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1.
Medicine (Baltimore) ; 102(1): e32612, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36607884

RESUMO

OBJECTIVE: Etomidate is often combined in rapid succession during induction of anesthesia. However, the effect of pretreatment with oxycodone on recovery of cognitive function and adverse effects has rarely been studied. We conducted a prospective randomized controlled trial to compare etomidate alone with etomidate combined with oxycodone in elderly patients undergoing painless gastroscopy. METHODS: Hundred elderly patients undergoing painless gastroscopy were divided into a control and an observation group, with 50 cases in each group. The age, gender, height, weight, body mass index and American Society of Anesthesiologists physical status (I/II) of patients in both groups were recorded. The recovery of cognitive function was compared in both groups using the Neurobehavioral Cognitive Status Examination. Adverse events, including somatic motor reactions, hypotension, bradycardia, myocardial tremor, nausea and vomiting, and injection pain, were also recorded in both groups. Moreover, heart rate, peripheral capillary oxygen saturation, systolic blood pressure, and diastolic blood pressure were evaluated in the 2 groups at different time points. RESULTS: A total of 100 patients were enrolled in this study. The demographic characteristics in the 2 groups were not significantly different (P > .05). Regarding the recovery of cognitive functions, more subjects in the observation group passed the memory, arithmetic and orientation test than in the control group (P < .05). Fewer adverse events such as dynamic body reactions, cardiac tremor, nausea and vomiting, and injection pain occurred in the observation group than in the control group (P < .05). During anesthesia and after awakening, the results of peripheral capillary oxygen saturation, systolic blood pressure and diastolic blood pressure were better in the observation group than in the control group (P < .05). CONCLUSION: Etomidate in combination with oxycodone for painless gastroscopic operation in the elderly is a safe and effective anesthetic strategy.


Assuntos
Etomidato , Propofol , Humanos , Idoso , Etomidato/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Oxicodona/efeitos adversos , Gastroscopia/métodos , Estudos Prospectivos , Tremor , Dor/induzido quimicamente , Vômito/induzido quimicamente , Náusea/induzido quimicamente
2.
Rev. esp. anestesiol. reanim ; 69(10): 663-673, dic. 2022. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-211944

RESUMO

Introducción: La secuencia de intubación rápida es una técnica de protección y rescate de la vía aérea que requiere el uso de sedantes para propiciar un adecuado escenario durante la intubación orotraqueal. Son utilizados diferentes sedantes inductores, siendo el etomidato el más común por sus cualidades farmacocinéticas y farmacodinámicas, donde resalta su estabilidad hemodinámica. Sin embargo, en comparación con otros sedantes esta superioridad es controvertida. Materiales y métodos: Se realizó un metaanálisis con un protocolo definido a priori y siguiendo las etapas de la guía PRISMA. Se calculó la diferencia de medias de la presión arterial sistólica antes y después de la administración del sedante, además de un metaanálisis de riesgos relativos de hipotensión. Resultados: Se incluyeron 10 estudios en los cuales la incidencia de hipotensión en el grupo de pacientes que recibió el etomidato osciló entre el 6,4% y el 75,2%, mientras que en los que recibieron otros sedantes osciló entre el 24,0% y el 65,9%. En los metaanálisis de diferencia de medias no se hallaron diferencias significativas de la presión arterial sistólica durante la preintubación 0,01mmHg (IC 95%: –0,90; 0,92), ni en la postintubación 0,98mmHg (IC 95%: –0,24; 2,20). Además, el metaanálisis de riesgos relativos indica que el riesgo de hipotensión es igual a un RR 1,19 (IC 95%: 0,92-1,54) entre quienes recibieron el etomidato y aquellos que recibieron los otros sedantes. Conclusiones: El riesgo de hipotensión posterior a la secuencia de intubación rápida con etomidato no presenta diferencias significativas comparado con otros sedantes. Sin embargo, hay heterogeneidad en los estudios incluidos.(AU)


Introduction: Rapid sequence intubation is an airway rescue and protection technique in which different sedatives are used to perform orotracheal intubation. Etomidate, due to its pharmacokinetic and pharmacodynamic qualities, particularly hemodynamic stability, is the most widely used sedative in this scenario. However, its superiority over other sedatives is controversial. Materials and methods: We performed a meta-analysis using a pre-designed protocol and PRISMA guidelines to evaluate the mean difference between systolic blood pressure before and after administration of the sedative. We also analyzed the relative risks of hypotension. Results: Ten studies were included. The incidence of hypotension in patients receiving etomidate ranged from 6.4% to 75.2%, and between 24.0% and 65.9% in patients receiving other sedatives. No significant differences were found in the mean difference in systolic blood pressure during pre-intubation 0.01mmHg (95% CI: –0.90; 0.92) or in post-intubation 0.98mmHg (95% CI: –0.24; 2.20). The relative risk analysis showed that the risk of hypotension is equal to an RR of 1.19 (95% CI: 0.92-1.54) between those who received etomidate and those who received the other sedatives. Conclusions: The risk of hypotension after rapid intubation sequence with etomidate does not differ significantly compared to other sedatives. However, the studies included in this review were heterogeneous.(AU)


