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etomidate infusion

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https://www.readbyqxmd.com/read/29744071/etomidate-in-the-control-of-severe-cushing-s-syndrome-by-neuroendocrine-carcinoma
#1
Alfredo Adolfo Reza-Albarrán, Gerson Geovany Andino Ríos, Laura Gabriela Gómez Herrera
Etomidate is a very effective drug in severe Cushing's syndrome that is refractory to ketoconazol. Control of the serum cortisol levels in ectopic Cushing's syndrome can be obtained with infusion rates much lower than those used in anesthesia, without respiratory side effects.
May 2018: Clinical Case Reports
https://www.readbyqxmd.com/read/29628594/an-unusual-case-of-a-parturient-with-uncorrected-pentalogy-of-fallot-presenting-for-elective-cesarean-section-delivery-of-twins
#2
Ying Ci Ho, Sek Koon Boey, Abey Matthew Varughese Mathews, Hooi Geok See, Nian Chih Hwang
We present a 31-year-old primigravida with uncorrected pentalogy of Fallot, pregnant with monochorionic-diamniotic twins, undergoing elective lower segment cesarean section at 36 weeks gestation. Preoperative workup included a transthoracic echocardiogram which revealed a large ventricular septal defect of 1.8 cm with bidirectional shunting, a moderate size atrial septal defect of 1.8 cm with predominant left-to-right shunting, an overriding aorta, moderate right ventricular hypertrophy, and severe pulmonary valve stenosis...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29416230/etomidate-derivatives-novel-pharmaceutical-agents-in-anesthesia
#3
REVIEW
Raymond J Malapero, Michael P Zaccagnino, Ethan Y Brovman, Alan David Kaye, Richard D Urman
Etomidate is an imidazole derivative that possesses important sedative properties employed in anesthesia practice, however, etomidate has a number of well-know side effects which limit its use in certain subpopulations and over long periods of time, mostly related to dose-dependent adrenal suppression. This review focuses on novel etomidate derivatives with an emphasis on pharmacological properties which afford improved safety profile and potentially desirable clinical effects. The pharmacology and clinical investigation of some of these etomidate derivatives, e...
October 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29157794/analgosedative-interventions-after-rapid-sequence-intubation-with-rocuronium-in-the-emergency-department
#4
Emily Kilber, Daniel H Jarrell, John C Sakles, Christopher J Edwards, Asad E Patanwala
OBJECTIVES: The use of etomidate and rocuronium for rapid sequence intubation (RSI) results in a duration of paralysis that exceeds the duration of sedation. The primary objective of this study was to compare the number of analgosedative (AGS) interventions early versus late post-RSI, with this drug combination. The secondary objective was to descriptively assess time to first AGS intervention. METHODS: This was a retrospective cohort study conducted in an academic ED in the United States between January 2015 and June 2016...
November 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28890850/minimum-infusion-rate-and-adrenocortical-function-after-continuous-infusion-of-the-novel-etomidate-analog-et-26-hcl-in-rats
#5
Junli Jiang, Bin Wang, Zhaoqiong Zhu, Jun Yang, Jin Liu, Wensheng Zhang
BACKGROUND: Because etomidate induces prolonged adrenal suppression, even following a single bolus, its use as an infused anesthetic is limited. Our previous study indicated that a single administration of the novel etomidate analog methoxyethyletomidate hydrochloride (ET-26-HCl) shows little suppression of adrenocortical function. The aims of the present study were to (1) determine the minimum infusion rate of ET-26-HCl and compare it with those for etomidate and cyclopropyl-methoxycarbonylmetomidate (CPMM), a rapidly metabolized etomidate analog that is currently in clinical trials and (2) to evaluate adrenocortical function after a continuous infusion of ET-26-HCl as part of a broader study investigating whether this etomidate analog is suitable for long infusion in the maintenance of anesthesia...
