Background: There is a debate regarding the safety of etomidate. We evaluated the effects of etomidate on mortality in a large cohort of critical care patients.
Methods: This retrospective matched-cohort study was performed using the Medical Information Mart for Intensive Care version 3 (MIMIC-III) database. Among 12,526 adult patients who were prescribed etomidate or propofol on the first day of mechanical ventilation, 625 patients administered etomidate were statistically matched with 6,250 patients administered propofol. The primary outcome measures were all-cause in-hospital mortality, 48-hour survival, cardiovascular morbidity, and infectious morbidity. Logistic regression analysis with stepwise selection of variables was performed to examine the dose-mortality relationship of etomidate.
Results: All-cause in-hospital mortality was 1.84 times higher in the etomidate cohort (OR, 1.84; 98.75% CI, 1.42, 2.37). Compared to the propofol cohort, the etomidate cohort showed 57% lower odds of 48-hour survival (0.43 [0.27, 0.73]), no difference in odds of cardiovascular morbidity (0.86 [0.66, 1.12]), and 1.77 times higher odds of infectious morbidity (1.77 [1.35, 2.31]). Additionally, the odds of mortality increased by 1.36 times per 0.1 mg/kg of etomidate (1.36 [95% CI: 1.23, 1.49]).
Conclusions: Etomidate is a poor choice as a hypnotic drug on the first day of mechanical ventilation, as it is associated with a dose-dependent increase in all-cause mortality, and does not improve survival for the first 48 h.
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http://dx.doi.org/10.4097/kja.20509 | DOI Listing |
AAPS J
December 2024
Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China.
NH600001 is a new general anaesthetic drug with a structure similar to etomidate. The objective of this study was to investigate the relationship between concentrations of NH600001 and sedation efficacy based on data from phase I-II studies and factors influencing the pharmacokinetics and pharmacodynamics of NH600001. The dataset consisted of 2 phase I studies in healthy subjects and 1 phase II study in patients undergoing gastroscopy.
View Article and Find Full Text PDFEndocrine
December 2024
Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland.
Purpose: Severe Cushing's syndrome (SCS) is a life-threatening endocrine condition that requires prompt medical intervention. Intravenous etomidate infusion is considered to be the most effective in rapid cortisol overproduction inhibition. This single-center retrospective study aimed to present the safety and effectiveness of intravenous, low-dose, lipid-formulated etomidate infusion in patients with SCS.
View Article and Find Full Text PDFNanomaterials (Basel)
December 2024
Key Laboratory of Materials Physics, Anhui Key Laboratory of Nanomaterials and Nanotechnology, Institute of Solid State Physics, HFIPS, Chinese Academy of Sciences, Hefei 230031, China.
Etomidate (ET), a medical anesthetic, is increasingly being incorporated into e-liquids for consumption and abuse as a new psychoactive substance (NPS), leading to significant social issues. In this work, large-area Au micro- and nano-structured ordered arrays were engineered as surface-enhanced Raman spectroscopy (SERS) substrates for fast detection and precise identification of ET and its metabolites. This ordered array, characterized by abundant electromagnetic enhancement hotspots and structural uniformity, imparts unique properties to the SERS substrate, including ultra-sensitivity, spectral signal reproducibility, and precise quantitative capabilities.
View Article and Find Full Text PDFCureus
November 2024
Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, Guwahati, IND.
Catatonia is a serious neuropsychiatric syndrome of motor and behavioral dysfunction where electroconvulsive therapy (ECT) is a well-proven treatment modality. ECT is also preferred as it is a low-risk procedure compared to chronic medications having significant side effects. However, the cardiovascular events that occur during ECT are a major cause of morbidity and mortality in patients with an abnormal cardiovascular pathophysiology.
View Article and Find Full Text PDFDrug Des Devel Ther
December 2024
Department of Anesthesiology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, People's Republic of China.
Background: Etomidate has been observed to precipitate myoclonus in patients undergoing induction of general anaesthesia. This study was designed to investigate the effect of pretreatment with a small dose of esketamine on the incidence of myoclonus induced by etomidate.
Methods: One hundred adult patients, who were scheduled to undergo selective operations with general anesthesia, were randomly divided into two groups, with one group receiving esketamine (Group E) and the other receiving normal saline (Group C).
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