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TWO-STAGE INFUSION OF ETOMIDATE FOR THE INDUCTION AND MAINTENANCE OF ANAESTHESIA
Br. J. Anaath. (1984), 56,1239
TWO-STAGE INFUSION OF ETOMIDATE FOR THE INDUCTION AND MAINTENANCE OF ANAESTHESIA N. W. LEES AND W. R. A. ANTONIOS SUMMARY
A two-stage infusion technique of etomidate with a separate infusion of fentanyi was compared with thiopentone and halochane or morphine, p p , phis p nitrous oxide in oxygen, y g , for the induction and TnQinfnnrwv of anaesthesia in 200 patients. Cardiovascular and respiratory indices and recovery times were found to be r in the two groups.
PATIENTS AND METHODS Two hundred patients undergoing general surgical or gynaecological operations gave informed consent for the infusion of etomidate, and were allocated to
one of two groups of 100 patients matched for age, sex, weight, body build (table I), and operative procedure (table IT). Fifty patients in each group required artifical ventilation; the others were allowed to breathe spontaneously. Twenty of the spontaneously breathing patients gave permission for the sampling of arterial blood. Patients in both groups were premedicated with either morphine and atropine or papaveretum and hyoscine. Before the induction of anaesthesia, a fast-flowing infusion was started in a forearm vein. All drugs were given via this infusion. All patients in both groups received a bolus of fentanyi l-1.5figkg~' i.v. before the induction of anaesthesia, the exact dose being dependent on age and general fitness. The infusion group (A) received a rapid infusion of etomidate 2.5figml"1 in normal saline via a Treonic DC2 infusion pump at an initial rate of 100ngml~1min~1 for lOmin. The rate was then decreased to 10jigkg~1min~1 for the remainder of the operation. Once the patient was settled on the operating table, a rapid infusion of fentanyi 30ngml~' in water was given (Treonic IP3 digital
TABLE I. Clinical dttaib ofpatunts and duration ofoptratkms (mtan valuts ± SEM) No. (M:F)
Respiratory mode
Age (yr)
Weight (kg)
Group A (Infusions)
13M:37F 24M:26F
IPPV Spont.
53±3 48±3
65±2 68±2
57±3 47±4
Group B (Control)
13M:37F 24M:26F
IPPV Spont.
49±3 51±3
62±2 69±1
62 ±6 41±3
NORMAN W.
Duration (min)
LEES, M.B., CH.B., F.F.A.R.CS.; WAGIH R.A. AN-
TONIOS, M3.,CH.B.,D.A.,F.F.AJLCS., Department of Anaesthesia,
Victoria Infirmary, Glasgow G42 9TY.
© The Macmillan Press Ltd 1984
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 14, 2015
Although etomidate has been used widely as an induction agent, it has the disadvantage of causing pain on injection and excitatory movements (Miller, Hendry and Lees, 1978; Zacharias et al., 1978) when given as a bolus. However, because of its lack of cumulation (Kay, 1976) it can be used as an infusion to maintain anaesthesia. Indeed, its use in such infusion techniques has been described previously (Schuttler et al., 1980; Lees et al., 1981). In an attempt to decrease the incidence of pain and muscle movement on injection, etomidate was administered rapidly to induce anaesthesia and then the rate of the infusion was decreased to provide a dose adequate to maintain anaesthesia. Fentanyi was infused separately to provide analgesia. Patients breathed oxygen-enriched air. This technique was compared with more conventional techniques using halothane or morphine with nitrous oxide in oxygen.
