etomidate

Etomidate, a short-acting hypnotic drug, plays a pivotal role in induction for intubation, particularly in emergency settings. Its favourable hemodynamic profile renders it a suitable choice for patients with hemodynamic instability

In this systematic review, we aim to delineate its role in emergency ward settings. Through a systematic search across databases, we identified nine eligible studies for inclusion. We searched the databases of PubMed, Scopus, ProQuest, and Medline (Ovid) from 2004 to 2023 for Randomized Controlled Trials (RCTs) and observational studies in which the study population was referred to the emergency department and received etomidate for Rapid sequence intubation (RSI).

These studies collectively underscored the safety and efficacy of etomidate in emergency patients, with its suppressive effects on the adrenal axis deemed clinically insignificant.

The rapid onset of action and favourable hemodynamic profile position etomidate as a desirable agent for rapid sequence induction. However, further studies are warranted to strengthen recommendations in this regard.

Nausea While elderly patients are at an increased risk of perioperative morbidity and mortality; old age alone is not a contraindication for surgery. General factors that should be considered in preoperative risk assessments include age, functional status, cognition, nutritional status, and comorbidities, such as cardiac, pulmonary, renal, and endocrine disorders. Induction of anesthesia is a critical step in surgery, particularly for elderly patients and those with a high physical status. Commonly used drugs for this purpose include etomidate and propofol. Therefore, this study aimed to compare the impact of Ketofol versus etomidate alone on the hemodynamic status of patients who fall under the ASA class II or higher.

The study was a prospective randomized double-blind clinical trial, with a study population of age of ≥65 years, ASA physical status class II or higher, that were randomized into two groups. Ketofol (n=45) and, Etomidate (n=45) groups. Patients followed for clinical outcomes including their hemodynamic status during the induction period.

The present study showed that, the examination of hemodynamic parameters up to 10 minute after laryngoscopy showed that none of these parameters were significantly different between the two groups, while immediately after anesthesia induction, heart rate and blood pressure were found to be significantly different. However, there was no significant difference in terms of SPO2 among the two groups in any given interval.

The results of the present study revealed that Ketofol resulted in better regulation and stability of blood pressure and heart rate in patients undergoing endotracheal intubation, compared to etomidate alone.

Due to the associated hypertension and cardiovascular disease in patients with ESRD hemodynamic changes during operations are detrimental and may be life-threatening. Therefore, hemodynamic stability is an important criterion in selecting the anesthetic approach.

72 ASA class III/IV, ESRD Patients were studied in randomized double blind clinical trial. They were divided into two groups by four-block randomization. A group of patients were induced and maintained by etomidate and second of patients were induced by Na thiopental and maintained by isoflurane. Systolic, diastolic and mean arterial blood pressure and heart rate were measured at interval of pre and post induction, postintubation, pre and post abdominal insufflation during and at the end of surgery and in recovery. The total BP modulators were recorded and postoperative nausea and vomiting was registered in the recovery. Data were analyzed by STATA version 12.

There was no significant difference in physical characteristics between two groups. There was no statistical difference between the groups in SBP and HR (P>0.05), although DBP fluctuation>20% at interval postinduction and prior to abdominal insufflation during surgery and at the end of surgery, was significantly higher in the isoflurane group of patients. (P=0.004, 0.001, 0.003 and 0.009, respectively). Also, the MAP fluctuation at interval of post induction, preinsufflation and at the end of surgery was significantly higher in isoflurane of patients. (P=0.04, 0.001, and 0.02, respectively).

The group anesthetized with isoflurane had a higher hemodynamic fluctuation, compared to the group anesthetized with etomidate. As hemodynamic changes are critical in patients with ESRD, etomidate is a more appropriate anesthetic choice for implantation of peritoneal dialysis catheter by laparoscopic approach.

Hemodynamic disorders during anesthesia lead to complications. To reduce hemodynamic complications, this study was conducted to compare midazolam, etomidate, and propofol following anesthesia induction in patients undergoing coronary artery bypass grafting surgery (CABG).

A double-blind, randomized clinical trial was conducted involving 90 patients with coronary artery disease. These patients were randomly assigned to 1 of 3 groups receiving propofol, etomidate, or midazolam. Hemodynamic variables, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP), and heart rate (HR), were measured at baseline, before intubation, and 1 and 5 minutes after intubation.