2017: PeerJ
https://www.readbyqxmd.com/read/28738000/comparison-of-cardiac-output-measured-by-use-of-computed-tomography-and-thermodilution-in-dogs
#6
Sharon Tenenbaum, Fernando L Garcia-Pereira, Clifford R Berry, Tori Obert
OBJECTIVE To compare cardiac output (CO) measured by use of CT coronary angiography and thermodilution (criterion-referenced standard) at various CO values, record adverse effects, and determine the time needed to measure CO. ANIMALS 5 healthy purpose-bred Beagles (2 males and 3 females). PROCEDURES A prospective nonrandomized crossover study was conducted. Dogs were premedicated with butorphanol tartrate (0.2 mg•kg-1 , IM). Anesthesia was induced by IV administration of etomidate (1 to 2 mg•kg-1 ) and midazolam (0...
August 2017: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/28459733/a-phase-1-single-center-double-blind-placebo-controlled-study-in-healthy-subjects-to-assess-the-safety-tolerability-clinical-effects-and-pharmacokinetics-pharmacodynamics-of-intravenous-cyclopropyl-methoxycarbonylmetomidate-abp-700-after-a-single-ascending
#7
Michel M R F Struys, Beatrijs I Valk, Douglas J Eleveld, Anthony R Absalom, Peter Meyer, Sascha Meier, Izaak den Daas, Thomas Chou, Kai van Amsterdam, Jason A Campagna, Steven P Sweeney
BACKGROUND: Cyclopropyl-methoxycarbonylmetomidate (ABP-700) is a new "soft" etomidate analog. The primary objectives of this first-in-human study were to describe the safety and efficacy of ABP-700 and to determine its maximum tolerated dose. Secondary objectives were to characterize the pharmacokinetics of ABP-700 and its primary metabolite (cyclopropyl-methoxycarbonyl acid), to assess the clinical effects of ABP-700, and to investigate the dose-response and pharmacokinetic/pharmacodynamic relationships...
July 2017: Anesthesiology
https://www.readbyqxmd.com/read/28337083/continuous-infusion-etomidate-in-a-patient-receiving-extracorporeal-membrane-oxygenation
#8
Joseph M LaRochelle, Bonnie Desselle, Janet L Rossi
We describe a 16-year-old, 65-kg male deployed on extracorporeal membrane oxygenation (ECMO) for refractory respiratory failure secondary to ingestion of multiple substances. During his ECMO course, standard sedative and analgesic strategies failed and alternative medications were used. The patient received various dosages of fentanyl, morphine, hydromorphone, clonidine patches, dexmedetomidine, lorazepam, methadone, pentobarbital, olanzapine, and propofol. Despite administration of multiple agents, on day 29 of ECMO the patient experienced elevated blood pressures due to agitation, and continuous infusion etomidate was started...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/27878281/etomidate-inhibits-nuclear-factor-%C3%AE%C2%BAb-through-decreased-expression-of-glucocorticoid-receptor-in-septic-rats
#9
Yu Zhang, Ruo-Meng Li, Chun Wang, Na Liu, Shen Lv, Jun-Yu Xiong
The present study aimed to investigate the effect of etomidate administered prior to or following cecal ligation and puncture (CLP) on the expression of glucocorticoid receptor (GR) and lymphocyte apoptosis in septic rats. Right jugular vein catheterization was performed on female Sprague‑Dawley rats under isoflurane anesthesia, and CLP surgery was performed to induce sepsis 3 days following catheterization. The rats were randomly divided into five groups. All groups were infused with 2 ml of either etomidate or 5‰ dimethyl sulfoxide (DMSO) at 1 ml/h for 2 h from 6 h post‑surgery...
December 2016: Molecular Medicine Reports
https://www.readbyqxmd.com/read/27703286/a-comparison-between-the-hemodynamic-effects-of-cisatracurium-and-atracurium-in-patient-with-low-function-of-left-ventricle-who-are-candidate-for-open-heart-surgery
#10
RANDOMIZED CONTROLLED TRIAL
Masoud Ghorbanlo, Mahmoud Reza Mohaghegh, Forozan Yazdanian, Mehrdad Mesbah, Ziya Totonchi
BACKGROUND: The need for muscle relaxants in general anesthesia in different surgeries including cardiac surgeries, and the type of relaxant to be used considering its different hemodynamic effects on patients with heart disease can be of considerable importance. In this study, the hemodynamic effects of two muscle relaxants, Cisatracurium and Atracurium in patients whit low function of left ventricle who are candidate for open heart surgery have been considered. METHOD: This study has been designed as a randomized prospective double-blind clinical trial...