BRITISH JOURNAL OF ANAESTHESIA
1240 TABLE II. Types of operation. Patina maack group men matched forage, sex, weight and duration of operation Respiratory mode IPPV
Spontaneous ventilation
Operation
No. pain 13 17 18 2
Total
50
Mastectomy and biopsy Inguinal hernia, hydrocele etc. Haemorrhoidectomy Varicose vein
18 16 8 8
Total
50
syringe pump). The rate of the infusion of fentanyl was altered according to the patient's response to surgical stimulation, as judged by changes in heart rate, arterial pressure, sweating, lachrymation and, in those who were breathing spontaneously, respiratory rate. Individual requirements varied considerably, but the initial average infusion rate (±SEM) was found to be 0.225 (±0.015) /igkg-'min" 1 for 3-4 min. This was then decreased to 0.1 (±0.005) ngkg-'min-'for 8-9min. Inmost patients this rate could be decreased further to a mean of 0.05 (±0.003) uglcg^mkr 1 for the duration of die operation. In all patients in die control group (B) anaesthesia was induced with thiopentone Smgkg"1 and they breathed 66% nitrous oxide in oxygen supplemented with halothane during spontaneous ventilation or morphine 0.2 nig kg"1 during artificial ventilation. In all patients heart rate, arterial pressure (oscillotonometer) and ECG were monitored. Arterial blood was sampled from 20 matched patients from each group before the induction of anaesthesia; 20 min after a steady state of maintenance anaesthesia had been achieved, and again 15 min following the end of die operation. Blood-gas tensions were measured using an ABLl Automatic Gas Analyser. The time from die end of anaesthesia until die patient obeyed simple commands was noted by die recovery room staff, who were unaware of die method of anaesthesia. The time of die first administration of analgesia after operation was recorded. All patients were visited on die day after surgery and die infusion site inspected for evidence of damage to the vein.
RESULTS
Quality of anaesthesia. Induction witii an infusion of etomidate resulted in loss of die eyelash reflex in 103 ±2.7 (SEM) s. Four people in diis group complained of pain during die infusion and anodier 14 complained of mild tingling around die infusion site. In no patient was die pain severe enough to cause the infusion to be abandoned. Muscle movement and twitching were slight and did not cause any inconvenience. Except for a short 5-min period of apnoea in four elderly patients, which required temporary cessation of die infusion of fentanyl, no complications arose which required abandonment of die chosen technique. Neidier pain on injection nor muscle movement were seen in die control group. Respiration. In die 20 matched patients from each group in whom arterial carbon dioxide tensions were measured, die control group showed a mean increase of 1.33kPa (±0.18) kPa during anaesthesia, which decreased slightiy (mean increase of 0.93 kPa (±0.23)) 15 min after operation. The etomidate group showed an increase in Pacch 1.46 (±0.18kPa) and 0.8 (±0.18) kPa, respectively. These Paco? values were significantly greater ( P < 0.01) thantiioseobtained before die operation, but diere were no statistical differences between die two groups. Circulation. Compared widi die values before operation, bodi die morphine and halotiiane subgroups showed a statistically significant (P<0.05) decrease in systolic arterial pressure following die injection of die morphine or die administration of die halothane. However, diese did not give rise to any clinically significant change. Recovery period. Recovery (±SEM) in die patients requiring artificial ventilation (Group A: 8.2 ±1.5min; group B: 6.7± 1.8min) was significandy (P<0.02) more rapid dian in die patients of bodi groups who breadied spontaneously (group A: 16.6±2.6min; group B: 18.2± 1.8min). In each group only one patient had not recovered consciousness witiiin 40 min. Restlessness, muscle movement
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 14, 2015
Upper abdominal Lower abdominal Major gynaecological Peripheral vascular
Student's t test was used to analyse die cardiovascular, respiratory and recovery data, and die time until die first injection of postoperative analgesia was required.
