ABSTRACT
Introduction: An ideal induction agent for general anesthesia should have hemodynamic stability, minimal respiratory side effect and rapid recovery. Presently etomidate and propofol are popular rapid acting inducing agents. Material and methods: After obtaining informed written consent from patients this prospective, randomized, double blind study was conducted in 100 patients of ASA grade 3 and 4 posted for elective surgeries under general anaesthesia. They were divided into two groups of 50 in each group based on random number as group A and group B. The patients in Group A given Inj. Propofol and the patients in Group B received Inj. Etomidate. Parameters such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and spo2 were monitored continuously and recorded. Incidence and degree of pain of myoclonic movements were recorded. Demographic variables such as age,Result: gender, weight and ASA grade were comparable no significant difference existed between both the groups.Baseline mean heart rate, mean systolic blood pressure and mean diastolic blood pressure were comparable in both the Groups. (P>0.05)Significant (P<0.05) fall in mean systolic blood pressure, mean diastolic pressure and mean arterial pressure was observed immediately after induction, at 2, 5, 10 minutes up to 30 minutes in group A (propofol) compare to group B (etomidate). After then no significant difference seen in mean systolic pressure, mean diastolic pressure and mean arterial pressure. Etomidate was found ideal for its hemodynamic stability when compared to PropofolConclusion: along with less incidence of pain on injection, the only drawback being high incidence of myoclonus elderly patient.
ABSTRACT
Objective:To observe the protective effect of etomidate (ET) on cultured retinal ganglion cells (RGC) with mechanical injury in vitro.Methods:New Sprague-Dawley rat RGC was cultured in vitro and identified by double immunofluorescent labeling of Thy1.1 and microtubule associated protein 2. The cultured primary cells were randomly divided into control group, RGC scratch group, ET low dose group (1 μmol/L), ET medium dose group (5 μmol/L) and ET high dose group (10 μmol/L). The RGC mechanical injury model was established by using iris knife to culture cells in RGC scratch group and ET group with different concentration. Seven days after modeling, the RGC survival rate of each group was detected by cell count Kit 8 proliferation assay. The apoptosis rate of RGC was detected by Annexin Ⅴ/propyl iodide double staining. Single factor analysis of variance was used to compare the groups. The pairwise comparison between groups was tested by the least significant difference method.Results:The survival rates of RGC in RGC scratch group, ET low dose group, ET medium dose group and ET high dose group were (72.60±2.97)%, (73.73±1.14)%, (79.19±1.79)% and (83.88±0.94)%, respectively. The RGC apoptosis rates of control group, RGC scratch group, ET low dose group, ET medium dose group and ET high dose group were (5.08±0.17)%, (18.67±1.24)%, (17.96±0.74)%, (15.11±0.56)% and (11.67±1.32)%, respectively. Comparison of RGC survival rate between groups: compared with RGC scratch group, the cell survival rate of ET low-dose group, ET medium-dose group and ET high-dose group was increased, and the difference between RGC scratch group and ET low-dose group was not statistically significant ( P=0.728); the differences between RGC scratch group, ET medium dose group and ET high dose group were statistically significant ( P<0.001); the difference between ET medium dose group and ET high dose group was statistically significant ( P=0.002). Comparison of apoptosis rate of RGC among groups: the apoptosis rate of RGC scratch group was significantly higher than that of control group, the difference was statistically significant ( P<0.001). Compared with RGC scratch group, the apoptosis rate of ET low-dose group, ET medium-dose group and ET high-dose group was decreased, and there was no statistical significance between RGC scratch group and ET low-dose group ( P=0.869). The differences of apoptosis rate between RGC scratch group, ET medium dose group and ET high dose group were statistically significant ( P<0.05). The difference of apoptosis rate between ET medium dose group and ET high dose group was statistically significant ( P=0.007). Conclusion:ET has neuroprotective effect on RGC cultured in vitro with mechanical injury, and the protective effect increases with the increase of ET dose in a certain range.
