The Effect of Repeated Etomidate Anesthesia on Adrenocortical Function During a Course of Electroconvulsive Therapy

Wang, Ning; Wang, Xiao Hai; Lu, Jun; Zhang, Jian You

doi:10.1097/yct.0b013e3182182be0

Cited by 35 publications

(14 citation statements)

References 17 publications

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“…Although the study supports the hypothesis that the combined use of etomidate and propofol reduces the side effects of etomidate and propofol with minimal effects on safety and recovery, a larger trial that is sufficient to detect differences is needed to confirm these findings before a change in clinical practice is recommended. Secondly, although plasma corticosteroid concentrations were not recorded in the current study, a number of studies have demonstrated that the induction dose of etomidate can decrease plasma corticosteroid concentrations, and that this can be sustained for 6-8 h, leading to adrenocortical dysfunction (24)(25)(26). Thirdly, only the short-term hemodynamic effects on elderly patients were investigated.…”

Section: A B Cmentioning

confidence: 99%

Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

Meng

Cao

Liu

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study is to compare the safety, efficacy and cost effectiveness of anesthetic regimens by compound, using etomidate and propofol in elderly patients undergoing gastroscopy. A total of 200 volunteers (65-79 years of age) scheduled for gastroscopy under anesthesia were randomly divided into the following groups: P, propofol (1.5-2.0 mg/kg); E, etomidate (0.15-0.2 mg/kg); P+E, propofol (0.75-1 mg/kg) followed by etomidate (0.075-0.1 mg/kg); and E+P, etomidate (0.075-0.01 mg/kg) followed by propofol (0.75-1 mg/kg). Vital signs and bispectral index were monitored at different time points. Complications, induction and examination time, anesthesia duration, and recovery and discharge time were recorded. At the end of the procedure, the satisfaction of patients, endoscopists and the anesthetist were evaluated. The recovery (6.1±1.2 h) and discharge times (24.8±2.8 h) in group E were significantly longer compared with groups P, P+E and E+P (P<0.05). The occurrence of injection pain in group P+E was significantly higher compared with the other three groups (P<0.05). In addition, the incidence of myoclonus and post-operative nausea and vomiting were significantly higher in group P+E compared with the other three groups (P<0.05). There was no statistical difference among the four groups with regards to the patients' immediate, post-procedure satisfaction (P>0.05). Furthermore, there was no difference in the satisfaction of anesthesia, as evaluated by the anesthetist and endoscopist, among the four groups (P>0.05). The present study demonstrates that anesthesia for gastroscopy in elderly patients can be safely and effectively accomplished using a drug regimen that combines propofol with etomidate. The combined use of propofol and etomidate has unique characteristics which improve hemodynamic stability, cause minimal respiratory depression and less side effects, provide rapid return to full activity and result in high levels of satisfaction.

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Section: A B Cmentioning

confidence: 99%

Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

Meng

Cao

Liu

et al. 2016

Experimental and Therapeutic Medicine

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“…A clear limitation of this assessment is the assumption that the clinical efficacy of ECT depends solely on the electrical length of the evoked seizure, when there is no evidence that this assumption is true ( Fear et al, 1994 ; Geretsegger et al, 1998 ; Sackeim, 1999 ; Azuma et al, 2007 ; Bauer et al, 2009 ; Stewart, 2012 ; Martinez-Amoros et al, 2014 ). In fact, different values for the lower limit of the electrical convulsion can be found in the literature: 15 s ( Gonzalez et al, 2007 ), 20 s ( Bertolin-Guillen et al, 2006 ; Ramirez-Segura and Ruiz-Chow, 2013 ), 25 s ( Nguyen et al, 1997 ; Dogan et al, 2011 ; Gombar et al, 2011 ; Hizli Sayar et al, 2014 ; Martinez-Amoros et al, 2014 ), and 26 s ( Wang et al, 2011 ). These data preclude us from directly comparing the percentage of sessions that were considered ineffective.…”

Section: Discussionmentioning

confidence: 99%

The Psychiatric Patient as a Health Resource Consumer: Costs Associated with Electroconvulsive Therapy

Sevilla

Gonzalez-Moral²,

Tolosa-Perez³

2016

Front. Psychol.

