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Anaesthesia Feb 2006
Topics: Adrenal Insufficiency; Anesthetics, Intravenous; Emergencies; Etomidate; Evidence-Based Medicine; Humans
PubMed: 16430574
DOI: 10.1111/j.1365-2044.2005.04518_1.x -
Anesthesiology Jun 2009
Topics: Anesthetics, Intravenous; Carotid Arteries; Conscious Sedation; Etomidate; Injections, Intra-Arterial; Magnetic Resonance Imaging; Monitoring, Intraoperative
PubMed: 19461303
DOI: 10.1097/ALN.0b013e3181a5e1c7 -
Neuroendocrinology 2010Cushing's syndrome is associated with serious morbidity and increased mortality. Irrespective of its cause, i.e. a pituitary adenoma, ectopic ACTH production or an... (Review)
Review
Cushing's syndrome is associated with serious morbidity and increased mortality. Irrespective of its cause, i.e. a pituitary adenoma, ectopic ACTH production or an adrenal neoplasia, Cushing's syndrome is primarily treated surgically. However, when surgery is unsuccessful or contraindicated, medical therapy is needed to treat hypercortisolism. The spectrum of available drugs includes adrenal-blocking agents, neuromodulatory drugs and glucocorticoid receptor antagonists. Adrenal blocking drugs suppress adrenal cortisol production via inhibition of steroidogenic enzymes. Ketoconazole and metyrapone are most frequently used for this purpose, but chronic treatment with these drugs can be limited by side effects like hepatotoxicity (ketoconazole) and increased androgen and mineralocorticoid production (metyrapone). Etomidate can be used to rapidly reverse cortisol excess in patients with acute complications of (severe) hypercortisolism like psychosis. In Cushing's disease, combination therapy with drugs that target the corticotropic adenoma, i.e. the universal somatostatin analogue pasireotide and/or the dopamine agonist cabergoline, and low-dose ketoconazole seems a rational approach to achieve biochemical control.
Topics: Cushing Syndrome; Enzyme Inhibitors; Etomidate; Humans; Ketoconazole; Metyrapone; Mitotane
PubMed: 20829630
DOI: 10.1159/000314292 -
Medicine Jun 2017Myoclonus, a common complication during intravenous induction with etomidate, is bothersome to both anesthesiologists and patients. This study explored the preventive... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Myoclonus, a common complication during intravenous induction with etomidate, is bothersome to both anesthesiologists and patients. This study explored the preventive effect of pretreatment with propofol on etomidate-related myoclonus.
METHODS
This was a prospective, double-blind, clinical, randomized controlled study. Totally, 363 patients who were scheduled for a short-duration, painless gastrointestinal endoscopy were divided into 5 groups. Four groups received 0 mg/kg (E group), 0.25 mg/kg (LPE group), 0.50 mg/kg (MPE group), or 0.75 mg/kg (HPE group) propofol pretreatment before etomidate anesthesia. Another group only received 1 to 2 mg/kg of propofol (P group) as anesthesia. The incidence and severity of myoclonus, patient circulation and respiratory status, and intraoperative and postoperative complications were recorded.
RESULTS
The incidence of myoclonus in the LPE group (26.8%), MPE group (16.4%), HPE group (14.9%), and P group (0) was lower than the E group (48.6%, P < .05). The incidence of grade 1, 2, and 3 of myoclonus in the LPE group, MPE group, HPE group, and P group was significantly lower than the E group, and that in the P group was lower than the LPE group (P < .05). The incidence of hypoxemia in the P group was higher than the E group, and the incidence of adverse events in the HPE group and P group was lower than the E group (P < .05).
DISCUSSION
Pretreatment with propofol was feasible for preventing etomidate-related myoclonus. Furthermore, as propofol dosage increased, its effect on reducing the incidence and severity of myoclonic movements induced by etomidate increased.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthetics, Intravenous; Dose-Response Relationship, Drug; Double-Blind Method; Etomidate; Female; Gastroscopy; Hemodynamics; Humans; Incidence; Male; Middle Aged; Myoclonus; Postoperative Complications; Propofol; Respiration; Severity of Illness Index; Time Factors; Young Adult
PubMed: 28658112
DOI: 10.1097/MD.0000000000007212 -
BMC Geriatrics Jan 2024Etomidate has been advocated for anesthesia in older and critically ill patients because of its hemodynamic stability. Clinical studies have shown that dexmedetomidine... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of dexmedetomidine combined with etomidate on postoperative cognitive function in older patients undergoing total intravenous anaesthesia: a randomized, double-blind, controlled trial.