ABSTRACT
Objective:To investigate the dose-effect relationship of alfentanil inhibiting cardiovascular responses to tracheal intubation when combined with midazolam and etomidate.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index<32 kg/m 2, undergoing elective operation under general anesthesia with endotracheal intubation, were enrolled in this study.Midazolam 0.025 mg/kg was intravenously injected for adequate sedation, and 5 min later mean arterial pressure and heart rate were recorded for 3 consecutive times at an interval of 3 min, and the mean value was calculated and served as the baseline value.Etomidate 0.3 mg/kg was intravenously injected, and alfentanil and rocuronium 0.6 mg/kg were intravenously injected when bispectral index value < 60, and then 1.4 min later tracheal intubation was performed.The dose of alfentanil was determined by the Dixon′s up-and-down method.The initial dose of alfentanil was set at 20 μg/kg.The dose of alfentanil in the next patient was determined according to the development of cardiovascular responses to tracheal intubation, and the ratio between the two successive doses was 1.0∶1.1.The cardiovascular response was defined as as positive when the maximum value of mean arterial pressure or heart rate increased by ≥20% of the baseline value within 2 min after endotracheal intubation.Probit method was used to determine the ED 50, ED 95 and 95% confidence interval of alfentanil inhibiting cardiovascular responses to tracheal intubation. Results:When combined with midazolam and etomidate, the ED 50 (95% confidence interval) of alfentanil inhibiting cardiovascular responses to tracheal intubation was 21.343 (19.105-24.516) μg/kg, and the ED 95 (95% confidence interval) was 25.043 (22.983-48.983) μg/kg. Conclusions:When combined with midazolam and etomidate, the ED 50 and ED 95 of alfentanil inhibiting cardiovascular responses to tracheal intubation are 21.343 and 25.043 μg/kg, respectively.
ABSTRACT
Objective:To evaluate the dose-response relationship of alfentanil in combination with midazolam-etomidate inhibiting cardiovascular responses to laryngeal mask airway implantation in elderly patients.Methods:American Society of Anesthesiologists Physical Status Ⅰ or Ⅱ patients of either sex, aged 65-85 yr, with body mass index of 20-30 kg/m 2, undergoing elective operation under general anesthesia, were enrolled in this study.Midazolam 0.025 mg/kg was intravenously injected for adequate sedation, 5 min later mean arterial pressure and heart rate were recorded for 3 consecutive times at 3-min interval, the mean value was collected and considered as the baseline value.Etomidate 0.2 mg/kg was intravenously injected, and alfentanil and rocuronium 0.6 mg/kg were intravenously injected when bispectral index value < 60.A laryngeal mask airway was inserted at 1.4 min after intravenous injection of alfentanil, and mechanical ventilation was performed.The dose of alfentanil was determined by the Dixon′s up-and-down method.The initial dose of alfentanil was set at 6.83 μg/kg.The dose of alfentanil in the next patient was determined according to the development of cardiovascular response to laryngeal mask airway placement.If the cardiovascular response to laryngeal mask airway placement occurred, the dose was increased for the next patient, and if cardiovascular response to laryngeal mask airway placement did not occur, the dose was decreased, and the ratio between the two successive doses was 1.0∶1.1.The cardiovascular response to laryngeal mask airway placement was defined as increase in maximum mean arterial pressure or maximum heart rate by≥20% of baseline values within 2 min after laryngeal mask airway placement.The median effective dose (ED 50), 95% effective dose (ED 95) and 95% confidence interval (95% CI) of alfentanil inhibiting cardiovascular responses to laryngeal mask airway placement in elderly patients were calculated by the Probit method. Results:When combined with midazolam and etomidate, the ED 50 (95% CI) of alfentanil inhibiting the cardiovascular responses to laryngeal mask airway placement in elderly patients were 5.605 (5.036-6.082) μg/kg, and the ED 95 (95% CI) were 6.625 (6.125-9.763) μg/kg. Conclusions:When combined with midazolam and etomidate, the ED 50 and ED 95 of alfentanil inhibiting the cardiovascular responses to laryngeal mask airway placement are 5.605 and 6.625 μg/kg, respectively, in elderly patients.