Assuntos
Humanos , Hemodinâmica , Etomidato , Intubação , Hipnóticos e Sedativos , Hipotensão , Anestesiologia , Pressão Arterial
3.
Trials ; 23(1): 992, 2022 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-36503508

RESUMO

BACKGROUND: Patients with a history of cardiac disease are prone to develop cardiovascular adverse events such as hypotension, hypertension, and tachycardia during anesthesia induction. Therefore, hemodynamic stability is one of the most important concerns for induction of anesthesia in patients undergoing cardiac surgery. Remimazolam tosilate is a new, ultra-short-acting benzodiazepine agent, with the advantages of rapid onset, rapid offset, and minimal cardiorespiratory depression. We aim to compare the effect of remimazolam tosilate and etomidate on hemodynamics during anesthesia induction in patients undergoing valve replacement surgery. METHODS/DESIGN: The trial is a prospective, randomized, double-blinded, controlled, single-center trial to compare the effect of remimazolam tosilate and etomidate on hemodynamics in patients undergoing valve replacement surgery. One hundred seventeen patients undergoing selective valve replacement surgery between January 1, 2022, and December 31, 2023, will be enrolled and randomly allocated into one of three groups: low-dose remimazolam group (Group LR), high-dose remimazolam group (Group HR), or etomidate group (Group E). The primary outcome is hemodynamic fluctuations during anesthesia induction (the difference between mean arterial pressure [MAP] to baseline, ▴MAP; and the difference between maximum or minimum heart rate [HR] and baseline, ▴HR). Secondary outcomes include the incidence of adverse cardiovascular events (hypotension, severe bradycardia, hypertension, tachycardia, and arrhythmia), the cumulative doses of vasoactive drugs used per patient, incidence and degree of injection pain and myoclonus, blood glucose values, and vital signs at different time points. DISCUSSION: This research will determine the effectiveness and safety of remimazolam tosilate induction on hemodynamics in patients undergoing valve replacement surgery. TRIAL REGISTRATION: www.chictr.org .cn identifier ChiCTR2100052535 . Registered on 17th Dec 2021, http://www.chictr.org.cn/ ).


Assuntos
Benzodiazepinas , Etomidato , Hipertensão , Hipotensão , Humanos , Anestesia Geral/métodos , Anestésicos Intravenosos/efeitos adversos , Benzodiazepinas/efeitos adversos , Etomidato/efeitos adversos , Hipertensão/induzido quimicamente , Hipotensão/induzido quimicamente , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Ann Card Anaesth ; 25(4): 441-446, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36254908

RESUMO

Background and Aims: Transcatheter device closure of congenital heart defects (CHD) has recently gained popularity. As limited literature exists regarding the ideal anesthetic technique for these procedures, we studied the perioperative anesthetic management and its effects on hemodynamics and complication rate in patients undergoing device closure. Methods: In this prospective observational study, all patients of 1 month to 50 years of age with acyanotic congenital heart diseases undergoing device closure were included. The anesthesia technique, i.e., general anesthesia with endotracheal tube (GETA)/supraglottic airway device (SGD) or conscious sedation with face mask (S-FM), and intravenous induction agent used was noted. Intraoperatively vital parameters, use of transesophageal echocardiography (TEE), and perioperative complications if any, were noted. Descriptive statistical analysis was done using a statistical package for the social sciences (SPSS) version 15. Results: GETA was used in the atrial septal defect (ASD) (62.8%), patent ductus arteriosus (PDA) (66.7%), ventricular septal defect (VSD) (65%) patients, SGD in ASD (6.3%), PDA (16.7%), and VSD (13.3%) patients. S-FM in ASD (31.3%), PDA (16.7%) and VSD (21.7%) patients. Etomidate was used as an induction agent in 30.61% of the patients and propofol in 69.39% of the patients. The mean arterial pressure (MAP) in the etomidate and propofol groups was statistically insignificant while decreased heart rate was noted in both groups. Complications like SGD dislodgement, supraventricular tachycardia, and device dislodgements were seen. Conclusion: In PDA device closure patients, GETA should be preferred. Patients for VSD device closure should receive general anesthesia as complications are common. In ASD device closure, patients without TEE use can be done under general anesthesia with SGD.