BACKGROUND
Etomidate has been advocated for anesthesia in older and critically ill patients because of its hemodynamic stability. Clinical studies have shown that dexmedetomidine has neuroprotective and anti-inflammatory properties and improves postoperative cognitive dysfunction in older patients. The present study was to evaluate the effects of the combination of etomidate and dexmedetomidine with different anaesthesia time on postoperative cognitive function in older patients.
METHODS
A total of 132 older patients undergoing ureteroscopic holmium laser lithotripsy were randomly divided into EN group and ED group equally. Patients whose surgery time was less than or equal to 1 h in each group were allocated to short-time surgery group (EN group and ED group), and whose surgery time was more than 1h were allocated to long-term surgery group (EN group and ED group). The primary outcome was the score of the Mini-Mental State Examination. The secondary outcomes were State-Trait Anxiety Inventory scores, Riker sedation agitation scores, Zung Self-Rating Depression Scale scores, the memory span for Arabic numerals, the plasma concentrations of S-100 calcium-binding protein B and neuron specific enolase, the time to spontaneous respiration, recovery, and extubation.
RESULTS
The MMSE scores at t were higher in ED and ED groups than in EN and EN groups (p<0.05). Compared with ED and ED groups, the ZSDS scores, the S-AI scores and the T-AI scores at t were higher in EN and EN groups (p<0.05), respectively. The recalled Arabic numbers at t were higher in ED group than in EN group (p<0.05). The plasma concentration of S-100β at t in EN group and t in EN group were higher than that in ED and ED groups (p<0.05), respectively. Compared with ED and ED groups, the plasma concentrations of NSE were higher at t in EN group and t in EN group (p<0.05), respectively.
CONCLUSION
The administration of dexmedetomidine could improve postoperative cognitive dysfunction, emergence agitation, depression and anxiety, attenuate the plasma concentrations of S-100β and NSE in older patients undergoing total intravenous anaesthesia with etomidate.
TRIAL REGISTRATION
Registration number: ChiCTR1800015421, Date: 29/03/2018.
Topics: Humans; Aged; Dexmedetomidine; Etomidate; Postoperative Cognitive Complications; S100 Calcium Binding Protein beta Subunit; Anesthesia, Intravenous; Cognition; Double-Blind Method
PubMed: 38273248
DOI: 10.1186/s12877-024-04726-7 -
European Biophysics Journal : EBJ Apr 2016Aurein 2.6-COOH and aurein 3.1-COOH were studied along with their naturally occurring C-terminally amidated analogues. Circular dichroism (CD) and molecular dynamic (MD)...
Aurein 2.6-COOH and aurein 3.1-COOH were studied along with their naturally occurring C-terminally amidated analogues. Circular dichroism (CD) and molecular dynamic (MD) simulations were used to study the effects of amidation on the interaction of antimicrobial peptides (AMPs) with lipid bilayers. CD measurements and MD analysis suggested that both peptide analogues were predominantly random coil and adopted low levels of α-helical structure in solution (<30%) and in the presence of a lipid bilayer the peptides formed a stable α-helical structure. In general, amidated analogues have a greater propensity than the non-amidated peptides to form a α-helical structure. MD simulations predicted that aurein 2.6-COOH and aurein 3.1-CHOOH destabilised lipid bilayers from 1,2-dimyristoyl-sn-glycero-3-phosphocholine and 1,2-dimyristoyl-sn-glycero-3-phosphoserine via angled bilayer penetration. They also showed that aurein 2.6-CONH₂ and aurein 3.1-CONH₂ formed a helix horizontal to the plane of an asymmetric interface.
Topics: Amides; Antimicrobial Cationic Peptides; Dimyristoylphosphatidylcholine; Lipid Bilayers; Molecular Dynamics Simulation
PubMed: 26745958
DOI: 10.1007/s00249-015-1094-x -
Anesthesiology Nov 1998
Topics: Administration, Oral; Adult; Anesthetics, Intravenous; Etomidate; Humans; Solutions; Tablets
PubMed: 9822026
DOI: 10.1097/00000542-199811000-00039 -
BMC Emergency Medicine May 2023Ketamine and etomidate are commonly used as sedatives in rapid sequence intubation (RSI). However, there is no consensus on which agent should be favored when treating...