ABSTRACT
Objective:To evaluate the effects of dexamethasone and etomidate on cortisol secretion in elderly patients undergoing general anesthesia.Methods:One hundred and twenty-five elderly patients of either sex, aged 66-90 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, undergoing minor and medium elective surgeries under general anesthesia, were allocated into 4 groups using a random number table method: propofol and normal saline group (group PN, n=31), propofol and etomidate group (group PD, n=31), etomidate and normal saline group (group EN, n=33) and etomidate and dexamethasone group (group ED, n=30). In PN and EN groups, propofol (2 mg/kg) was used to induce and maintain anesthesia, and normal saline 2 ml and dexamethasone 0.1 mg/kg were intravenously injected, respectively, at 5 min before anesthesia induction.In PD and ED groups, etomidate (0.2 mg/kg) was used to induce and maintain anesthesia, and normal saline 2 ml and dexamethasone 0.1 mg/kg were intravenously injected, respectively, at 5 min before anesthesia induction.The serum cortisol concentrations were measured at 8: 00 after entering the operating room on the morning of operation (T 1), 1 h after the start of anesthesia (T 2), 2 h after the start of anesthesia (T 3), 8: 00 on the next day ofoperation (T 4) and 8: 00 on the 2nd day of operation (T 5). Blood glucose concentrations were measured at T 1-T 3, and the hypotension during the peri-anesthesia period, nausea and vomiting in post-anesthesia care unit, and nausea and vomiting scores were recorded at 24 h after operation. Results:A total of 122 patients completed the trial.Compared with PN group, the concentration of serum cortisol was significantly decreased at T 2-T 5, blood glucose concentrations were increased at T 2 and T 3 ( P<0.05), and no significant change was found in the incidence of hypotension, nausea and vomiting and nausea and vomiting scores in PD group ( P>0.05), and the concentration of serum cortisol was significantly decreased at T 2-T 4, the incidence of hypotension was decreased ( P<0.05), and no significant change was found in the blood glucose concentrations, incidence of nausea and vomiting or nausea and vomiting scores in EN group ( P>0.05). Compared with ED group, the serum cortisol concentration was significantly increased at T 2 and T 3, the incidence of hypotension was increased, the incidence of nausea and vomiting and nausea and vomiting scores were decreased ( P<0.05), and no significant change was found in the blood glucose concentrations in PD group ( P>0.05), and the serum cortisol concentration was significantly decreased at T 2 and T 3 and increased at T 4 and T 5, the serum cortisol concentration was decreased at T 2 and T 3, and no significant change was found in the incidence of hypotension, nausea and vomiting and nausea and vomiting scores in EN group ( P>0.05). Conclusions:Combination of etomidate and dexamethasone significantly enhances the duration and degree of inhibition of cortisol secretion in elderly patients than etomidate or dexamethasone alone.
ABSTRACT
Objective:To determine the dose-effect relationship of oxycodone inhibiting responses to endotracheal intubation with combination of etomidate-rocuronium during induction of general anesthesia.Methods:A total of 120 patients, aged 20-63 yr, with body mass index of 18.0-25.2 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective surgery under general anesthesia with tracheal intubation, were divided into 4 groups ( n=30 each) using a random number table method: group O 0.15, group O 0.23, group O 0.34 and group O 0.51.In O 0.15, O 0.23, O 0.34 and O 0.51 groups, oxycodone 0.15 mg/kg, 0.23 mg/kg, 0.34 mg/kg and 0.51 mg/kg were injected intravenously, respectively, 3 min later etomidate 0.3 mg/kg and rocuronium 0.8 mg/kg were intravenously injected in turn, and tracheal intubation was performed using Macintosh laryngoscope.Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure immediately before intubation and the peak levels of HR, BP and diastolic blood pressure within 3 min after intubation were recorded.The response to endotracheal intubation was defined by the SBP and (or) HR having increased by more than 30% following intubation.The occurrence of adverse events during induction of anesthesia were recorded. Results:The rate of response to endotracheal intubation was 97%, 73%, 27%, and 3% in O 0.15, O 0.23, O 0.34 and O 0.51 groups, respectively.The median effective dose (ED 50) (95% confidence interval) of oxycodone inhibiting responses to endotracheal intubation was 0.259 (0.230-0.292) mg/kg, and the 95% effective dose (ED 95) (95% confidence interval) was 0.387 (0.358-0.420) mg/kg.Only the incidence of hypotension (27%) was significantly higher in group O 0.51 than in the other 3 groups ( P<0.05). Conclusion:With combination with etomidate-rocuronium, the ED 50 and ED 95 of oxycodone inhibiting responses to endotracheal intubation performed using Macintosh laryngoscope during induction of general anesthesia are 0.259 mg/kg and 0.387 mg/kg, respectively, and the optimum dose 0.51 mg/kg is recommended.
ABSTRACT
Objective:To compare the effects of intravenous anesthesia between propofol and etomidate in patients undergoing laparoscopic surgery and their effects on plasma nitric oxide (NO) and endothelin-1 (ET-1).Methods:The clinical data of 80 patients with laparoscopic surgery in Guangrao People′s Hospital from March 2017 to March 2019 were retrospectively analyzed. Among them, 40 cases were given propofol intravenous anesthesia (propofol group), and 40 cases were given etomidate intravenous anesthesia (etomidate group). The anesthetic effect, plasma NO and ET-1 levels, hemodynamic indexes and adverse reactions (muscle spasm, nausea and vomiting, injection site pain, body movement and respiratory depression) were compared between the two groups.Results:The time of consciousness disappearance, tracheal intubation, eye opening, spontaneous breathing and speech response in etomidate group were significantly shorter than those in propofol group: (57.48 ± 2.63) s vs. (86.17 ± 7.41) s, (4.39 ± 2.56) min vs. (6.42 ± 2.58) min, (5.39 ± 2.56) min vs. (9.42 ± 2.58) min, (5.21 ± 1.99) min vs. (8.75 ± 2.54) min and (8.39 ± 2.56) min vs. (8.39 ± 2.56) min, and the differences were statistically significant ( P<0.05). The levels of NO and ET-1 in the etomidate group were significantly lower than those in the propofol group at 0.5, 1.0 and 1.5 h after pneumoperitoneum ( P< 0.05). The levels of systolic blood pressure, diastolic blood pressure and oxygen saturation (SpO 2) in the etomidate group were significantly higher than those in the propofol group: (78.42 ± 4.68) mmHg (1 mmHg = 0.133 kPa) vs. (74.11 ± 6.63) mmHg, (132.86 ± 8.71) mmHg vs. (111.24 ± 3.56) mmHg and 0.982 ± 0.032 vs. 0.953 ± 0.043, and the differences were statistically significant ( P<0.05). The incidence of adverse reactions in the etomidate group was significantly lower than that in the propofol group: 17.5% (7/40) vs. 47.5% (19/40), P<0.05. Conclusions:Compared with propofol intravenous anesthesia, etomidate intravenous anesthesia in laparoscopic surgery patients has more stable hemodynamics and better anesthetic effect. It can effectively inhibit the release of NO and ET-1, and has higher safety.