TWO-STAGE INFUSION OF ETOMIDATE
1241
of the drug (Bennett, 1978). The use of a separate infusion of fentanyl allowed much greater flexibility in the titration of analgesia compared with the use of a combined etomidate plus fentanyl infusion (Lees et al., 1981), and greatly decreased the incidence of Nausea and vomiting. Seven patients in group A prolonged recovery. Dosage regimens have to be complained of nausea and vomiting, compared with judged according to each patient's requirement and five in group B. This was severe and upsetting in not given on a strict "procedure" basis. Concentrafour, but soon settled with the administration of tions of etomidate used in this way should not be greater than 0.25-0.5%, as it was found that the use prochlorperazine 12.5mgi.m. of a 1% solution can cause severe pain and venoPostoperative analgesia. There was no significant thrombosis when infused to forearm veins. difference between the groups in the time until the first injection of analgesia: the mean time (+ SEM) REFERENCES in group A was 5.8h (±0.6) compared with 6.2h Bennett, N. R. (1978). Aspects of total intravenous anaesthesia; in Adverse Reactions to Anaesthesia, eds J. Watkins and A. (± 0.7) in group B. On direct questioning no patient Milford Ward, p. 150. New York: Grune and Stratton. had recall of any event after "drifting off to sleep" Boys, E.,Cartwright, P., Cole, A., Consiglio, R-,Cookson, R., until awakening in the recovery ward. Dallas, S., Famsworth, G., Jones, D., Miller, B., Moss, E.,
and twitching similar to that seen after induction were seen in four very obese patients in group A after uneventful anaesthesia, possibly as a result of the excessive infusion of etomidate.
DISCUSSION Etomidate has a short initial plasma life of 2.5 min (Van Hamme, Ghoneim and Ambre, 1978) and Wagner (1974) has shown that, to achieve a constant plasma concentration, it is theoretically safer to use a rapid infusion initially and follow this by a slower maintenance infusion rather than give a high initial bolus i.v. combined with an infusion at constant rate. Schiittler and colleagues (1980) have shown that such a scheme using etomidate can provide hypnosis in healthy volunteers. This regimen was modified by Boys and co-workers (1981), and was used in this trial. The use of this two-stage infusion technique of etomidate with a separate infusion of fentanyl produced satisfactory operating conditions in all patients. Irrespective of the mode of ventilation, cardiovascular stability was superior to that in the control group. Respiratory depression was similar in the two spontaneously breathing groups. Other advantages seen with this technique were a decrease in the incidence of pain on injection and muscle movement. This could be attributable to the administration of fentanyl i.v. before commencing the infusion of etomidate (Holdcroft et al., 1976; Schuermann et al.j 1978), or to the infusion itself effectively decreasing the rate of injection and the concentration
Patel, A., Pounder, D., Ransome, P., Rollin, A., Roscoe, B., Thompson, E., Ward, M., Wilkins, D . , and Wright, C. (1981). Etomidate infusion for routine surgery of patients with controlled ventilation: A multicentre evaluation of a two-step technique. Clin. Res. Rev., 1, 103. Holdcroft, A., Morgan, M., Whitwam, J. G., and Lumley, J. (1976). Effect of dose and premedication on induction complications with etomidate. Br. J. Anaesth., 48, 199. Kay, B. (1976). A dose-response relationship for etomidate with some observations on cumulation. Br. J. Anaesth., 48, 213. Lees, N. W., Glasser, J., McGroarty, F. J., and Miller, B. M. (1981). Etomidate and fentanyl for mflintainacf of anflrwthrnifl. Br.J. Anaesth., Si, 959. Miller, B. M., Hendry, J. G. B., and Lees, N. W. (1978). Etomidate and methohexitone, a comparative clinical study in out-patient anaesthesia. Anaesthesia, 32,450. Schuermanns, V., Dom, J., Dony, J., Scheijgrond, H., and Brugmans, J. (1978). Multinational evaluation of etomidate for anaesthesia induction. Anaesthesist, 27, 52. Schiittler, J., Stoeckel, H., Wilms, M., Schwilden, H., and Laven, P. M. (1980). Ein Phannakokinetisch Begrundetes Infusionsmodell fur Etomidat zum Aufrechterhattung von Steady State Plasmaspiegeln. Anaesthesist, 29,662. Van Hamme, M. J., Ghoneim, M. M., and Ambre, J. J. (1978). Pharmacokinetics of etomidate, a new intravenous anesthetic. Anetthesiology, 49, 274. Wagner, J. G. (1974). A safe method forrapidlyachieving plasma concentration plateaus. Clin. Pharmacol. Ther, 16, 691. Zacharias, M., Clarke, R. S. J.,Dundee, J. W., and Johnston, S. B. (1978). Evaluation of three preparations of etomidate. Br. J. Anaesth., 50, 925.