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Background: Clinical practice protocols should consider both the psychological criteria related to a patient’s satisfaction as a consumer of health services and the economic criteria to allocate resources efficiently. An electroconvulsive therapy (ECT) program was implemented in our hospital to treat psychiatric patients. The main objective of this study was to determine the cost associated with the ECT sessions implemented in our hospital between 2008 and 2014. A secondary objective was to calculate the cost of sessions that were considered ineffective, defined as those sessions in which electrical convulsion did not reach the preset threshold duration, in order to identify possible ways of saving money and improving satisfaction among psychiatric patients receiving ECT.Methods: A descriptive analysis of the direct health costs related to ECT from the perspective of the public health system between 2008 and 2014 was performed using a retrospective chart review. All of the costs are in euros (2011) and were discounted at a rate of 3%. Based on the base case, a sensitivity analysis of the changes of those variables showing the greatest uncertainty was performed.Results: Seventy-six patients received 853 sessions of ECT. The cumulative cost of these sessions was €1409528.63, and 92.9% of this cost corresponded to the hospital stay. A total of €420732.57 (29.8%) was inefficiently spent on 269 ineffective sessions. A sensitivity analysis of the economic data showed stable results to changes in the variables of uncertainty.Conclusion: The efficiency of ECT in the context outlined here could be increased by discerning a way to shorten the associated hospital stay and by reducing the number of ineffective sessions performed.

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“…In der o. g. Fachinformation wird vor einer kontinuierlichen Infusion oder wiederholten Verabreichungen von Etomidat gewarnt, da als direkte Folge eine prolongierte Suppression des endogenen Kortisols und Aldosterons auftreten kann. Zwar fanden einige Autoren [95][96][97] keinen solchen Zusammenhang, allerdings stellten Kogan-Goloborodko und Grözinger [98] den Fall eines Patienten vor, bei dem im Rahmen einer hochfrequenten EKT-Behandlungsserie mit täglichen Sitzungen unter Etomidat-Narkosen ein sukzessiver Abfall des Kortisolspiegels beobachtet werden konnte. Dieser lag erstmalig am 10 Behandlungstag unterhalb des Normwertes, erholte sich dann aber wieder rasch.…”

Section: Etomidatunclassified

Tako-Tsubo-Kardiomyopathie während einer EKT-Serie: Fallbericht, systematische Literaturrecherche und Diskussion spezifischer Risikofaktoren

Kudling

Schoels

Kuhn

2018

Fortschr Neurol Psychiatr

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Zusammenfassung Hintergrund Bei der Tako-Tsubo-Kardiomyopathie (TTK) handelt es sich um eine akute reversible Erkrankung des Herzmuskels. Sie wird ursächlich mit einem Überschuss an Adrenalin, Noradrenalin und Dopamin in Zusammenhang gebracht. Als bekannte Risikofaktoren gelten psychischer und physischer Stress. Es existieren Fallberichte über das Auftreten von TTK nach Krampfanfällen sowie EKT-Behandlungen. Methoden Es wird der Fall eines 63 Jahre alten Patienten vorgestellt, bei dem es im Verlauf einer zweiten EKT-Serie unter Etomidat-Narkose und laufender antidepressiver Medikation mit Tranylcypromin zu einer TTK kam. Mögliche pathophysiologische Zusammenhänge werden anhand der zur Verfügung stehenden Literatur diskutiert. In Anbetracht eines erhöhten Rezidivrisikos wird der Frage nachgegangen, ob die Wiederaufnahme der EKT-Behandlung nach Abklingen der TTK verantwortbar ist. Ergebnisse Depressive Störungen, EKT-Behandlungen mit konvulsiven Anfällen, der Einsatz von Etomidat als Narkotikum sowie eine Behandlung mit Tranylcypromin könnten eine theoretische Rolle als Risikofaktoren für die TTK spielen. Die durch Etomidat vermittelten Effekte könnten auf die substanzbedingte Störung der Kortisolsynthese und einer daraus resultierenden sympathomimetischen und pro-inflammatorischen Wirkung zurückgeführt werden. Es konnten 19 publizierte TTK-Fälle im Zusammenhang mit EKT gefunden werden. Einschließlich des hier vorgestellten Patienten wurde in 8 Fällen von einer erfolgreichen und komplikationslosen Wiederaufnahme der EKT-Behandlung berichtet. Diskussion Das Auftreten der TTK scheint letztlich multifaktoriell begründet zu sein. Die Konstellation unseres Falles sowie die analysierte medizinische Literatur erlauben keinen Rückschluss, dass einer der genannten Faktoren alleine für die Entstehung der TTK verantwortlich gemacht werden kann. Angesichts der theoretischen Überlegungen und Teilbefunde über die mögliche Rolle eines relativen Kortisol-Defizits für die TTK wären gezielte Untersuchungen wünschenswert. Die Wiederaufnahme der EKT-Behandlung nach einem TTK-Fall ist, unter Risikoabwägung und Berücksichtigung besonderer Vorsichtsmaßnahmen, nicht ausgeschlossen.

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The Effect of Repeated Etomidate Anesthesia on Adrenocortical Function During a Course of Electroconvulsive Therapy

Cited by 35 publications

References 17 publications

Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

The Psychiatric Patient as a Health Resource Consumer: Costs Associated with Electroconvulsive Therapy

Tako-Tsubo-Kardiomyopathie während einer EKT-Serie: Fallbericht, systematische Literaturrecherche und Diskussion spezifischer Risikofaktoren

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