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Feasibility of continuous intravenous transfusion of etomidate monitored by Narcotrend

ZHOU Shan-shan, LAN Hai-zhen, DONG Rong, YU Bu-wei   

  1. Department of Anesthesiology,Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China
  • Online:2015-11-28 Published:2016-01-13


Objective  To evaluate the effects of etomidate on general anesthesia induction and continuous intravenous transfusion during maintenance. Methods  Seventy ASAⅠorⅡ patients undergoing selective operations and general anesthesia were enrolled. Anesthesia was induced with the order of intravenous injection of midazolam 0.03 mg/kg, etomidate 0.3 mg/kg, sufentanil 0.2 μg/kg, and cisatracurium 0.2 mg/kg. The injection pain and myoclonus during induction were recorded. During anesthesia maintenance, etomidate of 10-15 μg/(kg·min) was infused continuously and the depth of anesthesia was monitored by Narcotrend. Infusion speed was adjusted according to the Narcotrend index (NT value). During the operation, remifentanil was infused with the speed of 0.1-0.2 μg/(kg·min) and cisatracurium was injected at intervals. Mean artery pressure (MAP), heart rate (HR), and NT values were recorded before induction (T0), 1 min after induction (T1), endotracheal intubation (T2), the start and end of surgery (T3,T4), and extubation (T5). Surgery time, anesthesia time, awakening time after surgery, extubation time, and adverse events were recorded, as well as dosages of etomidate, cisatracurium, and remifentanil. Results  The NT level of patients maintained at D1-D2 grade with NT value of 40-60 by continuous intravenous infusion of etomidate of 10-15μg/(kg·min) during surgery. Compared with T0, the NT value at T1 decreased rapidly to meet the requirement of intubation. MAP at T1 decreased but the fluctuation was less than 15%. MAP and HR significantly increased at T5. NT values of most patients maintained at ideal level by continuous intravenous infusion of etomidate of 10-15μg/(kg·min). NT values of most patients recovered back to 85 (A-B1 grade) within 16-22 min after stopping transfusion of etomidate. The incidence of myoclonus during induction was 14.3%. Conclusion  Anesthesia induction of ASAⅠ or Ⅱ adult patients by etomidate is safe and quick and hemodynamics is stable. It can maintain ideal depth of anesthesia by continuous intravenous infusion of etomidate of 10-15 μg/(kg·min) during anesthesia maintenance. Patients wake up quickly and completely without delay after stopping transfusion and adverse events are rare.

Key words: Narcotrend, etomidate, continuous intravenous transfusion, depth of anesthesia