Etomidate 투여 후 간대성근경련을 예방하기 위한 Alfentanil 전투여의 적정용량

조상윤,전우재,남유미,염종훈,김경헌 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.53 No.3

Background: Myoclonus is a common problem during induction of general anesthesia with etomidate. We investigated the optimal dosage of alfentanil pretreatment for prevention of myoclonus after injection of etomidate. Methods: In a double blinded fashion, 76 patients scheduled for outpatient elective surgery were randomized into 4 groups according to pretreatment drug: alfentanil 2.5μg/kg, alfentanil 5μg/kg, alfentanil 10μg/kg, or normal saline. The pretreatment was followed by etomidate 0.3 mg/kg IV. Laryngeal mask airway (LMA) was inserted at 5 minutes after the induction. The patients were observed for any myoclonic movement. Onset time, duration and intensity of myoclonus, side effects of alfentanil, mean arterial pressure and heart rate were measured during the study period. Results: There were significant differences in the incidence and intensity of myoclonus. An injection of 5, and 10μg/kg alfentanil before etomidate prevented increase of mean arterial pressure and heart rate after LMA insertion. But injection of 10 μg/kg alfentanil before etomidate appeared generalized muscle rigidity, bradycardia and hypotension. Conclusions: An injection of 2.5, 5, and 10μg/kg alfentanil before etomidate decreases the incidence and intensity of myoclonus. But injection of 10μg/kg alfentanil before etomidate appeared side effects. Therefore the optimal dosage of alfentanil pretreatment for prevention of myoclonus after injection of etomidate is 5μg/kg. Background: Myoclonus is a common problem during induction of general anesthesia with etomidate. We investigated the optimal dosage of alfentanil pretreatment for prevention of myoclonus after injection of etomidate. Methods: In a double blinded fashion, 76 patients scheduled for outpatient elective surgery were randomized into 4 groups according to pretreatment drug: alfentanil 2.5μg/kg, alfentanil 5μg/kg, alfentanil 10μg/kg, or normal saline. The pretreatment was followed by etomidate 0.3 mg/kg IV. Laryngeal mask airway (LMA) was inserted at 5 minutes after the induction. The patients were observed for any myoclonic movement. Onset time, duration and intensity of myoclonus, side effects of alfentanil, mean arterial pressure and heart rate were measured during the study period. Results: There were significant differences in the incidence and intensity of myoclonus. An injection of 5, and 10μg/kg alfentanil before etomidate prevented increase of mean arterial pressure and heart rate after LMA insertion. But injection of 10 μg/kg alfentanil before etomidate appeared generalized muscle rigidity, bradycardia and hypotension. Conclusions: An injection of 2.5, 5, and 10μg/kg alfentanil before etomidate decreases the incidence and intensity of myoclonus. But injection of 10μg/kg alfentanil before etomidate appeared side effects. Therefore the optimal dosage of alfentanil pretreatment for prevention of myoclonus after injection of etomidate is 5μg/kg.