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 14, 2015
Venous sequelae. One patient had a severe thrombophlebitis which lasted for several weeks after a 1% solution of etomidate had been used. Otherwise, there were no venous sequelae which could be attributed to the use of etomidate.
BRITISH JOURNAL OF ANAESTHESIA
1242 ZWEIPHASEN-INFUSION VON ETOMIDATE FOR EINLEITUNG UND ERHALT EINER NARKOSE
INFUSION DE ETOMIDATO EN DOS FASES PARA INDUCCION Y MANTENIMIENTO DE LA ANESTESIA
ZUSAMMENFASSUNG
SUMARIO
Bei 200 Paticnten wurde eine Zweiphasen-Infusionstechnik von Etomidate mit sepantcr Fentanylinfusion mit Thiopental und Halothan $owie Morphin mit Twhflmi in Sauerstoff bezliglich Einleitung und Erhalt cincr Narkose miteinandcr vcrglichcn. KreisJauf- und Atmungsverhalten sowie Erholungszeiten erwiesen sich in den Gruppen als glekh.
Se Uevo a cabo una comparacion de una tecntca de infusion de etomidato en dos fases con infusion sepaiada de fentanilo con tiopentona y balotano, o con morfina mas oxido nitroso en oxigeno, con miras a inducir y a mantener la anestesia en 200 pacientes. Se encontraron en am bos grupos indices cardiovasculares y respiratorios similares asi como tiempos de rccupcracion anilogos.
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 14, 2015
TWO-STAGE INFUSION OF ETOMIDATE FOR THE INDUCTION AND MAINTENANCE OF ANAESTHESIA N. W. LEES AND W. R. A. ANTONIOS SUMMARY
A two-stage infusion technique of etomidate with a separate infusion of fentanyi was compared with thiopentone and halochane or morphine, p p , phis p nitrous oxide in oxygen, y g , for the induction and TnQinfnnrwv of anaesthesia in 200 patients. Cardiovascular and respiratory indices and recovery times were found to be r in the two groups.
PATIENTS AND METHODS Two hundred patients undergoing general surgical or gynaecological operations gave informed consent for the infusion of etomidate, and were allocated to
one of two groups of 100 patients matched for age, sex, weight, body build (table I), and operative procedure (table IT). Fifty patients in each group required artifical ventilation; the others were allowed to breathe spontaneously. Twenty of the spontaneously breathing patients gave permission for the sampling of arterial blood. Patients in both groups were premedicated with either morphine and atropine or papaveretum and hyoscine. Before the induction of anaesthesia, a fast-flowing infusion was started in a forearm vein. All drugs were given via this infusion. All patients in both groups received a bolus of fentanyi l-1.5figkg~' i.v. before the induction of anaesthesia, the exact dose being dependent on age and general fitness. The infusion group (A) received a rapid infusion of etomidate 2.5figml"1 in normal saline via a Treonic DC2 infusion pump at an initial rate of 100ngml~1min~1 for lOmin. The rate was then decreased to 10jigkg~1min~1 for the remainder of the operation. Once the patient was settled on the operating table, a rapid infusion of fentanyi 30ngml~' in water was given (Treonic IP3 digital
TABLE I. Clinical dttaib ofpatunts and duration ofoptratkms (mtan valuts ± SEM) No. (M:F)
Respiratory mode
Age (yr)
Weight (kg)
Group A (Infusions)
13M:37F 24M:26F
IPPV Spont.