ABSTRACT
OBJECTIVES@#To explore the effect of etomidate on the neuronal activity of ventral thalamic reuniens nucleus and the underlying mechanisms.@*METHODS@#Whole-cell patch clamp method was used to explore the effect of etomidate on the activity of ventral thalamic reuniens neurons in the acute brain slices obtained from 4-5 weeks old C57BL/6J mice. The electrophysiological characteristics of ventral thalamic reuniens neurons were recorded in the current clamp mode, and then the effects of etomidate (0.5, 2.0, 8.0 μmol/L etomidate groups) and intralipid (intralipid group) on the discharge frequency and membrane potential of ventral thalamic reuniens neurons were recorded. During the experiment, the ventral thalamic reuniens neuron firing rates (RNFRs) were recorded as F@*RESULTS@#In the intralipid group, there was no significant difference among the F@*CONCLUSIONS@#Etomidate can inhibit the activity of ventral thalamic reuniens neurons in concentration-dependent manner, and which is reversible. Etomidate with sub-anesthetic concentration inhibits the activity of ventral thalamic reuniens neurons via targeting the GABA
Subject(s)
Animals , Mice , Etomidate/pharmacology , Mice, Inbred C57BL , Neurons , Patch-Clamp Techniques , Receptors, GABA-AABSTRACT
Electroconvulsive therapy (ECT) is a standard procedure in the modern psychiatric armamentarium. It involves, application of electric stimulus for a brief time in psychiatric patients to induce generalized seizure. ECT is utilized for treating various severe, treatment-resistant or refractory psychiatric disorders, schizophrenia and major depressive disorder (MDD). During ECT, severe disturbances can be noted in the cerebrovascular and cardiovascular system. Various anaesthetic drugs used in modified ECT can prevent these disturbances. We wanted to compare induction time, alteration of hemodynamics, seizure duration, and recovery time by using intravenous etomidate and intravenous propofol for induction of anaesthesia in modified electroconvulsive therapy.METHODSSixty patients were included in this prospective and comparative study. Patients of age group of 18–60 years of either sex, who had been posted for ECT therapy were randomly divided into two groups. Group E received Inj. Etomidate at 0.2 mg/Kg IV and Group P received Inj. Propofol 1% at 1.5 mg/Kg for induction of anaesthesia. Patients were monitored for various haemodynamic parameters such as heart rate, blood pressure at basal, after induction, and 1 min, 2 min, 3 min, 5 min, 10 min and 20 min following ECT. Induction time, seizure duration, quality of anaesthesia and recovery time from anaesthesia were also noted.RESULTSInduction of anaesthesia is faster with propofol (40.30 ± 3.65 sec) than with etomidate (48.63 ± 3.29 sec). Longer seizure duration was found with etomidate (58.90 ± 11.91 sec) induction in comparison to propofol (22.16 ± 5.48 sec) induction. Propofol group had more stable hemodynamic parameters compared to etomidate group following ECT. Propofol group (7 ± 1.43 min) achieved consciousness earlier than those of etomidate group (8.60 ± 1.16 min) following induction.CONCLUSIONSPropofol had the advantage of smooth induction, stable hemodynamic parameters, and rapid recovery as compared to etomidate. However, it was associated with shorter seizure duration. Etomidate had longer seizure duration which results in better clinical outcomes over propofol. However, it was associated with greater incidence of myoclonic jerks during induction.