Assuntos
Anestésicos , Permeabilidade do Canal Arterial , Etomidato , Cardiopatias Congênitas , Comunicação Interatrial , Comunicação Interventricular , Propofol , Cateterismo Cardíaco/métodos , Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia Transesofagiana/métodos , Cardiopatias Congênitas/cirurgia , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Estudos Prospectivos , Resultado do Tratamento
5.
Clin Nucl Med ; 47(11): 936-942, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36215396

RESUMO

BACKGROUND: Appropriate treatment of primary aldosteronism (PA) depends on accurate lateralization. 11 C-metomidate (MTO) is a tracer used in PET that provides functional information about the adrenal cortex. We aimed to perform MTO PET for patients with PA who are managed according to the guideline and to verify its correlation with other lateralization modalities and usefulness in outcome prediction. METHODS: Seventeen patients with PA who underwent MTO PET and had ≥1 lateralization modality (adrenal venous sampling and/or NP-59 adrenal scintigraphy) were included. SUV max of each adrenal gland (higher uptake side, HSUV max ; lower uptake side, LSUV max ) and the ratio of HSUV max to LSUV max (contrast) were compared with lateralization modalities, postsurgical outcomes, and medical treatment outcomes. Cutoff values were used as outcome predictors. RESULTS: HSUV max and LSUV max increased in the order of bilateral, unilateral, and negative findings of CT, with opposite order of contrast. High discordant rate between MTO PET and other lateralization modalities was noted. Biochemical responders (n = 8) had significantly lower HSUV max and LSUV max than nonresponders, and clinical responders (n = 6) had borderline lower HSUV max than nonresponders. By optimal cutoff values of HSUV max and LSUV max , MTO PET was able to predict biochemical and clinical outcomes in patients with medical treatment. CONCLUSION: According to adrenal CT findings, MTO PET presented different uptake patterns. Patients with PA under medical treatment showed significantly lower tracer uptake in responders. Thus, MTO PET may be a useful imaging biomarker to predict medical treatment outcome. Multicenter prospective study with a larger number of patients is needed for further validation.


Assuntos
Adosterol , Hiperaldosteronismo , Etomidato/análogos & derivados , Fluordesoxiglucose F18 , Humanos , Hiperaldosteronismo/tratamento farmacológico , Hiperaldosteronismo/terapia , Tomografia por Emissão de Pósitrons/métodos , Estudos Prospectivos
6.
Semin Cardiothorac Vasc Anesth ; 26(4): 260-265, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36198482

RESUMO

Background. Intubations, especially in emergent settings, carry a high risk of hemodynamic instability with potentially catastrophic outcomes. Weight-based dosing of induction drugs can be inappropriately high for elective or emergent intubations and lead to hemodynamic instability. We hypothesized that monitoring the patient state index of SEDLine monitors (Masimo, Irvine, CA) would decrease the dose of induction drugs in the operating room during elective intubations.Methods. In this randomized study, SEDLine monitoring was provided to the intervention group but not to the control group during the induction of anesthesia in the operating room. Anesthesia providers in the intervention group were advised to titrate induction drugs to a Patient State Index of <50 before proceeding with intubation. The primary outcome was the induction dose of propofol and etomidate per kilogram normalized to propofol dose equivalents. Secondary outcomes included supplemental doses of ketamine, midazolam, fentanyl, phenylephrine, and ephedrine per kg, time from induction to intubation, administration of additional propofol or vasopressors after induction, mean arterial pressure ≥ or <65 mmHg, and lowest mean arterial pressure post-induction.Results. We found no significant difference in propofol equivalents between groups (P = .41). Using a SEDLine decreased the odds that a patient would require vasopressors during induction (odds ratio of .39 [95% confidence interval, .15-.98]).Conclusion. SEDLine monitoring during induction did not decrease dosing of the induction drugs etomidate and propofol but decreased the odds of receiving vasopressors. Further studies are warranted to assess the utility of processed electroencephalography in emergent intubations outside of the operating room.


Assuntos
Etomidato , Propofol , Humanos , Propofol/farmacologia , Anestésicos Intravenosos , Projetos Piloto , Hemodinâmica , Vasoconstritores
7.
In Vivo ; 36(6): 2722-2729, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36309382

RESUMO

BACKGROUND/AIM: The influence of surgical interventions and anaesthesiological procedures on tumour progression was investigated as early as the 1920s. In current cancer management, the perioperative phase is increasingly being considered a vulnerable period with an increased risk of tumour cell dissemination due to medication, surgical manipulation, and immunosuppression. The extent to which narcotics administered in the perioperative setting influence the oncological outcomes of patients with pancreatic cancer is still unclear. MATERIALS AND METHODS: To investigate the effect of propofol and etomidate on the proliferation, cell-cycle distribution, apoptosis, and necrosis of pancreatic tumour cells in vitro, PaTu 8988t and Panc-1 pancreatic cancer cells were treated with 0-1,000 µM propofol or etomidate for 24 h each. Cell proliferation was measured with enzyme-linked immunosorbent-bromodeoxyuridine assay. The apoptosis rate was analysed with annexin V staining and the cell-cycle distribution with flow cytometry. RESULTS: Propofol at 1,000 µM induced apoptosis and inhibited cell proliferation. The cell cycle showed an increased S-phase and reduced cells in the G1-phase. At 100 µM, propofol significantly inhibited proliferation of the pancreatic cancer cell line PaTu 8988t and reduced cells in the G2-phase in the cell cycle. Etomidate had no effects on cell-cycle distribution, proliferation, apoptosis, and necrosis at the concentrations used. CONCLUSION: In this study, propofol was shown to have anticancer effects by induction of apoptosis and inhibition of cell proliferation, while etomidate did not affect pancreatic cancer cells. However, it is too early to make any recommendation for changes in clinical practice and further clinical studies are warranted to investigate the effect of anaesthetics on cancer progression.


