A systematic review and meta-analysis of the hemodynamic effects of etomidate versus other sedatives in patients undergoing rapid sequence intubation

Velásquez, J. Arteaga; Rodríguez, Jorge; Higuita-Gutiérrez, Luis Felipe; Vergara, Martínez

doi:10.1016/j.redare.2021.05.020

Cited by 2 publications

(2 citation statements)

References 27 publications

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“…Lina et al (27) reported a lower incidence of adverse reactions with a 1:2 volume ratio compared to the 1:1 ratio. Of course, the choice of etomidate/propofol ratio should consider factors such as patient characteristics, procedural complexity, treatment goals, drug dosage, and administration speed, these factors influence the outcome of the study (28)(29)(30). Patients with comorbidities or increased sensitivity to sedatives may benefit from lower etomidate doses to minimize hemodynamic instability (31,32).…”

Section: Discussionmentioning

confidence: 99%

Optimizing sedation in gastroscopy: a study on the etomidate/propofol mixture ratio

Tang,

Zheng,

et al. 2024

Front. Med.

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ObjectivePropofol and etomidate are the most commonly used sedative agents in procedural sedation, each with its own advantages and disadvantages. However, there remains considerable controversy regarding the optimal ratio for the mixture of these two drugs, warranting further investigation. Therefore, this study aims to investigate the optimal ratio for combining propofol and etomidate during gastroscopy.MethodsThis study is a prospective, double-blinded, randomized controlled clinical trial. One hundred and sixty-two patients from July 2019 to December 2022 were evenly classified into three groups using a random number table as follows: (1) P group (propofol); (2) EP1 group (5 mL etomidate +10 mL propofol); (3) EP2 group (10 mL etomidate +10 mL), 54 patients per group. The medications, including a pre-sedation dose of 50 μg/kg dezocine followed by sedatives, ceasing when the patient’s eyelash reflex vanished, indicating adequate sedation. Mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) measurements taken before anesthesia (T1), immediately after the administration of sedatives (T2), immediately gastroscopic insertion (T3) and immediately recovery (T4) were determined. Additional, perioperative related outcomes and adverse events were also recorded.ResultsThe EP2 group exhibited a higher MAP at T2 compared to the P and EP1 groups (p < 0.05). Calculated decreases in MAP revealed values of 19.1, 18.8, and 13.8% for the P, EP1, and EP2 groups at T2, respectively. Adverse events: Group EP2 exhibited a significantly lower hypotension incidence (11.1%) compared to the Propofol group (50%) and EP1 (31.5%). Concerning injection pain, Group EP2 also showing a significant decrease in comparison to P and EP1 groups (p < 0.05).ConclusionThe use of a mixture of 10 mL etomidate and 10 mL propofol (at a 1:1 ratio) combined with dezocine for painless gastroscopy demonstrates hemodynamic stability, a low incidence of adverse reactions.Clinical Trial Registrationhttps://www.chictr.org.cn/showproj.html?proj=39874

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Section: Discussionmentioning

confidence: 99%

Optimizing sedation in gastroscopy: a study on the etomidate/propofol mixture ratio

Tang,

Zheng,

et al. 2024

Front. Med.

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“…Although this agent is often used as an induction agent, due to its undesirable effects on the synthesis of cortisol in the adrenal gland, practices in the form of recurrent and continuous infusion are avoided [4,5].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the hemodynamic effects of etomidate-midazolam and ketamine-midazolam combinations in anesthesia induction in coronary artery bypass surgery

FIRAT

Kömürcü²,

BAYRAKTAR³

et al. 2023

Turkish Journal of Clinics and Laboratory

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Aims: We aimed to compare the effects of anesthesia induction on hemodynamic parameters of ketamine-midazolam or etomidate-midazolam combinations and coronary artery bypass grafting surgery. Material and Methods: 40 adult patients undergoing CABG were randomly allocated into two groups for this prospective randomized double-blinded study. Ketamine group (n = 20) and Etomidate group (n = 20). Intraoperative and postoperative hemodynamic variables, adrenal gland functions and intensive care period were compared after anesthesia induction with etomidate and ketamine. Results: Perioperative hemodynamic parameters were not significantly different between the groups. Despite similar baseline measurements, cortisol levels were significantly higher 5 minutes after induction, during rewarming, and after ACTH stimulation test at postoperative day 1 in group ketamine than group etmidate. The groups were not significantly different in terms of duration of postoperative mechanical ventilation, frequency of postoperative delirium, and intensive care unit and hospital lengths of stay. Conclusion: Ketamine-midazolam combination is an acceptable alternative to etomidate-midazolam combination in terms of hemodynamic stability. Compared with the ketamine-midazolam combination, the etomidate-midazolam combination significantly decreased cortisol levels during the intraoperative and early postoperative periods

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A systematic review and meta-analysis of the hemodynamic effects of etomidate versus other sedatives in patients undergoing rapid sequence intubation

Cited by 2 publications

References 27 publications

Optimizing sedation in gastroscopy: a study on the etomidate/propofol mixture ratio

Optimizing sedation in gastroscopy: a study on the etomidate/propofol mixture ratio

Comparison of the hemodynamic effects of etomidate-midazolam and ketamine-midazolam combinations in anesthesia induction in coronary artery bypass surgery

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