ABSTRACT
In this nonrandomized controlled clinical trial, with the use of sample size formula, 100 patients over 60 years of age who had undergone orthopaedic surgery under general anaesthesia referred to Rafsanjan Ali-Ebn-Abi-Taleb Hospital in 2018 were enrolled in the study by convenience sampling method. After obtaining informed consent, participants were divided into two groups: A) Propofol (2 mg/Kg) and B) Etomidate (0.2 mg/Kg) for induction of anaesthesia. Haemodynamic parameters (heart rate, blood pressure, arterial oxygen saturation, amount of bleeding) and cognitive impairment were measured 1 hour before surgery, one day and three days after surgery by MMSE (for checking dementia) and NEECHAM scale (for evaluation of delirium levels). Data was analysed using Independent T-test and chi-square test. The significance level of the tests was considered to be equal to or less than 0.05.RESULTSOf the 100 patients under study, 56 (56%) were male and 44 (44%) were female. Hemodynamic change in propofol group was significantly higher than Etomidate group (p= 0.001) .The amount of bleeding in Propofol group was significantly lower than Etomidate group (p= 0.047). On the first day after surgery, the mean of MMSE score (representing dementia) in the Propofol group was lower than in the Etomidate group (p=0.043) and on the third day after surgery it was more than Etomidate group (p = 0.002). On the first day after surgery, the level of delirium in the Propofol group was lower than Etomidate group significantly (p<0.05).CONCLUSIONSThe results of this study indicate that the use of Propofol for orthopaedic surgery in elderly patients decreases the chance of delirium and increases the amount of bleeding.
ABSTRACT
BACKGROUND: To date, it has been confirmed that etomidate pre-treatment can reduce the damage of remote organs caused by limb ischemia-reperfusion, but whether etomidate post-treatment has protective effect on remote organs and its mechanism has been rarely reported. OBJECTIVE: To investigate the influence of etomidate post-treatment on limb ischemia-reperfusion lung injury. METHODS: A rat model of limb ischemia-reperfusion lung injury was prepared by clamping the bilateral femoral arteries for 2 hours and reperfusion for 3 hours. After 2 hours of limb ischemia, I/R group experienced the process of limb ischemia-reperfusion; I/R+ETO group, I/R+Dex 0.2 group, I/R+Dex 0.5 group and I/R+Dex 1.0 group, besides the model of limb ischemia-reperfusion, were injected with etomidate 1.0 mg/kg and dexamethasone 0.2, 0.5 and 1.0 mg/kg respectively through tail vein. At 3 hours of reperfusion, blood samples were extracted from the carotid artery, blood gas analysis was performed and the partial pressure of blood oxygen (PaO2) was recorded. The pathological changes were detected by immunohistochemistry. Apoptotic index was detected by Hoechst 33258 staining and wet/dry weight ratio was detected. Fas protein and Fasl mRNA of lung tissue were detected by western blot and RT-PCR respectively. Tumor necrosis factor-α and interleukin-1β levels were detected by ELISA. RESULTS AND CONCLUSION: Compared with the I/R group, PaO2 increased (P 0.05). To conclude, etomidate post-treatment can reduce lung injury caused by limb ischemia-reperfusion in rats, and its mechanism may be related to the down-regulation of Fas/FasL. In the statistical point of view, etomidate 1.0 mg/kg has the potency intensity of reducing lung injury, almost equivalent to dexamethasone 0.5 mg/kg.
ABSTRACT
Objective@#To observe the anesthesia and hemodynamic effect of etomidate compound remifentanyl in laparoscopic surgery.@*Methods@#From January 2016 to May 2016, 160 patients with gynecologic laparoscopic surgery in the Second Hospital of Shanxi Medical University were selected and randomly divided into observation group and control group according to the digital table, with 80 cases in each group.The observation group received the etomidate compound remifentanyl anesthesia, while the control group received the propofol compound remifentanyl anesthesia.the The anesthesia effect, awakening time, extubation time, pain relief time and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) before and after extubation of the two groups were observed and recorded.@*Results@#The excellent and good rate in the observation group was 98.0%, which was significantly higher than 86.0% in the control group (χ2=4.444, P<0.05). The waking time, extubation time, analgesic time in the observation group were shorter than those in the control group, the differences were no statistically significant(t=1.875, 1.631, 1.761, all P>0.05). At tracheal intubation, the SBP, DBP, HR and other indicators between the two groups had no statistically significant differences(t=1.301, 1.093, 1.097, all P>0.05). After induction of anesthesia, the SBP, DBP in the observation group were higher than those in the control group, the differences were statistically significant(t=6.182, 7.388, all P<0.05), but HR between the two groups had no statistically significant difference(t=1.428, P>0.05). After laparoscopic placement and tracheal extubation, the SBP and DBP in the observation group were significantly higher than those in the control group, the differences were statistically significant (t=5.781, 5.028, all P<0.05), and the SBP in the observation group was higher than that in the control group after tracheal extubation(t=1.203, 1.039, all P<0.05).@*Conclusion@#The anesthesia effect of etomidate compound remifentanyl is superior to propofol compound remifentanyl, the hemodynamic parameters of SBP, DBP, HR are more stable during the period of anesthesia, the curative effect is clear.