Assuntos
Etomidato , Neoplasias Pancreáticas , Propofol , Humanos , Etomidato/farmacologia , Etomidato/uso terapêutico , Propofol/farmacologia , Propofol/uso terapêutico , Apoptose , Necrose , Neoplasias Pancreáticas/patologia , Ciclo Celular , Proliferação de Células
8.
Pediatr Endocrinol Diabetes Metab ; 28(3): 226-232, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36134674

RESUMO

The purpose of this work was to present the current state of knowledge on the effects of frequently used therapeutic forms, selected pharmacotherapy (including glucocorticosteroids, immune checkpoint inhibitors, mitotane, metyrapone, aminoglutetimide, etomidate, ketoconazole, fluconazole), but also radiation therapy on the functioning of the hypothalamic-pituitary-adrenal axis in children and adolescent during and after oncological treatment. The most common pediatric cancers, where complications of adrenal insufficiency occur, are presented. Moreover, current recommendations how to diagnose the function of the adrenal axis in oncological pediatric patients, as well during oncological treatment as after it, including patients treated with steroids and also patients in severe stages, are reported. The rules of the treatment of adrenal dysfunction in those patients are presented. This understanding is of key importance for oncologists and endocrinologists in the process of diagnosing, treating and developing patient health care, as well as during therapy as after it, offering safety and improving the quality of life.


Assuntos
Etomidato , Sistema Hipófise-Suprarrenal , Adolescente , Glândulas Suprarrenais , Criança , Etomidato/farmacologia , Fluconazol/farmacologia , Humanos , Sistema Hipotálamo-Hipofisário , Inibidores de Checkpoint Imunológico , Cetoconazol/farmacologia , Cetoconazol/uso terapêutico , Metirapona/farmacologia , Metirapona/uso terapêutico , Mitotano/farmacologia , Mitotano/uso terapêutico , Qualidade de Vida
9.
Eur Rev Med Pharmacol Sci ; 26(17): 6221-6235, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36111923

RESUMO

OBJECTIVE: Etomidate-induced myoclonus is common in clinical anesthesia. Propofol and lidocaine, as other sedative hypnotic and anticonvulsant drugs, rarely induce myoclonus. The mechanism of the myoclonus remains unclear. MATERIALS AND METHODS: Eighty-four adult male Sprague-Dawley (SD) rats anesthetized intravenously with etomidate, propofol, or lidocaine plus etomidate were observed of the behavioral changes at 0, 1, 2, 3, 4 and 5 min after anesthesia. Five minutes later, glutamate levels were measured in the cerebrospinal fluid (CSF), neocortex and hippocampus. The mRNAs and proteins expression of EAAT1, EAAT2, and GFAP in the neocortex and hippocampus were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR), Western blot and immunofluorescence staining. RESULTS: Etomidate increased the mean behavioral scores at different time points and the neocortical glutamate level compared with the propofol (p=0.0283) and the lidocaine plus etomidate group (p=0.0035); The correlation analysis revealed a strong correlation between the mean behavioral score and the neocortical glutamate content (Spearman's r=0.6638, p=0.0027). No significant difference was found in the EAAT1, EAAT2, or GFAP mRNAs in the neocortex and hippocampus among three groups; etomidate decreased EAAT1 (p=0.0416 and p=0.0127) and EAAT2 (p=0.0363 and p=0.0109) proteins but increased the GFAP (p=0.0145 and p=0.0149) protein in the neocortex compared to the propofol and lidocaine plus etomidate group. Furthermore, etomidate activated GFAP-positive cells in the neocortex, but conversely inhibited proteins of EAATs in motor cortex. CONCLUSIONS: Etomidate-induced myoclonus is associated with neocortical glutamate accumulation. Suppression of the astrogliosis in neocortex and promoting extracellular glutamate uptake by regulating glutamate transporters (EAATs) in the motor cortex may be the therapeutic target for prevention of etomidate-induced myoclonus.


Assuntos
Sistema X-AG de Transporte de Aminoácidos , Astrócitos , Etomidato , Mioclonia , Sistema X-AG de Transporte de Aminoácidos/efeitos dos fármacos , Sistema X-AG de Transporte de Aminoácidos/metabolismo , Animais , Anticonvulsivantes/uso terapêutico , Astrócitos/efeitos dos fármacos , Astrócitos/metabolismo , Etomidato/efeitos adversos , Etomidato/farmacologia , Ácido Glutâmico/metabolismo , Hipnóticos e Sedativos/efeitos adversos , Lidocaína , Masculino , Mioclonia/induzido quimicamente , Mioclonia/metabolismo , Neocórtex/metabolismo , Propofol , Ratos , Ratos Sprague-Dawley
10.
Mol Biol Cell ; 33(13): ar119, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36103253