Ninety patients with coronary artery disease (mean age: 60.83 y) were included in the study. Women and men comprised 74.4% and 25.6% of the study population. HR, SBP, DBP, and MABP exhibited significant decreases in all 3 groups after intubation. The etomidate group demonstrated the least change in SBP (P<0.001) and MABP (P<0.001), followed by the midazolam group. Concerning HR, the least change was observed in the midazolam group, followed by the propofol group (P=0.688). After intubation, blood pressure increased almost equally in the etomidate and midazolam groups compared with the levels during intubation. In contrast, the propofol group exhibited a downward trend in blood pressure during intubation, a significant difference across all 3 groups (P<0.001).

This study, conducted on candidates for CABG, demonstrated that anesthesia induction with etomidate and midazolam resulted in less variation in hemodynamic variables compared with propofol.

Gastrointestinal endoscopy is a prevalent diagnostic and therapeutic procedure employed for both children and adults. Since Etomidate is a short acting intravenous drug with hemodynamic stability and also it is the choice for sedation and anesthesia among patients afflicted with cardiovascular conditions, we decided to compare the benefits and drawbacks of the mentioned drugs in children undergoing endoscopy.

For conducting the research, 90 pediatric participants, aged from 1 to 15 years, with ASA I and II class requiring upper gastrointestinal endoscopy (admitted to Mofid Children Hospital) were randomly selected. For 45 patients, intravenous anesthetic drug Propofol (Group P) was administered for sedation required during endoscopy, while in the remaining 45 patients, Etomidate (Group E) was used, and hemodynamic fluctuations, apnea occurrence frequency, sedation recovery length, and nausea and vomiting after sedation were monitored and compared between the two groups. Finally, the data were analyzed using SPSS v.18 software, and t-test and chi-square statistical tests.

The average age of the patients was 7.8 ± 7.9 years. The recovery following anesthesia in Group P was 8.3 ± 4.3 minutes, while in Group E, it was 7 ± 3.2 minutes (p=0.373). The reduction in SPO2 levels in Group P was 7.1 ± 3.9%, and in Group E, it was 1.4 ± 0.6% (p=0.01). The variations in heart rate (HR) were 3.9 ± 7.1 in Group P and 0.6 ± 1.4 in Group E (p=0.01). Changes in blood pressure (BP) were 10.1 ± 7.9 mmHg in Group P and 2.7 ± 1.3 mmHg in Group E (p = 0.235). The incidence of apnea was 26.7% (12 individuals) in Group P and 46.7% (21 individuals) in Group E (p=0.02). The occurrence of nausea and vomiting was 4.4% (2 individuals) in Group P and 20% (9 individuals) in Group E (p=0.01).

The result of the findings suggests that the patients receiving Etomidate experienced lower saturation drop, and quicker awakening compared to the group of patients receiving Propofol, while the occurrence of apnea, nausea, and vomiting were higher.

 Laryngoscopy and tracheal intubation lead to an increased sympathetic reflex response, which is associated with increased heart rate and blood pressure. This response can be detrimental in patients with myocardial ischemia. This study aimed to investigate the effects of etomidate in comparison to a combination of midazolam and sodium thiopental in reducing the sympathetic response to laryngoscopy and tracheal intubation.

 This double-blind, randomized clinical trial study was conducted on two groups of 39 candidates for elective surgery under general anesthesia. Anesthesia was induced by etomidate (E) 0.3 mg/kg in the first group and sodium thiopental 2.5 mg/kg and midazolam 0.075 mg/kg in the second group (TM); then, the patients were intubated. Laryngoscopy findings and cardiovascular response were evaluated during the study. Finally, the data were analyzed using SPSS version 23 (IBM SPSS, Armonk, NY, USA).

 There was no significant difference between the two groups in terms of age (P = 0.82), weight (P = 0.42), height (P = 0.201), body mass index (P = 0.78), gender (P = 0.65), American Society of Anesthesiologists (ASA) physical status (P = 0.36), and laryngoscopy view grading (P = 0.83). The average laryngoscopy time in the E group was less than the TM group (P = 0.019). In the TM group, at 10 minutes after intubation, mean diastolic blood pressure (P = 0.029) and mean arterial blood pressure (P = 0.023) were significantly lower; however, at other times, there was no significant difference between the two groups (P > 0.05). There was no significant difference between the two groups in terms of adverse responses to laryngoscopy and intubation (P = 0.19).

 The results of the present study showed that etomidate (E) and a combination of midazolam-sodium thiopental (TM) acted similarly in attenuating the cardiovascular response to laryngoscopy and tracheal intubation, and it seems that TM can be used instead of E if needed.