July 27, 2016: Medical Archives
https://www.readbyqxmd.com/read/27540247/application-of-pharmaceutical-knowledge-to-the-unconventional-use-of-a-rarely-used-anaesthetic-agent
#11
Caroline Cole
CASE SUMMARY: A 6 yr old 45 kg child with severe Cushinoid features was admitted to PICU with probable hypertensive encephalopathy. She presented with increasing headaches, vomiting and seizures becoming unresponsive with a GCS of 3. She was profoundly hypertensive and her cortisol levels were significantly elevated (>2000 nmol/L). Rapid reduction in cortisol levels was required to stabilise her condition prior to surgery. Etomidate is the only readily available intravenous preparation which reliably suppresses adrenocortical function...
September 2016: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/27537760/unrepaired-tetralogy-of-fallot-related-pathophysiologic-changes-reduce-systemic-clearance-of-etomidate-in-children
#12
Yang Shen, Mei-Hua Cai, Wei Ji, Jie Bai, Yue Huang, Ying Sun, Lin Lin, Jing Niu, Ma-Zhong Zhang
BACKGROUND: Pathophysiologic changes in children with congenital heart disease may alter the effect of drugs by influencing the pharmacokinetics (PK). Considering the limited literature that describes the PK of etomidate in pediatric patients, especially in those with tetralogy of Fallot (TOF), our aim was to characterize the PK of etomidate and explore the effects of TOF. METHODS: Twenty-nine pediatric patients (15 with TOF and 14 with normal cardiac anatomy) scheduled to undergo elective surgery under general anesthesia were recruited in the study...
September 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27405061/effects-of-increasing-hydrocortisone-to-300-mg-per-day-in-the-treatment-of-septic-shock-a-pilot-study
#13
RANDOMIZED CONTROLLED TRIAL
Hervé Hyvernat, Rémy Barel, Anne Gentilhomme, Jean François Césari-Giordani, Annie Freche, Michel Kaidomar, Bernard Goubaux, Christian Pradier, Jean Dellamonica, Gilles Bernardin
PURPOSE: The Surviving Sepsis Campaign guidelines recommend hydrocortisone in septic shock only when fluid resuscitation and vasopressors fail to restore hemodynamic stability. Hydrocortisone administration modalities are supported only by low-grade recommendations. Our main objective here was to determine differences in 28-day mortality between two low-dose hydrocortisone regimens for the treatment of septic shock. METHODS: We performed a multicenter, prospective, randomized, double-blind, pilot study in four adult medical intensive care units...
November 2016: Shock
https://www.readbyqxmd.com/read/27141514/ectopic-acth-production-leading-to-diagnosis-of-underlying-medullary-thyroid-carcinoma
#14
Leslee N Matheny, Jessica R Wilson, Howard B A Baum
Medullary thyroid carcinoma (MTC) has been described as a source of ectopic ACTH secretion in patients with Cushing's syndrome. This is an infrequent association, occurring in less than 1% of MTC cases. Among these, it is even more unusual for an initial diagnosis of hypercortisolism to lead to the discovery of underlying MTC. Here we present a case of a patient with weakness, diarrhea, and hypokalemia who was found first to have Cushing's syndrome and later diagnosed with metastatic MTC. The patient was treated initially with oral agents to control his hypercortisolism, then with an etomidate infusion after experiencing intestinal perforation...
April 2016: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/27136445/lipid-rescue-efficacy-and-safety-still-unproven
#15
Jonas Höjer, Dag Jacobsen, Pertti J Neuvonen, Per H Rosenberg
No abstract text is available yet for this article.