BACKGROUND
Ketamine and etomidate are commonly used as sedatives in rapid sequence intubation (RSI). However, there is no consensus on which agent should be favored when treating patients with trauma. This study aimed to compare the effects of ketamine and etomidate on first-pass success and outcomes of patients with trauma after RSI-facilitated emergency intubation.
METHODS
We retrospectively reviewed 944 patients who underwent endotracheal intubation in a trauma bay at a Korean level 1 trauma center between January 2019 and December 2021. Outcomes were compared between the ketamine and etomidate groups after propensity score matching to balance the overall distribution between the two groups.
RESULTS
In total, 620 patients were included in the analysis, of which 118 (19.9%) were administered ketamine and the remaining 502 (80.1%) were treated with etomidate. Patients in the ketamine group showed a significantly faster initial heart rate (105.0 ± 25.7 vs. 97.7 ± 23.6, p = 0.003), were more hypotensive (114.2 ± 32.8 mmHg vs. 139.3 ± 34.4 mmHg, p < 0.001), and had higher Glasgow Coma Scale (9.1 ± 4.0 vs. 8.2 ± 4.0, p = 0.031) and Injury Severity Score (32.5 ± 16.3 vs. 27.0 ± 13.3, p < 0.001) than those in the etomidate group. There were no significant differences in the first-pass success rate (90.7% vs. 90.1%, p > 0.999), final mortality (16.1% vs. 20.6, p = 0.348), length of stay in the intensive care unit (days) (8 [4, 15] (Interquartile range)), vs. 10 [4, 21], p = 0.998), ventilator days (4 [2, 10] vs. 5 [2, 13], p = 0.735), and hospital stay (days) (24.5 [10.25, 38.5] vs. 22 [8, 40], p = 0.322) in the 1:3 propensity score matching analysis.
CONCLUSION
In this retrospective study of trauma resuscitation, those receiving intubation with ketamine had greater hemodynamic instability than those receiving etomidate. However, there was no significant difference in clinical outcomes between patients sedated with ketamine and those treated with etomidate.
Topics: Humans; Etomidate; Ketamine; Retrospective Studies; Anesthetics, Intravenous; Rapid Sequence Induction and Intubation; Trauma Centers; Intubation, Intratracheal; Republic of Korea
PubMed: 37248552
DOI: 10.1186/s12873-023-00833-7 -
Current Opinion in Anaesthesiology Aug 2012Formal Monod-Wyman-Changeux allosteric mechanisms have proven valuable in framing research on the mechanism of etomidate action on its major molecular targets,... (Review)
Review
PURPOSE OF REVIEW
Formal Monod-Wyman-Changeux allosteric mechanisms have proven valuable in framing research on the mechanism of etomidate action on its major molecular targets, γ-aminobutyric acid type A (GABAA) receptors. However, the mathematical formalism of these mechanisms makes them difficult to comprehend.
RECENT FINDINGS
We illustrate how allosteric models represent shifting equilibria between various functional receptor states (closed versus open) and how co-agonism can be readily understood as simply addition of gating energy associated with occupation of distinct agonist sites. We use these models to illustrate how the functional effects of a point mutation, α1M236W, in GABAA receptors can be translated into an allosteric model phenotype.
SUMMARY
Allosteric co-agonism provides a robust framework for design and interpretation of structure-function experiments aimed at understanding where and how etomidate affects its GABAA receptor target molecules.
Topics: Allosteric Regulation; Anesthetics, Intravenous; Animals; Etomidate; GABA Agonists; Humans; Models, Biological; Mutation; Receptors, GABA-A; Structure-Activity Relationship
PubMed: 22614249
DOI: 10.1097/ACO.0b013e328354feea -
Molecules (Basel, Switzerland) Feb 2020Amide functional groups are prominent in a broad range of organic compounds with diverse beneficial applications. In this work, we report the synthesis of these...
Amide functional groups are prominent in a broad range of organic compounds with diverse beneficial applications. In this work, we report the synthesis of these functional groups via an iron(iii) chloride-catalyzed direct amidation of esters. The reactions are conducted under solvent-free conditions and found to be compatible with a range of amine and ester substrates generating the desired amides in short reaction times and good to excellent yields at a catalyst loading of 15 mol%
Topics: Amides; Antitubercular Agents; Catalysis; Chlorides; Esters; Ferric Compounds; Lactams; Pyrimidines; Solvents
PubMed: 32110915
DOI: 10.3390/molecules25051040