Etomidate is mentioned as one of the rapid intravenous anesthetic drugs whose unique characteristics include hemodynamic stability, negligible respiratory depression, and brain protection. The most common complication of etomidate is intravenous pain during injection. The purpose of this study was to compare the effectiveness of the Valsalva maneuver and fentanyl in reducing the pain caused by etomidate injection for anesthesia induction. This clinical trial was performed on 96 patients at Alzahra hospital, affiliated with the Isfahan University of Medical Sciences, from January to June 2021. Patients were divided into two groups of 48 people: the Valsalva maneuver group (group 1) and the fentanyl group (group 2). Blood pressure, heart rate (HR), oxygen saturation, and pain of etomidate injection using the withdrawal response score were graded on a four-point scale (no pain = zero, mild pain = 1, average pain = 2, and severe pain = 3). The collected information was entered into SPSS software version 24. Then, the pain score in the two groups was compared using the chi-square test. The significance level in the present study was P < 0.05. The mean HR (P = 0.07), mean arterial pressure (MAP) (P = 0.33), systolic pressure (P = 0.90), diastolic pressure (P = 0.67), and oxygen saturation level (P = 0.27) at different times between the two groups showed no significant difference (P > 0.05). However, during the etomidate injection, the HR increased and after the injection, the HR decreased in both groups (P = 0.042). The two groups had no significant difference regarding pain frequency. There was no difference in the effect of the Valsalva maneuver and fentanyl on reducing the pain caused by etomidate injection.

To compare dexmedetomidine, ketamine, and etomidate in the induction of sedation and hemodynamic changes in patients undergoing cataract surgery by phacoemulsification method.

This was a double‑blind clinical trial study carried out on 128 patients. Using the block randomization method, the patients were divided into four equal groups (dexmedetomidine, ketamine, etomidate, and control). Mean arterial pressure, heart rate, and arterial oxygen saturation, Ramsay Sedation Score were recorded every 5 min intraoperatively, in recovery, and 1, 2, 4, and 6 h postoperatively. Moreover, the Aldrete score was measured in recovery time for discharge from the recovery room.

The mean age of participants was found to be 63.16 ± 6.07 years, and there was no statistically significant difference between the groups in terms of age, sex, and body mass index, SpO2, and heart rate (P > 0.05). From 15 min after the start of surgery to 6 h postoperatively, the mean arterial pressure in the dexmedetomidine group was significantly lower than that in the other three groups, including ketamine, etomidate, and control (P < 0.05). The mean sedation score (Ramsay) during recovery and 1 h postoperatively was higher in the dexmedetomidine group compared with that in the control group, whereas the recovery time in the dexmedetomidine group was higher than that in the other groups (P < 0.001). In addition, the amount of propofol consumption in the two groups of dexmedetomidine and ketamine was significantly less than that in the etomidate and control groups (P < 0.001).

According to the results, dexmedetomidine caused better hemodynamic changes with more reduction in blood pressure and heart rate, and patients in the dexmedetomidine group did not require any specific medical treatment. Moreover, higher patient satisfaction and longer recovery duration were observed in the dexmedetomidine group than in the other study groups. As such, it is suggested that dexmedetomidine be used as an adjuvant in cataract surgery for more sedation, analgesia, and optimal intraoperative conditions.

Etomidate is an ultra-short-acting anesthetic agent derived from imidazole that can only be administered intravenously. Etomidate has excellent hemodynamic properties in inducing anesthesia, making it an ideal choice for patients with shock, hypovolemia, or significant cardiovascular disease, with minimal reduction in blood pressure. We report a case of a female patient who was given accidental etomidate intrathecally instead of ropivacaine because of its similar appearance, which led to a slight decrease in blood pressure and no change in the pulse rate. The patient had stable vital signs and no neurological complications.

This study aimed to compare the efficacies of four anesthetic induction drugs (thiopental, propofol, midazolam‑thiopental, and etomidate‑propofol) on cardiovascular response during laryngeal mask airway (LMA) placement in eye surgery.

The present clinical trial study included 128 patients who were candidates for ophthalmic surgery in four groups. Patients in the first group were given a combination of midazolam (0.04 mg/kg) with thiopental (2.5 mg/kg) (Group T + M). We administered propofol alone (2.5 mg/kg) to patients in the second group (Group P). The third group received a combination of etomidate (0.1 mg/kg) with propofol (1 mg/kg) (ET + P group) and patients in the fourth group received thiopental drug (5 mg/kg) alone (Group T). Then, the stability of patients’ hemodynamic parameters before anesthesia was evaluated and compared immediately after anesthesia, 1, 3, and 5 min after LMA placement.

