Adverse Responses to I.V. Anaesthetics

Studies with an wnnUinn formulation of ICI 35 868 (2,6-diisopropylphenol) indicate that this new formulation has anaesthetic properties in rats and mice, and haemodynamic effects in the mini-pig which are «jmil«r to those of the previously available Cremophor formulation. Administration of the emulsion formulation to dogs produced no untoward effect, whereas the Cremophor formulation produced a mwrVf<1 increase in plasma histamine concentration. In the mini-pig, no adverse response was produced by the repeated administration of the wniilmrm formulation of ICI 35 868, whereas the Cremophor formulation produced anaphylactoid responses when a second injection was given 1 week after an uneventful first exposure to this formulation. Behavioural responses in the rat suggest that the emulsion formulation may produce less discomfort on i.v. injection.

Section: Discussionmentioning

confidence: 99%

Pharmacology of an Emulsion Formulation of Ici 35868

GLEN¹,

HUNTER²

1985

“…Alternative induction agents also cause serious adverse reactions. 15 Several groups have studied propofol for induction and maintenance of anaesthesia during Caesarean section; neonatal scores and neurobehavioural measures were inferior when propofol was used in comparison to thiopental and inhalational agents respectively. 26 130 Propofol is not licensed for use in obstetric anaesthesia.…”

Section: Propofolmentioning

confidence: 99%

Recent advances in intravenous anaesthesia

Sneyd

2004

Efforts to develop new hypnotic compounds continue, although several have recently failed in development. Propofol has been reformulated in various presentations with and without preservatives. Pharmacokinetic and pharmacodynamic differences exist between some of these preparations, and it is currently unclear whether any have substantial advantages over the original presentation. The use of target-controlled infusion (TCI) has been extended to include paediatric anaesthesia and sedation. Application of TCI to remifentanil is now licensed. Linking of electroencephalogram (EEG) monitoring to TCI for closed-loop anaesthesia remains a research tool, although commercial development may follow. The availability of stereoisomer ketamine and improved understanding of its pharmacology have increased non-anaesthetic use of ketamine as an adjunct analgesic. It may be useful in subhypnotic doses for postsurgical patients with pain refractory to morphine administration.

“…The fact that the decrease in ICP correlated poorly with the change in arterial pressure in this study would be consistent with this hypothesis. Althesin has, however, several disadvantages, including the relatively high incidence of allergic reactions (Beamish and Brown, 1981;Clarke, 1982) and the potential hazards of larger doses of the solubilizing agent Cremophor EL (Knell, Turner and Chambers, 1983;Lawler, McHutchon and Bamber, 1983). Furthermore, during continuous infusion anaesthesia, Althesin appears to induce a more marked derangement of hepatic enzyme activity than do either etomidate or thiopentone (Blunnie et al,181).…”

Section: Discussion \mentioning

confidence: 99%

Comparison of Etomidate and Althesin in the Reduction of Increased Intracranial Pressure After Head Injury

Dearden

Mcdowall

1985

The increasing use of shorter-acting hypnotic agents to control intracranial pressure (ICP) following severe head injury has prompted a prospective double-blind controlled trial comparing the efficacy of etomidate and Althesin, given by i.v. infusion. Over the dose ranges used, the two drugs appeared equipotent in decreasing ICP whilst preserving cerebral perfusion pressure. However, in two patients (one in each group) ICP did not respond to hypnotic infusion, a feature noted in other studies to occur in a minority of patients. With the cessation of Althesin manufacture and the discussion about the use of etomidate infusions, it is timely to document the effectiveness of etomidate in decreasing ICP.