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

Wang, Fangjun; Zheng, Yufeng; Zeng, Sisi; Gao, Luyue; Li, Jiabei; Wang, Na

doi:10.1038/s41598-022-16679-1

Cited by 7 publications

(3 citation statements)

References 30 publications

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“…A significant association of etomidate with adrenal insufficiency has been established. Etomidate specifically and reversibly blocks 11α-hydroxylation and 11β-hydroxylation in adrenal steroid synthesis, leading to decreases in the synthesis of cortisol, corticosterone, and aldosterone ( 6 ) ( Figure 3 ). Cortisol is the most abundant endogenous glucocorticoid ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Etomidate-induced hypokalemia in electronic cigarette users: two case reports and literature review

Wu,

Xia,

Gan

et al. 2024

Front. Endocrinol.

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Hypokalemia is a common clinical condition that can lead to muscle weakness, difficulty breathing, malignant arrhythmias, and even death. This report describes two cases of severe hypokalemia resulting from the use of electronic cigarettes containing etomidate, both accompanied by varying degrees of adrenal hyperplasia. In both cases, the patients were admitted to the hospital with lower limb weakness and difficulty walking. Relevant examinations revealed low blood potassium, low cortisol, high adrenocorticotropic hormone, low renin, and low aldosterone levels in the patients, with Case 2 also having significant hypertension. In both cases, adrenal CT scans showed thickening of the adrenal glands. After the delivery of potassium supplementation in both cases, blood potassium levels gradually returned to normal and muscle strength gradually improved. The case reports are followed by a review of the literature on etomidate and its related mechanisms of action with discussion of its association with hypokalemia.

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Section: Discussionmentioning

confidence: 99%

Etomidate-induced hypokalemia in electronic cigarette users: two case reports and literature review

Wu,

Xia,

Gan

et al. 2024

Front. Endocrinol.

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“…Clinical studies have shown that dexmedetomidine has neuroprotective and anti-inflammatory properties and improves postoperative cognitive dysfunction in older patients [ 5 – 7 ]. In previous clinical study, we found that the combination of dexmedetomidine and etomidate could maintain perioperative hemodynamic stability and reduce the inhibitory effect of etomidate on adrenocortical function in older patients [ 8 ]. However, there is no report on the effect of the combination of etomidate and dexmedetomidine for anaesthesia on postoperative cognitive function of older patients, and it is not clear whether the combination of etomidate and dexmedetomidine with different anaesthesia time has different effects on postoperative cognitive function of older patients.…”

Section: Introductionmentioning

confidence: 99%

Effects of dexmedetomidine combined with etomidate on postoperative cognitive function in older patients undergoing total intravenous anaesthesia: a randomized, double-blind, controlled trial

Fu,

Xu,

Zhao

et al. 2024

BMC Geriatr

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Background Etomidate has been advocated for anesthesia in older and critically ill patients because of its hemodynamic stability. Clinical studies have shown that dexmedetomidine has neuroprotective and anti-inflammatory properties and improves postoperative cognitive dysfunction in older patients. The present study was to evaluate the effects of the combination of etomidate and dexmedetomidine with different anaesthesia time on postoperative cognitive function in older patients. Methods A total of 132 older patients undergoing ureteroscopic holmium laser lithotripsy were randomly divided into EN group and ED group equally. Patients whose surgery time was less than or equal to 1 h in each group were allocated to short-time surgery group (EN1 group and ED1 group), and whose surgery time was more than 1h were allocated to long-term surgery group (EN2 group and ED2 group). The primary outcome was the score of the Mini-Mental State Examination. The secondary outcomes were State-Trait Anxiety Inventory scores, Riker sedation agitation scores, Zung Self-Rating Depression Scale scores, the memory span for Arabic numerals, the plasma concentrations of S-100 calcium-binding protein B and neuron specific enolase, the time to spontaneous respiration, recovery, and extubation. Results The MMSE scores at t2-3 were higher in ED1 and ED2 groups than in EN1 and EN2 groups (p<0.05). Compared with ED1 and ED2 groups, the ZSDS scores, the S-AI scores and the T-AI scores at t1-2 were higher in EN1 and EN2 groups (p<0.05), respectively. The recalled Arabic numbers at t1-3 were higher in ED2 group than in EN2 group (p<0.05). The plasma concentration of S-100β at t1-2 in EN1 group and t1-3 in EN2 group were higher than that in ED1 and ED2 groups (p<0.05), respectively. Compared with ED1 and ED2 groups, the plasma concentrations of NSE were higher at t1-3 in EN1 group and t1-4 in EN2 group (p<0.05), respectively. Conclusion The administration of dexmedetomidine could improve postoperative cognitive dysfunction, emergence agitation, depression and anxiety, attenuate the plasma concentrations of S-100β and NSE in older patients undergoing total intravenous anaesthesia with etomidate. Trial registration Registration number: ChiCTR1800015421, Date: 29/03/2018.

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“…According to previous reports, the use of propofol has an increased risk ratio for hypotension compared with the use of etomidate during endoscopy [23,24] . However, etomidate is limited by myoclonus and postoperative nausea and vomiting (PONV), and there are also concerns regarding its cortisol suppressive function [25] . Therefore, etomidate is considered a twoedged sword when used for induction [26] .…”

Section: Introductionmentioning

confidence: 99%

Application of Propofol Target-Controlled Infusion Combined with Etomidate in Painless Gastrointestinal Endoscopy: A Prospective, Randomized Controlled Study

Luo,

Zheng,

Chen

et al. 2023

Preprint

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Background Propofol has been widely used in painless gastrointestinal endoscopy; however, it frequently leads to cardiovascular adverse events and respiratory depression. Propofol target-controlled infusion (TCI) can provide safe sedation but may require higher dosages of propofol. On the contrary, etomidate offers hemodynamic stability. This study aimed to investigate the efficacy and safety of propofol TCI combined with etomidate in painless gastrointestinal endoscopy. Methods A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups: P, 0.1EP, and 0.15EP. Patients in the P group received propofol TCI only, with an initial effect-site concentration of the propofol TCI system of 3.0 µg/mL. Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection, respectively, followed by propofol TCI. Results Patients in the 0.15EP group had higher mean blood pressure (MBP) after induction than the other groups (P < 0.05). Propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups (P < 0.05). The induction time was longer in the P group than in the other groups (P < 0.01). The recovery time was shorter in the 0.15EP group than in the other groups (P < 0.01). The incidence of hypotension and injection pain was lower in the 0.15EP group than in the other groups (P < 0.05). Furthermore, the incidence of respiratory depression was lower in the 0.15EP group than in the P group (P < 0.05). Additionally, the satisfaction of the patient, endoscopist, and anesthesiologist was higher in the 0.15EP group than in the other groups (P < 0.05). Conclusions Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption, which is followed by fewer cardiovascular adverse events and respiratory depression, along with higher patient, endoscopist, and anesthesiologist satisfaction. Thus, this anesthesia strategy is suitable for painless gastrointestinal endoscopy.

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

Cited by 7 publications

References 30 publications

Etomidate-induced hypokalemia in electronic cigarette users: two case reports and literature review

Etomidate-induced hypokalemia in electronic cigarette users: two case reports and literature review

Effects of dexmedetomidine combined with etomidate on postoperative cognitive function in older patients undergoing total intravenous anaesthesia: a randomized, double-blind, controlled trial

Application of Propofol Target-Controlled Infusion Combined with Etomidate in Painless Gastrointestinal Endoscopy: A Prospective, Randomized Controlled Study

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