뇌압이 증가된 환자에서 마취유도 용량의 Etomidate와 Propofol 일회량 정주가 뇌관류압에 미치는 효과의 비교

안우용,연준흠,김계민,이윤석,김정원,홍기혁 대한정맥마취학회 2000 정맥마취 Vol.4 No.2

서론: 두개내압 항진은 두부 외상 후에 자주 발생하고 치명적인 합병증이다. 이 연구는 두개내압이 항진되어 있는 중환자실 환자들에서 etomidate 일회 정주가 동맥혈압, 두개내압, 뇌관류압에 미치는 효과를 알아보고 propofol과 비교하기 위해서 고안되었다. 방법: 1998년 7월부터 12월까지 상계 백병원 중환자실에 두부외상으로 입원한 성인 환자 일곱명을 대상으로 하였다. 일차수술을 통해 혈종을 제거한 후 혼수상태로서 기계환기를 받고 있으면서 두개내 탐침으로 두개내압을 감시하고 있었다. 이미 시행되고 있는 신경외과적 치료는 별도로 통제하지 않았다. 평균 동맥혈압과 두개내압의기본값을 측정한 뒤 etomidate 0.3 ㎎/㎏과 propofol 2 ㎎/㎏ 중에서 무작위로 한가지 약물을 선택하여 말초혈관을 통해 서서히 정주하였다. 투여 후 2, 4, 6, 8, 10분에 평균 동맥혈압과 두개내압을 측정하여 뇌관류압을 계산하였다. 48시간이 지난 뒤 나머지 약물에 대한 연구를 같은 방법으로 시행하였다. 모든 측정치는 반복측정 분산분석으로 약물 내, 약물 간에 비교하였다. 결과: Etomidate와 propofol 투여로 인한 평균 동맥 혈압의감소는 etomidate에서 5 ㎜Hg, propofol에서 6 ㎜Hg로서 기본값에 비해서 투여 후 2분 동안 유의한 차이가 있었지만(P < 0.05) 약물간에는 차이가 없었다. 두개내압은 etomidate 투여 후 2분부터 10분까지 5 ㎜Hg, propofol 투여 후 2 ㎜Hg의 유의한 감소폭을 유지하였지만(P < 0.05) 약물 간의 차이는 없었다. 계산된 뇌관류압은 두 약제 모두에서 의미있는 변화를 보이지 않았다. 결론: 두개내압 항진에 대해서 이미 고식적인 치료가 시작된 두부외상 환자에서 마취유도 용량의 etomidate와 propofol 일회정주로는 뇌관류압 개선을 얻을 수 없었다. Background: Increased intracranial pressure (ICP) is one of life-threatening complications after head injury. This study was conducted to evaluate the effectiveness of etomidate single bolus on mean arterial pressure (MAP), ICP and cerebral perfusion pressure (CPP) compared to that of propofol in postoperative patients with increased ICP. Methods: Seven patients with increased ICP after head injury were randomly selected. ICP was monitored continuously in intensive care unit. Managements already given for lowering ICP, such as hyperventilation, barbiturate and mannitol, were not controlled. Study was done in 2 steps. Baseline measurements of MAP and ICP were obtained for 5 minutes. In the first step, etomidate 0.3 ㎎/㎏ in three patients and propofol 2 ㎎/㎏ in four patients were given slowly through peripheral vein. MAP and ICP were recorded at 2, 4, 6, 8 and 10 minutes after drug administration. In the second step, performed 48 hours later, study drug was swapped in each patient. Details were same with the first step. CPP was calculated by difference of MAP and ICP. All measurements were analyzed within and between drugs by repeated measures ANOVA & multiple comparison. Results: MAP reduced were 5 ㎜Hg by etomidate and 6 ㎜Hg by propofol, which were not significant between drugs and confined to 2 minutes after drug administration (P < 0.05). ICP reduced by 5 ㎜Hg by etomidate and 2 ㎜Hg by propofol, which such reductions were sustained for 10 minutes (P < 0.05), however, there was no statistical difference between drugs. CPP were not changed significantly by both drugs. Conclusions: Etomidate and propofol single boluses cannot improve CPP in patients with increased ICP.

The effect of injection rate on etomidate-induced myoclonus

도상환,한성희,박상현,김진희,황진영,손일순,김민석 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.53 No.3