RESUMO

Propofol is a widely used general anesthetic, yet the understanding of its cellular effects is fragmentary. General anesthetics are not as innocuous as once believed and have a wide range of molecular targets that include kinesin motors. Propofol, ketamine, and etomidate reduce the distances that Kinesin-1 KIF5 and Kinesin-2 KIF3 travel along microtubules in vitro. These transport kinesins are highly expressed in the CNS, and their dysfunction leads to a range of human pathologies including neurodevelopmental and neurodegenerative diseases. While in vitro data suggest that general anesthetics may disrupt kinesin transport in neurons, this hypothesis remains untested. Here we find that propofol treatment of hippocampal neurons decreased vesicle transport mediated by Kinesin-1 KIF5 and Kinesin-3 KIF1A ∼25-60%. Propofol treatment delayed delivery of the KIF5 cargo NgCAM to the distal axon. Because KIF1A participates in axonal transport of presynaptic vesicles, we tested whether prolonged propofol treatment affects synaptic vesicle fusion mediated by VAMP2. The data show that propofol-induced transport delay causes a significant decrease in vesicle fusion in distal axons. These results are the first to link a propofol-induced delay in neuronal trafficking to a decrease in axonal vesicle fusion, which may alter physiological function during and after anesthesia.


Assuntos
Anestésicos Gerais , Etomidato , Ketamina , Propofol , Anestésicos Gerais/metabolismo , Transporte Axonal/fisiologia , Axônios/metabolismo , Etomidato/metabolismo , Humanos , Ketamina/metabolismo , Cinesinas , Microtúbulos/metabolismo , Propofol/metabolismo , Propofol/farmacologia , Proteína 2 Associada à Membrana da Vesícula/metabolismo
11.
Hormones (Athens) ; 21(4): 735-742, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36129663

RESUMO

Endogenous Cushing's syndrome (CS) is associated with increased morbidity and mortality. Early diagnosis and initiation of therapy are essential, but effective treatment remains a challenge. In a long-term follow-up, biochemical control of hypercortisolemia, especially when severe, is difficult to achieve. Life-threatening hypercortisolemia is difficult to control due to the limitations of pharmacotherapy, including its side effects, and may require etomidate infusion in the intensive care unit (ICU) to rapidly lower cortisol levels. The effectiveness of hypercortisolemia management can be increased by a dual blockade of cortisol production. We report the efficacy, safety, and tolerability of combined therapy with two steroidogenesis inhibitors, etomidate, and osilodrostat, in a 32-year-old woman diagnosed with severe ACTH-dependent hypercortisolemia, subsequently maintaining a stable level of cortisol with osilodrostat monotherapy. This approach enabled achievement of relatively rapid control of the hypercortisolemia while using an etomidate infusion and concomitant increasing doses of oral osilodrostat applying a "titrations strategy." Our experience shows that it is worth taking advantage of the synergistic anticortisolic action of etomidate with osilodrostat.


Assuntos
Síndrome de Cushing , Etomidato , Feminino , Humanos , Adulto , Síndrome de Cushing/induzido quimicamente , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/tratamento farmacológico , Etomidato/efeitos adversos , Hidrocortisona/uso terapêutico , Imidazóis/uso terapêutico
12.
Am J Emerg Med ; 61: 131-136, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36096015

RESUMO

INTRODUCTION: Emergency department (ED) patients undergoing emergent tracheal intubation often have multiple physiologic derangements putting them at risk for post-intubation hypotension. Prior work has shown that post-intubation hypotension is independently associated with increased morbidity and mortality. The choice of induction agent may be associated with post-intubation hypotension. Etomidate and ketamine are two of the most commonly used agents in the ED, however, there is controversy regarding whether either agent is superior in the setting of hemodynamic instability. The goal of this study is to determine whether there is a difference in the rate of post-intubation hypotension who received either ketamine or etomidate for induction. Additionally, we provide a subgroup analysis of patients at pre-existing risk of cardiovascular collapse (identified by pre-intubation shock index (SI) > 0.9) to determine if differences in rates of post-intubation hypotension exist as a function of sedative choice administered during tracheal intubation in these high-risk patients. We hypothesize that there is no difference in the incidence of post-intubation hypotension in patients who receive ketamine versus etomidate. METHODS: A retrospective cohort study was conducted on a database of 469 patients having undergone emergent intubation with either etomidate or ketamine induction at a large academic health system. Patients were identified by automatic query of the electronic health records from 1/1/2016-6/30/2019. Exclusion criteria were patients <18-years-old, tracheal intubation performed outside of the ED, incomplete peri-intubation vital signs, or cardiac arrest prior to intubation. Patients at high risk for hemodynamic collapse in the post-intubation period were identified by a pre-intubation SI > 0.9. The primary outcome was the incidence of post-intubation hypotension (systolic blood pressure < 90 mmHg or mean arterial pressure < 65 mmHg). Secondary outcomes included post-intubation vasopressor use and mortality. These analyses were performed on the full cohort and an exploratory analysis in patients with SI > 0.9. We also report adjusted odds ratios (aOR) from a multivariable logistic regression model of the entire cohort controlling for plausible confounding variables to determine independent factors associated with post-intubation hypotension. RESULTS: A total of 358 patients were included (etomidate: 272; ketamine: 86). The mean pre-intubation SI was higher in the group that received ketamine than etomidate, (0.97 vs. 0.83, difference: -0.14 (95%, CI -0.2 to -0.1). The incidence of post-intubation hypotension was greater in the ketamine group prior to SI stratification (difference: -10%, 95% CI -20.9% to -0.1%). Emergency physicians were more likely to use ketamine in patients with SI > 0.9. In our multivariate logistic regression analysis, choice of induction agent was not associated with post-intubation hypotension (aOR 1.45, 95% CI 0.79 to 2.65). We found that pre-intubation shock index was the strongest predictor of post-intubation hypotension. CONCLUSION: In our cohort of patients undergoing emergent tracheal intubation, ketamine was used more often for patients with an elevated shock index. We did not identify an association between the incidence of post-intubation hypotension and induction agent between ketamine and etomidate. Patients with an elevated shock index were at higher risk of cardiovascular collapse regardless of the choice of ketamine or etomidate.