October 2016: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/26991617/distinct-hypnotic-recoveries-after-infusions-of-methoxycarbonyl-etomidate-and-cyclopropyl-methoxycarbonyl-metomidate-the-role-of-the-metabolite
#16
Ervin Pejo, Jifeng Liu, Xiangjie Lin, Douglas E Raines
BACKGROUND: Methoxycarbonyl etomidate (MOC-etomidate) and cyclopropyl methoxycarbonyl metomidate (CPMM) are rapidly metabolized "soft" etomidate analogs. CPMM's duration of hypnotic effect is context insensitive, whereas MOC-etomidate's is not. In this study, we tested the hypothesis that CPMM's effect is context insensitive because, unlike MOC-etomidate, its metabolite fails to reach physiologically important concentrations in vivo even with prolonged continuous infusion. METHODS: We compared the potencies with which MOC-etomidate and CPMM activate α1(L264T)β3γ2 γ-aminobutyric acid type A receptors and induce loss-of-righting reflexes (i...
April 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26926335/a-forecast-of-relevant-pediatric-sedation-trends
#17
REVIEW
Mohamed Mahmoud, Keira P Mason
PURPOSE OF REVIEW: Over the past decade, the field of pediatric sedation has benefited from contributions which include the introduction and update of policies, procedures, and guidelines regarding training, physiologic monitoring and delivery, the approval of new sedatives, the multispecialty collaborations intended to advance the field and the development of sedatives, and delivery systems. This review will explore new drug innovations as well as evolved formulations of already approved agents, unique sedative delivery systems, the clinical application of pharmacogenetics and will conclude with a reflection on the current and future trends and focus of pediatric sedation research...
March 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/26871805/low-dose-ketamine-pretreatment-reduces-the-incidence-and-severity-of-myoclonus-induced-by-etomidate-a-randomized-double-blinded-controlled-clinical-trial
#18
RANDOMIZED CONTROLLED TRIAL
Guan-Nan Wu, Hai-Jun Xu, Fang-Fang Liu, Xian Wu, Hai Zhou
Myoclonic movement induced by etomidate is a common but undesirable problem during general anesthesia induction. To investigate the influence of pretreatment with low-dose ketamine on the incidence and severity of myoclonus induced by etomidate, 104 patients were randomized allocated to 1 of 2 equally sized groups (n = 52) to receive either intravenous low-dose ketamine 0.5 mg/kg (group K) or an equal volume of normal saline (group S) 1 minute before induction of anesthesia with 0.3-mg/kg etomidate. The incidence and severity of myoclonus were assessed for 2 minutes after administration of etomidate...
February 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/26743223/effects-of-continuous-infusion-of-etomidate-at-various-dose-rates-on-adrenal-function-in-dogs
#19
Bangyong Qin, Hongzhuan Hu, Baofeng Cao, Zhaoqiong Zhu
BACKGROUND: Etomidate is a commonly used sedative in intravenous anesthesia. The aim of this study was to compare the effects of various etomidate doses administered by continuous infusion on adrenal function in dogs under general anesthesia. METHODS: Thirty-six healthy adult male dogs were randomly divided into six groups. Sodium pentobarbital alone was administered to the control group (group C); five experimental groups (E1, E2, E3, E4, and E5) were also given etomidate at doses of 10, 15, 20, 25, and 30 μg · kg(-1) · min(-1), respectively, to maintain anesthesia...
January 8, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/26623082/the-use-of-etomidate-for-rapid-sequence-induction-in-septic-patients
#20
Matthew R Dettmer, R Phillip Dellinger
There is continued debate about the clinical ramifications of single-dose etomidate for rapid sequence induction (RSI) in patients with sepsis. This history of this debate includes early studies identifying an association between etomidate infusions and mortality with adrenal suppression as a hypothesized mechanism. More recent data describing the high prevalence of adrenal insufficiency in patients with sepsis has prompted additional investigation as to the clinical effects of single-dose etomidate when utilized as an agent in RSI...
October 2015: Journal of Thoracic Disease
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