Background: Etomidate frequently causes myoclonus. Since the myoclonus is caused by a transient disequilibrium due to etomidate exposure in the CNS, we hypothesized that a slow rate of injection of the drug may decrease the incidence of myoclonus. We conducted a prospective randomized study to compare the effect of two different types of the etomidate injection rate on the incidence and severity of myoclonus. Methods: Fifty patients were randomly assigned to the fast-injection group (group F) or slow-injection group (group S): Group F patients received etomidate (0.3 mg/kg) over ten seconds. The same dose was administered over two minutes for group S patients. The response to the injection of etomidate was graded on a four-point scale in a blinded manner. The time to loss of consciousness (LOC) was also recorded. Results: The incidence of myoclonus was significantly lower (P < 0.001) in group S patients; 84% and 28% in group F and group S patients, respectively. The myoclonus was also significantly less severe in group S patients (P < 0.001). The time to LOC was significantly longer in group S patients (106 ± 22 sec) than that of group F patients (49 ± 18 sec, P < 0.001). Conclusions: With same dose, a slower rate of injection resulted in a lower incidence of myoclonus and can effectively reduce myoclonus without the use of a pretreatment agent. Background: Etomidate frequently causes myoclonus. Since the myoclonus is caused by a transient disequilibrium due to etomidate exposure in the CNS, we hypothesized that a slow rate of injection of the drug may decrease the incidence of myoclonus. We conducted a prospective randomized study to compare the effect of two different types of the etomidate injection rate on the incidence and severity of myoclonus. Methods: Fifty patients were randomly assigned to the fast-injection group (group F) or slow-injection group (group S): Group F patients received etomidate (0.3 mg/kg) over ten seconds. The same dose was administered over two minutes for group S patients. The response to the injection of etomidate was graded on a four-point scale in a blinded manner. The time to loss of consciousness (LOC) was also recorded. Results: The incidence of myoclonus was significantly lower (P < 0.001) in group S patients; 84% and 28% in group F and group S patients, respectively. The myoclonus was also significantly less severe in group S patients (P < 0.001). The time to LOC was significantly longer in group S patients (106 ± 22 sec) than that of group F patients (49 ± 18 sec, P < 0.001). Conclusions: With same dose, a slower rate of injection resulted in a lower incidence of myoclonus and can effectively reduce myoclonus without the use of a pretreatment agent.

Using Etomidate and Midazolam for Screening Colonoscopies Results in More Stable Hemodynamic Responses in Patients of All Ages

Jung Min Lee,Geeho Min,Bora Keum,Jae Min Lee,Seung Han Kim,Hyuk Soon Choi,Eun Sun Kim,Yeon Seok Seo,Yoon Tae Jeen,Hoon Jai Chun,Hong Sik Lee,Soon Ho Um,Chang Duck Kim 거트앤리버 소화기연관학회협의회 2019 Gut and Liver Vol.13 No.6

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.

응급실에서 기관내삽관시에 진정제로 사용된 Etomidate의 효과와 안정성

최상천,김기운,민영기,윤상규,조준필,정윤석 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Purpose: The purpose of this study was to estimate the efficacy and the safety of etomidate for rapid sequence intubation (RSI) in the emergency department. Methods: A retrospective analysis by chart review was done for patients who had needed intubation in the emergency department of Ajou university hospital from July 1999 to June 2000. Results: Three hundred (300) patients were enrolled in this study. Etomidates were used for 170 patients and Thiopental for 130 patients. in the Etomidate group, the average systolic blood pressures (SBP) were 127.7±42.2 mmHg prior to etomidate administration and 125.6±40.9 mmHg after. The average diastolic blood pressures (DBP) were 78.1±22.4 mmHg prior to etomidate administration and 79.1±21.3 mmHg after. There was no significant change in blood pressure after the use of etomidate. The average intubation time was about 3.9 minutes. Eight (8) patients experienced myoclonus and three (3) of vomiting after the use of etomidate. In the thiopental group, statistically significant decreases in the average SBP and DBP were seen after the administration of thiopental sodium. Twelve (12) patients had decreased blood pressure and one (1) patient arrhythmia after Thiopental administration. The average intubation time was about 5.9 minutes. Conclusion: The intubation time for etomidate group was superior to that for thiopental group. Also, in the etomidate group, no significant changes in the hemodynamic variables were noted during RSI. This study supports the efficacy and the safety of etomidate for RSI in the emergency department.

임상연구 : 근이완제 투여 없이 Remifentanil을 사용한 기관 삽관 시 마취 유도제로 사용된 Thiopental, Propofol, Etomidate가 기관 삽관 환경 및 혈역학적 변화에 미치는 영향

김용호 ( Yong Ho Kim ),민진혜 ( Jin Hye Min ),최영순 ( Young Soon Choi ),이우경 ( Woo Kyung Lee ),이용경 ( Yong Kyung Lee ),이현민 ( Hyun Min Lee ),채영근 ( Young Keun Chae ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1