Assuntos
Etomidato , Hipotensão , Ketamina , Choque , Humanos , Adolescente , Etomidato/efeitos adversos , Ketamina/efeitos adversos , Estudos Retrospectivos , Intubação Intratraqueal/efeitos adversos , Hipotensão/epidemiologia , Hipotensão/etiologia , Hipotensão/diagnóstico , Hipnóticos e Sedativos/efeitos adversos , Choque/complicações
13.
Contrast Media Mol Imaging ; 2022: 4863682, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35992545

RESUMO

In order to explore more ideal intravenous anesthesia drug in clinical practice, the analgesic effect of remazolam combined with etomidate in painless gastroenteroscopy and its effect on stress response is investigated. A total of 100 patients are selected for the gastric disease screening, and they are randomly divided into the single-drug group and composite group, with 50 cases in each group. Etomidate, mazzolone, and etomidate are used to anesthetize the patients, and then, the effects of different solutions on analgesia, sedation, and stress response are compared and analyzed, and the adverse reactions are improved. The etomidate and red horse azole shimron composite etomidate anesthesia were applied, and the comparative analysis of different solutions of analgesic, sedative effect, and response to stress is conducted. Then, the improvement of adverse reactions is analyzed. The experimental results demonstrate that remazolam combined with etomidate anesthesia can reduce the level of pain mediators and enhance the analgesia and sedation effect. Meanwhile, combined anesthesia can reduce the stress response and adverse reactions of patients and shorten the examination period effectively.


Assuntos
Anestesia , Etomidato , Propofol , Anestésicos Intravenosos/efeitos adversos , Animais , Etomidato/efeitos adversos , Cavalos , Propofol/efeitos adversos
14.
J Forensic Sci ; 67(6): 2479-2486, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35982590

RESUMO

Etomidate, with efficacy similar to that of propofol, has been used as a propofol substitute because propofol is a designated narcotic drug, and an increase in the frequency of illegal distribution and misuse has been reported in Korea. Previous analytical studies on etomidate used blood and urine. For long-term use and timing estimation, a method for etomidate analysis using hair should be developed. Therefore, in this study, an analytical method using LC-MS/MS was developed to determine etomidate and its major metabolite in hair. Human hair samples were segmented after washing to eliminate possible contaminants on the hair and stirred with methanol. The LC-MS/MS conditions were optimized, and the chromatographic separation time was 10 min. Selectivity, linearity, limit of detection, limit of quantification, precision, accuracy, recovery, process efficiency, matrix effect, and stability were evaluated to validate the analytical method. The calibration curves ranged from 0.25 to 50 pg/mg for etomidate and 2-250 pg/mg for etomidate acid; the coefficients of determination were higher than 0.997. The intra- and inter-assay precision results for all the compounds were <15% and satisfied at recovery, process efficiency, matrix effect, and stability. In addition, this method was applied to the hair of 4 rats which are administered with etomidate to evaluate. The etomidate concentrations in the rat hair ranged from 2.60 to 8.50 pg/mg, and the etomidate acid concentrations were 2.06-7.13 pg/mg. Thus, this method can be used as basic data for monitoring etomidate in hair.


Assuntos
Etomidato , Propofol , Humanos , Ratos , Animais , Cromatografia Líquida/métodos , Espectrometria de Massas em Tandem/métodos , Propofol/análise , Propofol/química , Cabelo/química , Detecção do Abuso de Substâncias/métodos
15.
Ann Emerg Med ; 80(4): 364-370, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35927113