ABSTRACT
Currently, sedation anesthesia is increasingly used in many medical fields, from gastroscopy to medical imaging. The demand for sedation anesthesia is expected to increase gradually with increasing number of day surgeries and increased expectations from medical services. The demand for sedation anesthesia is considerably higher than the available pool of anesthesiologists; therefore, in a significant number of cases, sedation anesthesia is induced by non-anesthesiologists. However, there is no systematic provision of education or expertise for non-anesthesiologists in delivering sedation anesthesia. In cases of non-anesthesiologists inducing anesthesia, social controversy is often caused by medical accidents and substance abuse. In this review, I have briefly summarized what non-anesthesiologists should know about sedation anesthesia and have presented guidelines simplifying sedation anesthesia for non-anesthesia medical personnel.
Subject(s)
Ambulatory Surgical Procedures , Anesthesia , Dexmedetomidine , Diagnostic Imaging , Education , Etomidate , Gastroscopy , Hypnotics and Sedatives , Ketamine , Propofol , Substance-Related DisordersABSTRACT
Objective To observe the anesthesia and hemodynamic effect of etomidate compound remifentanyl in laparoscopic surgery.Methods From January 2016 to May 2016,160 patients with gynecologic laparoscopic surgery in the Second Hospital of Shanxi Medical University were selected and randomly divided into observation group and controlgroup according to the digital table,with 80 cases in each group.The observation group received the etomidate compound remifentanyl anesthesia,while the control group received the propofol compound remifentanyl anesthesia .the The anesthesia effect,awakening time,extubation time,pain relief time and systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR) before and after extubation of the two groups were observed and recorded .Results The excellent and good rate in the observation group was 98.0％,which was significantly higher than 86.0％in the control group (χ2 =4.444,P<0.05).The waking time,extubation time,analgesic time in the observation group were shorter than those in the control group,the differences were no statistically significant (t =1.875,1.631,1.761,all P>0.05).At tracheal intubation,the SBP,DBP,HR and other indicators between the two groups had no statistically significant differences(t=1.301,1.093,1.097,all P>0.05).After induction of anesthesia,the SBP,DBP in the observation group were higher than those in the control group ,the differences were statistically significant (t=6.182,7.388,all P<0.05),but HR between the two groups had no statistically significant difference(t=1.428,P>0.05).After laparoscopic placement and tracheal extubation,the SBP and DBP in the observation group were significantly higher than those in the control group,the differences were statistically significant (t=5.781,5.028,all P<0.05),and the SBP in the observation group was higher than that in the control group after tracheal extubation (t=1.203,1.039,all P<0.05).Conclusion The anesthesia effect of etomidate compound remifentanyl is superior to propofol compound remifentanyl ,the hemodynamic parameters of SBP ,DBP,HR are more stable during the period of anesthesia ,the curative effect is clear .
ABSTRACT
OBJECTIVE：To o bserve the e fficacy and safety of the application of etomidate combined with propofol in diagnosis and treatment of elderly patients with painless tracheoscope. METHODS ：A total of 124 elderly patients with first selective bronchoscopy under general anesthesia were collected from Anhui Chest Hospital during Oct. 2019-May 2020，and then divided into propofol group （group P ），etomidate and propofol group （group EP ）according to random number table ，with 62 cases in each group. At anesthesia induction ，Sufentanil citrate injection 5 µg was slowly injected into both groups. Based on this base，group P was given Propofol injectable emulsion 2 mg/kg intravenously ；after the eyelash reflex disappeared ，group P was given intravenous infusion of Propofol injectable emulsion 4 mg/（kg·h）to maintain sedation and Remifentanil hydrochloride for injection 0.1-0.2 µg/（kg·min）to maintain analgesia. Group EP was given slow intravenous injection of 0.5％ Propofol injectable emulsion 1 mg/kg+0.1％ Etomidate injectable emulsion 0.2 mg/kg；after the eyelash reflex disappeared ，group EP was given intravenous pump of 0.5％ Propofol injectable emulsion+ 0.1％ Etomidate injectable emulision mixture（1 ∶ 1，V/V）20 mL/h to maintain sedation and Remifentanil hydrochloride for injection to maintain analgesia （same usage and dosage as group P ）；at the same time ，2 groups were given intravenous injection of Cisatracurium besilate for injection 0.1 mg/kg，the laryngeal mask was