53±3 48±3
65±2 68±2
57±3 47±4
Group B (Control)
13M:37F 24M:26F
IPPV Spont.
49±3 51±3
62±2 69±1
62 ±6 41±3
NORMAN W.
Duration (min)
LEES, M.B., CH.B., F.F.A.R.CS.; WAGIH R.A. AN-
TONIOS, M3.,CH.B.,D.A.,F.F.AJLCS., Department of Anaesthesia,
Victoria Infirmary, Glasgow G42 9TY.
© The Macmillan Press Ltd 1984
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 14, 2015
Although etomidate has been used widely as an induction agent, it has the disadvantage of causing pain on injection and excitatory movements (Miller, Hendry and Lees, 1978; Zacharias et al., 1978) when given as a bolus. However, because of its lack of cumulation (Kay, 1976) it can be used as an infusion to maintain anaesthesia. Indeed, its use in such infusion techniques has been described previously (Schuttler et al., 1980; Lees et al., 1981). In an attempt to decrease the incidence of pain and muscle movement on injection, etomidate was administered rapidly to induce anaesthesia and then the rate of the infusion was decreased to provide a dose adequate to maintain anaesthesia. Fentanyi was infused separately to provide analgesia. Patients breathed oxygen-enriched air. This technique was compared with more conventional techniques using halothane or morphine with nitrous oxide in oxygen.
BRITISH JOURNAL OF ANAESTHESIA
1240 TABLE II. Types of operation. Patina maack group men matched forage, sex, weight and duration of operation Respiratory mode IPPV
Spontaneous ventilation
Operation
No. pain 13 17 18 2
Total
50
Mastectomy and biopsy Inguinal hernia, hydrocele etc. Haemorrhoidectomy Varicose vein
18 16 8 8
Total
50
syringe pump). The rate of the infusion of fentanyl was altered according to the patient's response to surgical stimulation, as judged by changes in heart rate, arterial pressure, sweating, lachrymation and, in those who were breathing spontaneously, respiratory rate. Individual requirements varied considerably, but the initial average infusion rate (±SEM) was found to be 0.225 (±0.015) /igkg-'min" 1 for 3-4 min. This was then decreased to 0.1 (±0.005) ngkg-'min-'for 8-9min. Inmost patients this rate could be decreased further to a mean of 0.05 (±0.003) uglcg^mkr 1 for the duration of die operation. In all patients in die control group (B) anaesthesia was induced with thiopentone Smgkg"1 and they breathed 66% nitrous oxide in oxygen supplemented with halothane during spontaneous ventilation or morphine 0.2 nig kg"1 during artificial ventilation. In all patients heart rate, arterial pressure (oscillotonometer) and ECG were monitored. Arterial blood was sampled from 20 matched patients from each group before the induction of anaesthesia; 20 min after a steady state of maintenance anaesthesia had been achieved, and again 15 min following the end of die operation. Blood-gas tensions were measured using an ABLl Automatic Gas Analyser. The time from die end of anaesthesia until die patient obeyed simple commands was noted by die recovery room staff, who were unaware of die method of anaesthesia. The time of die first administration of analgesia after operation was recorded. All patients were visited on die day after surgery and die infusion site inspected for evidence of damage to the vein.
