total intravenous anesthesia with etomidate may reduce the dose needed for induction and reduce the incidence of myoclonus, making it a safer choice for etomidate anesthesia. Changes in cortisol or aldosterone concentration in the etomidate group were not associated with changes in corticotropin concentration. This finding is consistent with a previous report on patients in intensive care units, which suggested that reductions in cortisol and aldosterone levels were not mediated centrally via corticotropin level but rather peripherally via the effects on the adrenal cortex.…”

Section: Discussionmentioning

confidence: 99%

Effect of Etomidate vs Propofol for Total Intravenous Anesthesia on Major Postoperative Complications in Older Patients

et al. 2022

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A comparative study of two infusion doses of etomidate for induction vs standard induction dose of etomidate

Cited by 6 publications

References 11 publications

Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study

Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study

Effects of etomidate combined with dexmedetomidine on adrenocortical function in elderly patients: a double-blind randomized controlled trial

Effect of Etomidate vs Propofol for Total Intravenous Anesthesia on Major Postoperative Complications in Older Patients

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