RESUMO

STUDY OBJECTIVE: Drugs stored in rescue helicopters may be subject to extreme environmental conditions. The aim of this study was to measure whether drugs stored under the real-life conditions of a Swiss helicopter emergency medical service (HEMS) would retain their potency over the course of 1 year. METHODS: A prospective, longitudinal study measuring the temperature exposure and concentration of drugs stored on 2 rescue helicopters in Switzerland over 1 year. The study drugs included epinephrine, norepinephrine, amiodarone, midazolam, fentanyl, naloxone, rocuronium, etomidate, and ketamine. Temperatures were measured inside the medication storage bags and the crew cabins at 10-minute intervals. Drug stability was measured on a monthly basis over the course of 12 months using high-performance liquid chromatography. The medications were considered stable at a minimum remaining drug concentration of 90% of the label claim. RESULTS: Temperatures ranged from -1.2 °C to 38.1 °C (29.84 °F to 100.58 °F) inside the drug storage bags. Of all the temperature measurements inside the drug storage bags, 37% lay outside the recommended storage conditions. All drugs maintained a concentration above 90% of the label claim. The observation periods for rocuronium and etomidate were shortened to 7 months because of a supply shortage of reference samples. CONCLUSION: Drugs stored under the real-life conditions of Swiss HEMS are subjected to temperatures outside the manufacturer's approved storage requirements. Despite this, all drugs stored under these conditions remained stable throughout our study. Real-life stability testing could be a way to extend drug exchange intervals.


Assuntos
Amiodarona , Serviços Médicos de Emergência , Etomidato , Ketamina , Aeronaves , Cromatografia Líquida de Alta Pressão , Estabilidade de Medicamentos , Armazenamento de Medicamentos , Epinefrina , Fentanila , Humanos , Estudos Longitudinais , Midazolam , Naloxona , Norepinefrina , Estudos Prospectivos , Rocurônio , Temperatura
17.
JAMA Surg ; 157(10): 888-895, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35947398

RESUMO

Importance: Older patients may benefit from the hemodynamic stability of etomidate for general anesthesia. However, it remains uncertain whether the potential for adrenocortical suppression with etomidate may increase morbidity. Objective: To test the primary hypothesis that etomidate vs propofol for anesthesia does not increase in-hospital morbidity after abdominal surgery in older patients. Design, Setting, and Participants: This multicenter, parallel-group, noninferiority randomized clinical trial (Etomidate vs Propofol for In-hospital Complications [EPIC]) was conducted between August 15, 2017, and November 20, 2020, at 22 tertiary hospitals in China. Participants were aged 65 to 80 years and were scheduled for elective abdominal surgery. Patients and outcome assessors were blinded to group allocation. Data analysis followed a modified intention-to-treat principle. Interventions: Patients were randomized 1:1 to receive either etomidate or propofol for general anesthesia by target-controlled infusion. Main Outcomes and Measures: Primary outcome was a composite of major in-hospital postoperative complications (with a noninferiority margin of 3%). Secondary outcomes included intraoperative hemodynamic measurements; postoperative adrenocortical hormone levels; self-reported postoperative pain, nausea, and vomiting; and mortality at postoperative months 6 and 12. Results: A total of 1944 participants were randomized, of whom 1917 (98.6%) completed the trial. Patients were randomized to the etomidate group (n = 967; mean [SD] age, 70.3 [4.0] years; 578 men [59.8%]) or propofol group (n = 950; mean [SD] age, 70.6 [4.2] years; 533 men [56.1%]). The primary end point occurred in 90 of 967 patients (9.3%) in the etomidate group and 83 of 950 patients (8.7%) in the propofol group, which met the noninferiority criterion (risk difference [RD], 0.6%; 95% CI, -1.6% to 2.7%; P = .66). In the etomidate group, mean (SD) cortisol levels were lower at the end of surgery (4.8 [2.7] µg/dL vs 6.1 [3.4] µg/dL; P < .001), and mean (SD) aldosterone levels were lower at the end of surgery (0.13 [0.05] ng/dL vs 0.15 [0.07] ng/dL; P = .02) and on postoperative day 1 (0.14 [0.04] ng/dL vs 0.16 [0.06] ng/dL; P = .001) compared with the propofol group. No difference in mortality was observed between the etomidate and propofol groups at postoperative month 6 (2.2% vs 3.0%; RD, -0.8%; 95% CI, -2.2% to 0.7%) and 12 (3.3% vs 3.9%; RD, -0.6%; 95% CI, -2.3% to 1.0%). More patients had pneumonia in the etomidate group than in the propofol group (2.0% vs 0.3%; RD, 1.7%; 95% CI, 0.7% to 2.8%; P = .001). Results were consistent in the per-protocol population. Conclusions and Relevance: Results of this trial showed that, compared with propofol, etomidate anesthesia did not increase overall major in-hospital morbidity after abdominal surgery in older patients, although it induced transient adrenocortical suppression. Trial Registration: ClinicalTrials.gov Identifier: NCT02910206.


