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• W2019998591 abstract "S9 INTRODUCTION: The change of the solvent propylene glycol (PG) to lipid-emulsion has led to physiological osmolalities for the etomidate preparation. With the new formulation, TIVA without PG-related adverse drug reactions seems to be possible. The inhibition of the cortisol synthesis upon administration of etomidate, lasting up to 3 h, has been demonstrated in experimental studies [1]. Four to 6 h after injection, cortisol levels are in the normal range. Due to its pharmakological profile, etomidate is a suitable agent for TIVA. We suggested that 8 h after a TIVA of about 1 h duration, cortisol levels have returned to normal. METHODS: After IRB approval and written informed consent, 44 patients scheduled for day-case surgery expected to last less than 1 h were enrolled in a double-blind, four-arm randomized study. Patients received either etomidate or propofol in 2 subgroups. Anesthesia was induced with remifentanil (1 [micro sign]g/kg) and either etomidate (0.3 mg/kg) or propofol (2 mg/kg) and was maintained with remifentanil (0.25 mg/kg/h) and either etomidate (1 mg/kg/h) or propofol (8 mg/kg/h) (subgroup 1). Doses of etomidate and propofol were reduced in subgroup 2 according to the EEG criterion of 50% Bispectral Index (BIS). Blood for cortisol and ACTH determination was drawn at baseline, end of anesthesia, and 30 min, 3 h, and 8 h after the end of anesthesia. Cortisol and ACTH were measured by RIA and statistically evaluated by t-test (significant difference: P<or=to0.05). RESULTS: Demographic data of the 43 available patients (etomidate group: 22 pat.; propofol group: 21 pat.) did not differ significantly. Anesthesia of each group in subgroup 1 was maintained with a high dose of etomidate (0.85 mg/kg/h) or propofol (6.9 mg/kg/h), respectively. In subgroup 2, mean infusion rate was 0.6 mg/kg/h for etomidate and 5.4 mg/kg/h for propofol. The data for cortisol are shown in Table 1. ACTH serum concentrations were abnormally high in the etomidate group 3 h and 8 h after end of infusion. At no point were serum cortisol levels out of the normal range. Eight hours after end of infusion, concentrations did not differ significantly between the two hypnotics or between the high- and low-dose subgroups of the respective hypnotic (p>0.05; t-test).Table 1DISCUSSION: Serum cortisol levels were in the normal range and did not differ significantly between TIVA with etomidate and TIVA with propofol. Etomidate in a dose of 0.6 mg/kg/h and remifentanil are useful in combination for TIVA in day-case surgery. The cortisol suppression caused by etomidate is transient and does not limit its use in the maintenance of anesthesia." @default.
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• W2019998591 date "1999-02-01" @default.
• W2019998591 modified "2023-09-26" @default.
• W2019998591 title "TIVA WITH ETOMIDATE IN DAY-CASE SURGERY" @default.
• W2019998591 doi "https://doi.org/10.1097/00000539-199902001-00009" @default.
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