inserted into the anesthesia machine for mechanical ventilation ，and then the laryngeal mask w as placed into the tracheoscope fordiagnosis and treatment. Heart rate （HR） and mean arterial pressure （MAP） were observed in 2 groups at the time of entering the room （T1）， at the time of eyelash reflex disappearing after anesthesia induction （T2），at the beginning of t racheal intubation examination （T3），10 min after the beginning of the exam ination（T4），at the time of anesthesia recovery （T5），and at the time of leaving the room （T6）；operation time，anesthesia recovery time ，the use of vasoactive drugs ，postoperative 4 h cognitive function and adverse reactions were also observed in 2 groups. RESULTS ：Two patients in each group were excluded. At T 1，there was no statistical significance in MAP and HR between 2 groups（P＞0.05）. There was no statistical significance in MAP of group EP among different time points （P＞ 0.05）. MAP and HR of group P at T 2，MAP of group P at T 4，HR of group EP at T 2 were significantly lower than same group at T1，and MAP of group P at T 2 and T 4 were significantly shorter or lower than those of group EP at the same time （P＜0.05）. The anesthesia recovery time ，the incidence of hypotension and the utilization rate of vasoactive drugs in group EP were significantly lower than group P ；memory ability ，calculation ability and orientation force pass rate of group EP were significantly higher than those of group P of 4 h after operation （P＜0.05）. There was no statistical significance in operation time ，the incidence of injection pain，muscle spasm ，nausea and vomiting ，focus ability ，language ability ，structure ability ，reasoning ability pass rate between 2 groups（P＞0.05）. CONCLUSIONS ：Etomidate combined with propofol shows good therapeutic efficacy and safety for elderly patients with painless tracheoscope.
ABSTRACT
OBJECTIVE@#To investigate the effects of etomidate on electrophysiological properties and nicotinic acetylcholine receptors (nAChRs) of ventral horn neurons in the spinal cord.@*METHODS@#The spinal cord containing lumbosacral enlargement was isolated from 19 neonatal SD rats aged 7-12 days. The spinal cord were sliced and digested with papain (0.18 g/30 mL artificial cerebrospinal fluid) and incubated for 40 min. At the ventral horn, acute mechanical separation of neurons was performed with fire-polished Pasteur pipettes, and perforated patch-clamp recordings combined with pharmacological methods were employed on the adherent healthy neurons. In current-clamp mode, the spontaneous action potential (AP) of the ventral horn neurons in the spinal cord was recorded. The effects of pretreatment with different concentrations of etomidate on AP recorded in the ventral horn neurons were examined. In the voltage-clamp mode, nicotine was applied to induce inward currents in the ventral horn neurons, and the effect of pretreatment with etomidate on the inward currents induced by nicotine were examined with different etomidate concentrations, different holding potentials and different use time.@*RESULTS@#The isolated ventral horn neurons were in good condition with large diverse somata and intact processes. The isolated spinal ventral horn neurons (=21) had spontaneous action potentials, and were continuously perfused for 2 min with 0.3, 3.0 and 30.0 μmol/L etomidate. Compared with those before administration, the AP amplitude, spike potential amplitude and overshoot were concentration-dependently suppressed ( < 0.01), and spontaneous discharge frequency was obviously reduced ( < 0.01, =12). The APs of the other 9 neurons were completely abolished by etomidate at 3.0 or 30 μmol/L. At the same holding potential (VH=-70 mV), pretreatment with 0.3, 3.0 or 30.0 μmol/L etomidate for 2 min concentration-dependently suppressed the current amplitude induced by 0.4 mmol/L nicotine ( < 0.01, =7). At the holding potentials of - 30, - 50, and - 70 mV, pretreatment with 30.0 μmol/L etomidate for 2 min voltage-dependently suppressed the current amplitude induced by 0.4 mmol/L nicotine ( < 0.01, =6 for each holding potential). During the 6 min of 30.0 μmol/L etomidate pretreatment, the clamped cells were exposed to 0.4 mmol/L nicotine for 4 times at 0, 2, 4, and 6 min (each exposure time was 2 s), and the nicotinic current amplitude decreased gradually as the number of exposures increased. But at the same concentration, two nicotine exposures (one at the beginning and the other at the end of the 6 min pretreatment) resulted in a significantly lower inhibition rate compared with 4 nicotine exposures ( < 0.01, =6).@*CONCLUSIONS@#etomidate reduces the excitability of the spinal ventral neurons in a concentration-dependent manner and suppresses the function of nAChR in a concentration-, voltage-, and use-dependent manner.