There was no significant difference between the four groups in changes in oxygen saturation level (P > 0.05). Furthermore, the difference between decreased systolic blood pressure and diastolic blood pressure over time was not significant in 5 min in both Groups T + M and T (P > 0.05). In addition, the stability of these two groups was higher than the other two groups (P < 0.05) and the most unstable group was Group P. The changes pulse rate in the P group were significant (P < 0.05).

According to the results of the current study, thiopental and Midazolam can be used as an effective induction compound to facilitate LMA insertion with higher hemodynamic stability compared to propofol alone, propofol and etomidate, and thiopental alone. Keywords: Etomidate, l

Among the medications administered for the management of COVID-19 patients, the induction drugs used for intubation have received little attention. The aim of this study was to compare the effect of induction drugs on the mortality of patients with COVID-19 requiring intubation.

In this retrospective study, all patients who were admitted to Shahid Sadoughi and Shahid Rahnemoun hospitals in Yazd from February to March 2020 with definitive diagnosis of COVID-19 and needed intubation were enrolled. Patients were divided into 4 groups based on the type of drugs used in intubation, and mortality rate was assessed at the end of the first, second, fourth, and seventh days of the study. Statistical analyses were performed using SPSS 20 and P values < .05 was considered significant  .

In this study, 76 patients were examined. Patients were divided into 4 groups, of which 21 were in etomidate group, 8 in ketamine group, 21 in sodium thiopental group, and 35 in midazolam group. Mortality rate in these 4 groups was 25%, 12.5%, 14.3%, and 14.3% (p=0.822), respectively at the end of the first day after intubation; it was 83.3%, 12.5%, 28.6%, and 25.7% (p=0.001), respectively, at the end of the second day; it was 83.3%, 12.5%, 42.9%, and 42.9% (p=0.015), respectively, until the end of the fourth day; it was 100%, 25%, 61.9%, and 65.7% (p=0.007), respectively, until the end of the seventh day. Admission to intubation time interval was 0.91±0.99, 3.12±1.95, 4.09±2.44, and 4.74±2.62 days, respectively (p<0.001).

The results of this study suggest that the use of etomidate may be associated with higher mortality in COVID-19 patients. Further studies are needed to verify the results of this study.

The very idea of faster recovery and early ambulation has prompted patients to opt for day care surgeries. The concept of ERAS (enhanced recovery after surgery) is the backbone to achieve this goal. We conducted this study with primary objective to compare the post-operative recovery with etomidate and propofol in terms of early recovery (awakening), intermediate recovery (psychomotor and cognitive recovery) and ambulation “home readiness” and secondary objective to study the adverse effects.

60 eligible patients scheduled for day care gynaecological procedures were randomised in two groups of 30 each. Group E received etomidate 0.2mg/kg and group P received propofol 2mg/kg. Early, intermediate and late postoperative recovery (ambulation) was studied in both groups.

Demography between the groups were comparable while hemodynamic fluctuations were more with propofol (p>0.05), early recovery was faster with etomidate (p = 0.07), psychomotor tests revealed better alertness with etomidate (p= 0.1) and patient could ambulate earlier in etomidate group.

Both propofol and Etomidate facilitate early recovery but etomidate provides hemodynamic stability with early awakening, more alert patients and better ambulation and was found to be superior for day care surgeries.

 The purpose of this study is a comparison of Valsalva, lidocaine, and Valsalva with administration of lidocaine to reduce the pain associated with administration of etomidate.

 The present study is a clinical trial study. The number of samples in each group was 30 and a total of 90 people were selected. This study was a clinical trial and the subjects were randomly divided into three groups: Group 1: Valsalva, 2: Lidocaine, 3: Valsalva and Lidocaine. Pain due to etomidate was rated on a VAS from 1 (painless) to 3 (worst imaginable pain) and their information was recorded. The collected information was entered into SPSS 22 and analyzed with appropriate statistical tests.

 A total of 90 subjects participated in the present study and were divided into 3 groups: Valsalva, lidocaine, and Valsalva with lidocaine. No significant difference was observed between demographic variables in the study groups. There was a significant relationship between severity of pain in the three groups. According to the results, the highest pain intensity was in the Valsalva group and the lowest pain intensity was in the Valsalva with lidocaine group.

 Valsalva with lidocaine reduces the severity of pain caused by etomidate to a greater extent than other groups.
 

Etomidate is an efficient general anesthetic associated with injection pain. Etomidate-Lipurois its lipid emulsion, suggested to have less adverse effects. We aim to compare the injection pain of etomidate vs. etomidate-lipuro.

