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Neuropharmacology: Age-related changes
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Katleen Wyatt Chester, Olivia Johnson Morgan, Kruti Shah
Etomidate is routinely used as an anesthetic due to its rapid onset of action, producing sedation within 1 minute. After a single bolus dose of 0.3 mg/kg, patients generally recover within 5 minutes. Etomidate uniquely inhibits 11-beta-hydroxylase, thereby reducing plasma cortisol concentrations for up to 8 hours. In contrast to younger adult patients who experience no clinically significant cardiac effects from a bolus dose of etomidate, geriatric patients may experience decreases in heart rate, cardiac index, and mean arterial pressure (MAP). Geriatric patients with hypertension at baseline are particularly affected. Since older adult brains do not have a heightened sensitivity to etomidate, these effects on hemodynamics are likely the result of higher plasma concentrations after bolus administration due to reductions in volume of distribution and albumin-binding, which together significantly increase the free concentration of etomidate in the plasma compartment. The brains of older adults have not been shown to be more sensitive to etomidate (41,43). In addition to these hemodynamic effects, CBF decreases 20%–30% with etomidate and occurs with a proportional reduction in CMRO2. ICPs are transiently reduced after etomidate induction. Use of etomidate for neuroanesthesia is primarily limited to induction doses versus continuous infusions or long-term use due to its effects on cortisol and since each milliliter of etomidate contains 35% propylene glycol v/v. Etomidate also causes pain on injection and myoclonus (44).
Environmental toxicants on Leydig cell function
Published in C. Yan Cheng, Spermatogenesis, 2018
Leping Ye, Xiaoheng Li, Xiaomin Chen, Qingquan Lian, Ren-Shan Ge
Etomidate is an intravenous anesthetic agent. In intact Leydig cells, 30-μM etomidate inhibited androgen synthesis in isolated rat Leydig cells. Etomidate competitively inhibited both CYP11A1 and 3β-HSD1 activities with IC50 values of 12.62 and 2.75 μM, respectively. In addition, etomidate downregulated the expression levels of Cyp11a1, Hsd17b3, and Srd5a1.212 At 1 μM, etomidate inhibited testosterone and progesterone production in isolated rat Leydig cells.213
Anaesthesia for ECT
Published in Alan Weiss, The Electroconvulsive Therapy Workbook, 2018
Etomidate (0.15-0.3 mg/kg) is an intravenous anaesthetic agent that has limited worldwide availability. In countries where it is available it has been shown to be associated with longer seizure duration that may be helpful in patients with poor seizure expression despite maximal electrical stimulus applied (Avramov, Husain and White, 1995; Saffer and Berk, 1998; Trzepacz, Weniger and Greenhouse, 1993). A challenge for this agent is that it has reduced cardiovascular depressant properties, resulting in an accentuated acute haemodynamic response to ECT compared to barbiturates and propofol. In addition it may lead to increased level of postictal confusion, nausea and vomiting compared to other agents (Ding and White, 2002).
The effects of etomidate on expression of high mobility group box 1 via the nuclear factor kappa B pathway in rat model of sepsis
Published in Libyan Journal of Medicine, 2023
Yoo Jung Park, Kwon Hui Seo, Jin Deok Joo, Hong Soo Jung, Yong Shin Kim, Ji Yung Lee, Hunwoo Park
Etomidate, a potent imidazole hypnotic, has been frequently used as an anesthetic induction agent or sedative for old or critically ill patients owing to its fast onset of therapeutic effect, brief duration of action, and hemodynamic safety [9]. However, for critically ill patients, administration of etomidate may cause mortality and morbidity due to its suppressive effects on adrenal steroidogenesis by inhibition of the 11β-hydroxylase enzyme [10, 11]. Although single-dose etomidate use does not seem to lead to mortality of septic patients [12, 13], available evidence is limited. A few previous studies have revealed that etomidate regulates excessive immune responses by inhibiting pro-inflammatory cytokines such as interleukin (IL)-1β, IL-6, and tumor necrosis factor alpha (TNF-α) and lipopolysaccharide (LPS)-induced nuclear factor kappa B (NF-ĸB) activation in an acute lung injury model and rat macrophages [14,15]. The reciprocal relationship among acute-phase cytokines, HMGB1, and NF-ĸB activity has been determined [4], but the effects of etomidate on HMGB1 expression and release have not yet been elucidated in sepsis.
Dynamic prediction of hypoxemia risk at different time points based on preoperative and intraoperative features: machine learning applications in outpatients undergoing esophagogastroduodenoscopy
Published in Annals of Medicine, 2023
Zhaojing Fang, Daizun Zou, Weigen Xiong, Hongguang Bao, Xiuxiu Zhao, Chen Chen, Yanna Si, Jianjun Zou
The Nanjing First Hospital ethics committee approved this study and waived the requirement for informed consent [grant number: KY20220509-01-KS-01]. Outpatients’ data of the derivation cohort from June to September 2021 were collected retrospectively from electronic medical records. Patients who received routine anaesthesia-assisted EGD were included according to the following criteria: ≥18 years old; American Society of Anesthesiologists (ASA) class I–III. Exclusion criteria were as follows: pregnancy, severe cardiopulmonary diseases (uncontrolled circulatory and respiratory diseases that can be life-threatening, including severe aortic stenosis, unstable angina pectoris, acute exacerbations of chronic obstructive pulmonary disease, etc.), presence of acute upper respiratory tract infection, and unavailability of complete data. Patients who were induced with etomidate were also excluded.
Perioperative pharmacotherapy to prevent cardiac complications in patients undergoing noncardiac surgery
Published in Expert Opinion on Pharmacotherapy, 2021
Kirtipal Bhatia, Bharat Narasimhan, Gaurav Aggarwal, Adrija Hajra, Soumya Itagi, Shathish Kumar, Sandipan Chakraborty, Neelkumar Patel, Vardhmaan Jain, Dhrubajyoti Bandyopadhyay, Birendra Amgai, Wilbert S Aronow
Among the volatile anesthetics, halothane has been shown to reduce myocardial perfusion in a dose-dependent fashion [105]. Etomidate, an intravenous anesthetic, has been found to be associated with longer length of hospital stay, increased risk of mortality, and cardiovascular morbidity [106]. A more recent multicenter randomized controlled trial, however, failed to show any difference in cardiovascular morbidity and mortality between patients receiving sevoflurane or propofol for maintenance of anesthesia [107]. According to the American College of Cardiology/AmericanHeart Association (ACC/AHA) guidelines (2014), volatile agents or intravenous anesthetics are reasonable for anesthesia maintenance in patients at risk for myocardial ischemia [42]. Regional anesthesia has a theoretical advantage for preventing postoperative cardiac complications and can be utilized as an alternative for selected patients with high cardiac risk.