RESULTS
Quality of anaesthesia. Induction witii an infusion of etomidate resulted in loss of die eyelash reflex in 103 ±2.7 (SEM) s. Four people in diis group complained of pain during die infusion and anodier 14 complained of mild tingling around die infusion site. In no patient was die pain severe enough to cause the infusion to be abandoned. Muscle movement and twitching were slight and did not cause any inconvenience. Except for a short 5-min period of apnoea in four elderly patients, which required temporary cessation of die infusion of fentanyl, no complications arose which required abandonment of die chosen technique. Neidier pain on injection nor muscle movement were seen in die control group. Respiration. In die 20 matched patients from each group in whom arterial carbon dioxide tensions were measured, die control group showed a mean increase of 1.33kPa (±0.18) kPa during anaesthesia, which decreased slightiy (mean increase of 0.93 kPa (±0.23)) 15 min after operation. The etomidate group showed an increase in Pacch 1.46 (±0.18kPa) and 0.8 (±0.18) kPa, respectively. These Paco? values were significantly greater ( P < 0.01) thantiioseobtained before die operation, but diere were no statistical differences between die two groups. Circulation. Compared widi die values before operation, bodi die morphine and halotiiane subgroups showed a statistically significant (P<0.05) decrease in systolic arterial pressure following die injection of die morphine or die administration of die halothane. However, diese did not give rise to any clinically significant change. Recovery period. Recovery (±SEM) in die patients requiring artificial ventilation (Group A: 8.2 ±1.5min; group B: 6.7± 1.8min) was significandy (P<0.02) more rapid dian in die patients of bodi groups who breadied spontaneously (group A: 16.6±2.6min; group B: 18.2± 1.8min). In each group only one patient had not recovered consciousness witiiin 40 min. Restlessness, muscle movement
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 14, 2015
Upper abdominal Lower abdominal Major gynaecological Peripheral vascular
Student's t test was used to analyse die cardiovascular, respiratory and recovery data, and die time until die first injection of postoperative analgesia was required.
TWO-STAGE INFUSION OF ETOMIDATE
1241
of the drug (Bennett, 1978). The use of a separate infusion of fentanyl allowed much greater flexibility in the titration of analgesia compared with the use of a combined etomidate plus fentanyl infusion (Lees et al., 1981), and greatly decreased the incidence of Nausea and vomiting. Seven patients in group A prolonged recovery. Dosage regimens have to be complained of nausea and vomiting, compared with judged according to each patient's requirement and five in group B. This was severe and upsetting in not given on a strict "procedure" basis. Concentrafour, but soon settled with the administration of tions of etomidate used in this way should not be greater than 0.25-0.5%, as it was found that the use prochlorperazine 12.5mgi.m. of a 1% solution can cause severe pain and venoPostoperative analgesia. There was no significant thrombosis when infused to forearm veins. difference between the groups in the time until the first injection of analgesia: the mean time (+ SEM) REFERENCES in group A was 5.8h (±0.6) compared with 6.2h Bennett, N. R. (1978). Aspects of total intravenous anaesthesia; in Adverse Reactions to Anaesthesia, eds J. Watkins and A. (± 0.7) in group B. On direct questioning no patient Milford Ward, p. 150. New York: Grune and Stratton. had recall of any event after "drifting off to sleep" Boys, E.,Cartwright, P., Cole, A., Consiglio, R-,Cookson, R., until awakening in the recovery ward. Dallas, S., Famsworth, G., Jones, D., Miller, B., Moss, E.,
and twitching similar to that seen after induction were seen in four very obese patients in group A after uneventful anaesthesia, possibly as a result of the excessive infusion of etomidate.