This double-blind randomized clinical trial investigated 46 hands (23 patients) undergoing elective orthopedic surgery referring to our hospital from May to September 2017. For each patient, intravenous (IV) access was put on both hands, on oneof which 2 ml of etomidate (drug A) and on the other one, 2 ml of etomidate-lipuro (drug B) were infused simultaneously. Pain scores were compared between drug types by the Wilcoxon signed-rank test using the SPSS software.

Among 23 patients included in the study, 8 (34.8%) were female. Mean ± standard deviation (SD) of the patients’ age was 40.52 ± 13.07 years (range: 22-60 years). The type of drug injected to the right hand was drug A in 14 hands (60.9%) and drug B in 9 hands (39.1%). Mean ± SD of pain scores was 3.57 ± 3.30 for drug A (P < 0.001). The hand side (left/right) showed no significant effect on the pain scores (P = 0.535).

This randomized clinical trial used each person as his/her own control (left/right hands). Given the results, etomidate-lipuro showed significant superiority over etomidate regarding injection pain. In fact, most patients felt no pain, which suggests etomidate-Lipuro as an appropriate sedative.

Etomidate is an imidazole derivative and formulated in 35% propylene glycol. When given without a rapid lidocaine injection, etomidate is associated with pain after injection. Magnesium (Mg) is a calcium channel blocker and influences the N‑methyl‑D‑aspartate receptor ion channel. The aim of the study is to evaluate the efficiency of preemptive injection of magnesium sulfate and lidocaine on pain alleviation on etomidate intravenous injection.

In a randomized, double‑blinded trial study, 135 adult patients scheduled for elective outpatient or inpatient surgery were divided into three groups. Group M received 620 mg magnesium sulfate, Group L received 3 ml lidocaine 1% and Group S received normal saline, all in a volume of 5 mL followed by a maximal dose of 0.3 mg/kg of 1% etomidate. Pain was assessed on a four‑point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain and 3 = severe pain at the time of pretreatment and etomidate injection.

About 60% of patients in the control group had pain during etomidate injection as compared to 22.2% and 40% in the lidocaine and magnesium sulfate groups, respectively. There was difference in induction pain score between three treatment groups, significantly (P = 0.01) and observed differences in pain scores between “normal saline and lidocaine group” (P < 0.001) and “normal saline and magnesium sulfate groups” were statistically meaningful (P = 0.044).

Intravenous magnesium sulfate and lidocaine injection are comparably effective in reducing etomidate‑induced pain.

Ectopic increase of adrenocorticotropic hormone (ACTH) or ectopic Cushing syndrome is a rare initial presentation of small cell carcinoma and carcinoid tumor of the lung. Here, we reported a 36-year-old male with atypical symptoms of Cushing syndrome managed by Etomidate that had a central pulmonary nodule, and pathologic evaluation of pulmonary lobectomy revealed the diagnosis of well-differentiated, low-grade typical carcinoids of lung.

According to the favorable effects of combination therapy to provide better sedation during phacoemulsification and lack of any studies investigating the sedative effect of etomidate, propofol, and midazolam in combination with fentanyl during the procedure. The current study aimed at comparing the sedative properties of the mentioned three combination therapies in this field. The current double-blind, randomized, controlled clinical trial was conducted on patients referred for elective phacoemulsification surgery under sedation. They were randomly allocated to the three groups to receive fentanyl plus one of the following medications: Propofol, midazolam, and etomidate. Demographic characteristics, medical condition, and hemodynamic parameters before, during, and after surgery, sedation level, anesthetic complications, sedation-related adverse events, and patients’ and surgeons’ satisfaction were evaluated and recorded by the anesthesiologist and compared in the three studied groups. In the current study, out of 150 enrolled patients, 98 completed the study. Frequency of different levels of Ramsay scores was not significantly different between the groups (P = 0.41). Frequency of Ramsay scores 3 and 4 was 92%, 79.4%, and 88.2% in etomidate, midazolam and propofol groups, respectively (P = 0.32). The median recovery time was significantly higher in the midazolam group than the propofol group (P = 0.04); intergroup comparisons indicated that the patients’ mean score of satisfaction in the propofol group was significantly higher than that of the etomidate group (P = 0.006). The current study findings indicated that though the quality of sedation during phacoemulsification cataract surgery was acceptable in the three agents and the results had no significantly differences among the groups, and considering other factors including recovery time, hemodynamic evaluation, sedation-related complications, and patients’ satisfication scores, it is suggested that propofol was superior to the other two agents.