Assuntos
Etomidato , Propofol , Idoso , Aldosterona , Anestesia Geral , Anestesia Intravenosa , Anestésicos Intravenosos/efeitos adversos , Hospitais , Humanos , Hidrocortisona , Masculino , Complicações Pós-Operatórias/etiologia , Propofol/efeitos adversos
18.
Anesthesiology ; 137(5): 568-585, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36018576

RESUMO

BACKGROUND: Etomidate, barbiturates, alfaxalone, and propofol are anesthetics that allosterically modulate γ-aminobutyric acid type A (GABAA) receptors via distinct sets of molecular binding sites. Two-state concerted coagonist models account for anesthetic effects and predict supra-additive interactions between drug pairs acting at distinct sites. Some behavioral and molecular studies support these predictions, while other findings suggest potentially complex anesthetic interactions. We therefore evaluated interactions among four anesthetics in both animals and GABAA receptors. METHODS: The authors used video assessment of photomotor responses in zebrafish larvae and isobolography to evaluate hypnotic drug pair interactions. Voltage clamp electrophysiology and allosteric shift analysis evaluated coagonist interactions in α1ß3γ2L receptors activated by γ-aminobutyric acid (GABA) versus anesthetics [log(d, AN):log(d, GABA) ratio]. Anesthetic interactions at concentrations relevant to zebrafish were assessed in receptors activated with low GABA. RESULTS: In zebrafish larvae, etomidate interacted additively with both propofol and the barbiturate R-5-allyl-1-methyl m-trifluoromethyl mephobarbital (R-mTFD-MPAB; mean ± SD α = 1.0 ± 0.07 and 0.96 ± 0.11 respectively, where 1.0 indicates additivity), while the four other drug pairs displayed synergy (mean α range 0.76 to 0.89). Electrophysiologic allosteric shifts revealed that both propofol and R-mTFD-MPAB modulated etomidate-activated receptors much less than GABA-activated receptors [log(d, AN):log(d, GABA) ratios = 0.09 ± 0.021 and 0.38 ± 0.024, respectively], while alfaxalone comparably modulated receptors activated by GABA or etomidate [log(d) ratio = 0.87 ± 0.056]. With low GABA activation, etomidate combined with alfaxalone was supra-additive (n = 6; P = 0.023 by paired t test), but etomidate plus R-mTFD-MPAB or propofol was not. CONCLUSIONS: In both zebrafish and GABAA receptors, anesthetic drug pairs interacted variably, ranging from additivity to synergy. Pairs including etomidate displayed corresponding interactions in animals and receptors. Some of these results challenge simple two-state coagonist models and support alternatives where different anesthetics may stabilize distinct receptor conformations, altering the effects of other drugs.


Assuntos
Anestésicos , Etomidato , Propofol , Animais , Etomidato/farmacologia , Etomidato/metabolismo , Peixe-Zebra/metabolismo , Receptores de GABA/metabolismo , Mefobarbital , Receptores de GABA-A , Anestésicos/farmacologia , Propofol/farmacologia , Barbitúricos/farmacologia , Sítios de Ligação , Hipnóticos e Sedativos/farmacologia , Ácido gama-Aminobutírico , Eletrofisiologia
19.
Sci Rep ; 12(1): 12296, 2022 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-35853975

RESUMO

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.


Assuntos
Córtex Suprarrenal , Dexmedetomidina , Etomidato , Córtex Suprarrenal/efeitos dos fármacos , Hormônio Adrenocorticotrópico/metabolismo , Fatores Etários , Idoso , Anestésicos Intravenosos , Dexmedetomidina/administração & dosagem , Método Duplo-Cego , Etomidato/administração & dosagem , Humanos , Hidrocortisona/administração & dosagem , Propofol/administração & dosagem , Remifentanil/administração & dosagem
20.
BMC Anesthesiol ; 22(1): 206, 2022 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-35790907

RESUMO

BACKGROUND: Many of the anaesthetic drugs used for electroconvulsive therapy have anticonvulsant properties and may influence efficacy of electroconvulsive therapy. With this study we aim to provide more information on the effect of etomidate and methohexital on seizure duration. We explore the relationship between induction drug, motor and electroencephalography seizure duration. Moreover, we study the relationship of seizure duration and number of therapies. METHODS: In this retrospective study we collected data from patient records from 2005 until 2016. Inclusion criteria were the use of etomidate and/or methohexital and documentation of dosage, electroconvulsive therapy dosage and seizure duration. Exclusion criteria were missing data on either induction drug, dosage or seizure duration. RESULTS: Thirty seven patients were analysed. The mean age was 52 years and seventy six percent were female. Most patients were suffering from affective disorders (81%). Motor and electroencephalography seizure duration were analysed in 679 and 551 electroconvulsive therapies, respectively. Compared to methohexital, motor and electroencephalography seizures under etomidate were 7 and 13 s longer, respectively. Furthermore, there was a negative association between seizure duration and number of treatment and a negative association between seizure duration and electroconvulsive therapy dosage. CONCLUSIONS: This study demonstrates significant longer motor and electroencephalography seizure duration using etomidate compared to methohexital. Etomidate might therefore increase the effectiveness of electroconvulsive therapy. Moreover, we observed a negative association between seizure duration, number of treatment and electroconvulsive therapy dosage. With this study we contribute to the available literature comparing methohexital and etomidate as induction agents for electroconvulsive therapy.


Assuntos
Eletroconvulsoterapia , Etomidato , Anestésicos Intravenosos , Etomidato/farmacologia , Feminino , Humanos , Masculino , Metoexital/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos , Convulsões
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