Subject(s)
Animals , Rats , Animals, Newborn , Etomidate , Neurons , Patch-Clamp Techniques , Spinal CordABSTRACT
The objective of current study was to compare the efficacy of three different anaesthesia induction approachesi.e. Inj propofol, Inj etomidate and admixture of Inj propofol and Inj etomidate in maintaining hemodynamicstability during induction and following Proseal LMA insertion in laparoscopic cholecystectomy. Patientswere randomly divided in to 3 groups with 90 patients each and received 2.5mg/kg of propofol(P), 0.3mg/kgof etomidate(E) and 1mg/kg of propofol+0.2mg/kg of etomidate which was mixed in a 20ml syringe. We alsostudied side-effects like PONV, myoclonus, pain on Injection, allergic reactions and thrombophlebitis. Wefound that the use of P-E admixture for induction of Proseal LMA provides hemodynamic stability as itprevents hypotension caused by propofol and also hypertension caused by etomidate when used alone. Admixturewas also associated with less incidence of other side effects like PONV, pain on Injection and myoclonus. Weconcluded that combination of propofol and etomidate for induction of anaesthesia for Proseal LMA issignificantly better than either drug used alone
ABSTRACT
Endotracheal intubation during general anaesthesia has been associated with change in haemodynamic parameters such as pulse rate and blood pressure. In this study we have compared propofol, etomidate and propofol-etomidate combination as induction agent in patients undergoing laparoscopic cholecystectomy. Material & Methods:After approval from the institutional ethical committee and informed written consent, prospective randomised double blind study was done with ASA physical status I and II. Three groups propofol(P),etomidate(E) and propofol-etomidate combination(PE) including 30 patients in each group were assigned. Haemodynamic parameters heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP),mean bood pressure(MBP),side effects and complications were seen just before induction, at 0 hr soon after intubation, than from 1min to 7min and at 10 min after intubation. Result:There was no significant differences in HR,SBP,DBP,MBP after intubation and post intubation in etomidate group as compared to propofol-etomidate and propofol group. Conclusion: Etomidate has better haemodynamic stability than etomidate-propofol combination alone at 1 min after intubation, though propofol-etomidate combination was equally stable.
ABSTRACT
Direct current cardioversion is a low-risk and standard procedure to restore normal sinus rhythm in patients with tachyarrhythmias. It requires sedation to facilitate the procedure, as it is painful and distressful. The preferred anesthetic drug must be short acting, producing conscious sedation, to enable rapid recovery after the procedure. In this sense, this narrative review focuses on the critical analysis of recent randomized studies and presents about the safety and effectiveness of propofol, comparing it with other established sedatives, mainly etomidate and midazolam. The research was performed on MEDLINE database with Propofol and Cardioversion keywords. In most cases, propofol comes to be the best option, with a quick recovery time and low rates of side effects. Different studies have demonstrated no inferiority when comparing to other drugs and, when these adverse events happened, they were easily and quickly handled. Exceptions in this scenario are those patients, particularly the elderly, with baseline important structural heart disease, in which etomidate with fentanyl has been pointed to lead to better hemodynamic stability.
ABSTRACT
BACKGROUND/AIMS: Recent studies have demonstrated that etomidate is a safe sedative drug with noninferior sedative effects. In our recent study, we revealed that etomidate/midazolam was more hemodynamically stable than propofol/midazolam in elderly patients undergoing colonoscopies. We aimed to investigate whether compared with propofol/midazolam, etomidate/midazolam causes fewer cardiopulmonary adverse events with noninferior efficacy for screening colonoscopies in patients of all ages. METHODS: In this single-center, randomized, double-blind study, we prospectively enrolled 200 patients. The patients were divided into etomidate and propofol groups. The primary outcome was the occurrence of cardiopulmonary adverse events. The secondary outcomes were the proportion of patients with fluctuations in vital signs (oxygen desaturation and transient hypotension), adverse events interrupting the procedure, and sedation-related outcomes. RESULTS: Adverse cardiopulmonary events were more common in the propofol group than the etomidate group (65.0% vs 51.0%, respectively; p=0.045). Forty-six patients (46.0%) in the propofol group and 29 (29.0%) in the etomidate group experienced fluctuations in their vital signs (p=0.013). The proportions of patients experiencing adverse events that interrupted the procedure, including myoclonus, were not significantly different between the two groups (etomidate: 20.0% vs propofol: 11.0%; p=0.079). Both groups had similar sedation-related outcomes. Multivariate analysis revealed that compared with the propofol groups, the etomidate group had a significantly lower risk of fluctuations in vital signs (odds ratio, 0.427; 95% confidence interval, 0.230 to 0.792; p=0.007). CONCLUSIONS: Compared with using propofol/midazolam, using etomidate/midazolam for screening colonoscopies results in more stable hemodynamic responses in patients of all ages; therefore, we recommend using etomidate/midazolam for colonoscopies in patients with cardiovascular risk factors.