Background: Many studies have suggested that propofol in combination with remifentanil may provide adequate conditions for tracheal intubation without the use of muscle relaxants. Other hypnotic drugs have not been thoroughly investigated in this regard. The goal of our study was to evaluate the effect of thiopental, propofol or etomidate on tracheal intubating conditions and hemodynamic changes using remifentanil in the absence of muscle relaxants. Methods: A total of 45 healthy adults were divided randomly into three groups. After iv lidocaine 1.5 mg/kg, thiopental 5 mg/kg (thiopental group) or propofol 2.5 mg/kg (propofol group), or etomidate 0.4 mg/kg (etomidate group) were injected. After the injection of study drugs, remifentanil 2 mcg/kg was administered. Ninety seconds after the administration of remifentanil, laryngoscopy and intubation were attempted. Intubating conditions were assessed and the mean arterial pressure and the heart rate was measured. Results: There were no significant differences in intubating conditions between patients in the three groups. The heart rate was significantly lower in the propofol and etomidate group patients when compared to the thiopental group patients after anesthetic induction. The mean arterial pressure was significantly lower in the propofol group patients when compared to the thiopental and etomidate group patients. Both heart rate and mean arterial pressure after tracheal intubation were significantly elevated in etomidate group patinets when compared to their preintubation value. Conclusions: The use of thiopental 5 mg/kg, propofol 2.5 mg/kg, and etomidate 0.4 mg/kg did not differ in effect under intubating conditions for tracheal intubation using remifentanil in the absence of muscle relaxants. Thiopental provided the best hemodynamic conditions. (Korean J Anesthesiol 2007; 53: 61~6)

Effects of etomidate use in ICU patients on ventilator therapy: a study of 12,526 patients in an open database from a single center

Park Ha Yeon,이윤석,임지연,Kim Mina,Park Ji Eun,Lee Teakseon 대한마취통증의학회 2021 Korean Journal of Anesthesiology Vol.74 No.4

Background: There is a debate regarding the safety of etomidate. We evaluated the effects of etomidate on mortality in a large cohort of critical care patients.Methods: This retrospective matched-cohort study was performed using the Medical Information Mart for Intensive Care version 3 (MIMIC-III) database. Among 12,526 adult patients who were prescribed etomidate or propofol on the first day of mechanical ventilation, 625 patients administered etomidate were statistically matched with 6,250 patients administered propofol. The primary outcome measures were all-cause in-hospital mortality, 48-hour survival, cardiovascular morbidity, and infectious morbidity. Logistic regression analysis with stepwise selection of variables was performed to examine the dose–mortality relationship of etomidate.Results: All-cause in-hospital mortality was 1.84 times higher in the etomidate cohort (OR, 1.84; 98.75% CI, 1.42, 2.37). Compared to the propofol cohort, the etomidate cohort showed 57% lower odds of 48-hour survival (0.43 [0.27, 0.73]), no difference in odds of cardiovascular morbidity (0.86 [0.66, 1.12]), and 1.77 times higher odds of infectious morbidity (1.77 [1.35, 2.31]). Additionally, the odds of mortality increased by 1.36 times per 0.1 mg/kg of etomidate (1.36 [95% CI: 1.23, 1.49]).Conclusions: Etomidate is a poor choice as a hypnotic drug on the first day of mechanical ventilation, as it is associated with a dose-dependent increase in all-cause mortality, and does not improve survival for the first 48 h.

Etomidate가 임신 백서 자궁 평활근의 수축에 미치는 영향

정종달 ( Chong Dal Chung ),안태훈 ( Tae Hun An ),정기태 ( Ki Tae Jung ),이태헌 ( Tae Heon Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1

Background: It has been reported that etomidate has the relaxant effects on vascular, tracheal, and non-pregnant uterine smooth muscle in vitro. The purpose of this study was to investigate the relaxant effects of etomidate on the contraction of the pregnant rat uterine smooth muscle. Methods: Uterine muscle tissues were obtained from pregnant rats (n=15). The uterine segments were mounted in organ baths filled with Krebs solution. After oxytocin-induced contractile activity had been established, etomidate in incremental concentrations (10(-7) to 10(-3) M) was added cumulatively to the bath, each administered 20 min apart, and resultant changes in contractile activity were continuously recorded. EC5 (effective concentration of 5% reduction), EC25, EC50, EC75, and EC95 on active tension were calculated using a probit model. Results: Etomidate (10-(7) to 10(-3) M) induced dose-dependent decreases in amplitude and frequency of uterine contraction. The EC50 of etomidate on active tension were 5.91×10(-5) M. Conclusions: These results demonstrate that etomidate had inhibitory effects on pregnant rat uterine muscle at supraclinical concentration (5.91×10(-5) M). (Korean J Anesthesiol 2009; 57: 84~7)