DISCUSSION Etomidate has a short initial plasma life of 2.5 min (Van Hamme, Ghoneim and Ambre, 1978) and Wagner (1974) has shown that, to achieve a constant plasma concentration, it is theoretically safer to use a rapid infusion initially and follow this by a slower maintenance infusion rather than give a high initial bolus i.v. combined with an infusion at constant rate. Schiittler and colleagues (1980) have shown that such a scheme using etomidate can provide hypnosis in healthy volunteers. This regimen was modified by Boys and co-workers (1981), and was used in this trial. The use of this two-stage infusion technique of etomidate with a separate infusion of fentanyl produced satisfactory operating conditions in all patients. Irrespective of the mode of ventilation, cardiovascular stability was superior to that in the control group. Respiratory depression was similar in the two spontaneously breathing groups. Other advantages seen with this technique were a decrease in the incidence of pain on injection and muscle movement. This could be attributable to the administration of fentanyl i.v. before commencing the infusion of etomidate (Holdcroft et al., 1976; Schuermann et al.j 1978), or to the infusion itself effectively decreasing the rate of injection and the concentration
Patel, A., Pounder, D., Ransome, P., Rollin, A., Roscoe, B., Thompson, E., Ward, M., Wilkins, D . , and Wright, C. (1981). Etomidate infusion for routine surgery of patients with controlled ventilation: A multicentre evaluation of a two-step technique. Clin. Res. Rev., 1, 103. Holdcroft, A., Morgan, M., Whitwam, J. G., and Lumley, J. (1976). Effect of dose and premedication on induction complications with etomidate. Br. J. Anaesth., 48, 199. Kay, B. (1976). A dose-response relationship for etomidate with some observations on cumulation. Br. J. Anaesth., 48, 213. Lees, N. W., Glasser, J., McGroarty, F. J., and Miller, B. M. (1981). Etomidate and fentanyl for mflintainacf of anflrwthrnifl. Br.J. Anaesth., Si, 959. Miller, B. M., Hendry, J. G. B., and Lees, N. W. (1978). Etomidate and methohexitone, a comparative clinical study in out-patient anaesthesia. Anaesthesia, 32,450. Schuermanns, V., Dom, J., Dony, J., Scheijgrond, H., and Brugmans, J. (1978). Multinational evaluation of etomidate for anaesthesia induction. Anaesthesist, 27, 52. Schiittler, J., Stoeckel, H., Wilms, M., Schwilden, H., and Laven, P. M. (1980). Ein Phannakokinetisch Begrundetes Infusionsmodell fur Etomidat zum Aufrechterhattung von Steady State Plasmaspiegeln. Anaesthesist, 29,662. Van Hamme, M. J., Ghoneim, M. M., and Ambre, J. J. (1978). Pharmacokinetics of etomidate, a new intravenous anesthetic. Anetthesiology, 49, 274. Wagner, J. G. (1974). A safe method forrapidlyachieving plasma concentration plateaus. Clin. Pharmacol. Ther, 16, 691. Zacharias, M., Clarke, R. S. J.,Dundee, J. W., and Johnston, S. B. (1978). Evaluation of three preparations of etomidate. Br. J. Anaesth., 50, 925.
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 14, 2015
Venous sequelae. One patient had a severe thrombophlebitis which lasted for several weeks after a 1% solution of etomidate had been used. Otherwise, there were no venous sequelae which could be attributed to the use of etomidate.
BRITISH JOURNAL OF ANAESTHESIA
1242 ZWEIPHASEN-INFUSION VON ETOMIDATE FOR EINLEITUNG UND ERHALT EINER NARKOSE
INFUSION DE ETOMIDATO EN DOS FASES PARA INDUCCION Y MANTENIMIENTO DE LA ANESTESIA
ZUSAMMENFASSUNG
SUMARIO
Bei 200 Paticnten wurde eine Zweiphasen-Infusionstechnik von Etomidate mit sepantcr Fentanylinfusion mit Thiopental und Halothan $owie Morphin mit Twhflmi in Sauerstoff bezliglich Einleitung und Erhalt cincr Narkose miteinandcr vcrglichcn. KreisJauf- und Atmungsverhalten sowie Erholungszeiten erwiesen sich in den Gruppen als glekh.
Se Uevo a cabo una comparacion de una tecntca de infusion de etomidato en dos fases con infusion sepaiada de fentanilo con tiopentona y balotano, o con morfina mas oxido nitroso en oxigeno, con miras a inducir y a mantener la anestesia en 200 pacientes. Se encontraron en am bos grupos indices cardiovasculares y respiratorios similares asi como tiempos de rccupcracion anilogos.
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 14, 2015