Comparison of priming versus slow injection for reducing etomidateinduced myoclonus: a randomized controlled study

Parul Mullick,Vandana Talwar,Shipra Aggarwal,Smita Prakash,Mridula Pawar 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.4

Background: Etomidate injection is often associated with myoclonus. Etomidate injection technique influences the incidence of myoclonus. This study was designed to clarify which of the two injection techniques—slow injection or priming with etomidate—is more effective in reducing myoclonus. Methods: This prospective randomized controlled study was conducted on 189 surgical patients allocated to three study groups. Control group (Group C, n = 63) received 0.3 mg/kg etomidate (induction dose) over 20 s. Priming group (Group P, n = 63) received pretreatment with 0.03 mg/kg etomidate, followed after 1 min by an etomidate induction dose over 20 s. Slow injection group (Group S, n = 63) received etomidate (2 mg/ml) induction dose over 2 min. The patients were observed for occurrence and severity of myoclonus for 3 min from the start of injection of the induction dose. Results: The incidence of myoclonus in Group P (38/63 [60.3%], 95% CI: 48.0–71.5) was significantly lower than in Group C (53/63 [84.1%], 95% CI: 72.9–91.3, P = 0.003) and Group S (49/63 [77.8%], 95% CI: 66.0–86.4, P = 0.034). Myoclonus of moderate or severe grade occurred in significantly more patients in Group C (68.3%) than in Group P (36.5%, P < 0.001) and Group S (50.8%, P = 0.046), but the difference between Groups P and S was not significant (P = 0.106). Conclusions: Priming is more effective than slow injection in reducing the incidence of myoclonus, but their effects on the severity of myoclonus are comparable.

The effect of remifentanil for reducing myoclonus during induction of anesthesia with etomidate

Sang Woo Lee,Hyun Jue Gill,Sung Chul Park,Jun Young Kim,Ji Hyung Kim,Jong Yeon Lee,Hyeon Jeong Yang,Min Ku Kim 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.4

Background: Myoclonic movement is a common problem during induction of anesthesia with etomidate. We investigated the influences of pretreatment with remifentanil on etomidate induced myoclonus. Methods: Ninety ASA class I patients were divided randomly into three groups. Group NS received normal saline 2 ml as placebo (n=30), group R0.5 and group R1.0 were pretreated with remifentanil 0.5 μg/kg (n=30) or 1.0 μg/kg (n=30) 1 minute before induction with etomidate 0.3 mg/kg. Orotracheal intubation was performed after administration of rocuronium 0.5 mg/kg. We assessed the incidence, onset, duration and intensity of myoclonus. Mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) were recorded during induction. Results: Twenty five patients developed myoclonus in group NS (83.3%), 3 patients in group R0.5 developed myoclonus (10%), as did 5 patients in group R1.0 (16.7%). Moderate to severe myoclonus of grade 3 and 4 were found 66.7% of patients in group NS, whereas no patients in both remifentanil pretreated groups developed this grade of myoclonus. The duration of myoclonus was reduced significantly in the remifentanil groups: 93.8±59.5 sec in group NS, 49.3±34.9 sec in group R0.5, 36.0±27.0 sec in group R1.0 (P<0.05). HR was decreased by pretreatment with remifentanil prior to induction, while MAP and HR were decreased after induction with etomidate (P<0.05). BIS changes were not different among the three groups. The dose dependent differences between the two remifentanil doses were not noticed. Conclusions: Pretreatment with remifentanil significantly reduced the incidence, duration and intensity of etomidate induced myoclonus. (Korean J Anesthesiol 2009;57:438∼43)