Clinical study of etomidate emulsion combined with remifentanil in general anesthesia

Digui Weng, Menghua Huang, Runnian Jiang, Rufu Zhan, Chunni Yang

Department of Anesthesiology, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian, People's Republic of China

Background: The aim of this study was to investigate and evaluate the safety, recovery time, and side effects of general anesthesia with different doses of etomidate emulsion combined with remifentanil.
Methods: One hundred ten patients of American Society of Anesthesiologists class 1 or 2 who underwent gynecological general anesthesia with a 1-3-hour operation time were randomly divided into the following groups: etomidate emulsion group 1 ([E1] n = 30); etomidate emulsion group 2 ([E2] n = 30); etomidate emulsion group 3 ([E3] n = 20); and propofol group ([P group] n = 30). For induction of anesthesia, 0.3 mg/kg etomidate emulsion, and the continuous remifentanil infusion also to induce anesthesia (0.1~0.3 µg · kg^-1 · min^-1), was applied in all cases. Afterwards, continuous infusion of etomidate emulsion and remifentanil, respectively (E1: 10 µg · kg^-1 · min^-1 and 0.1 µg · kg^-1 · min^-1; E2: 15 µg · kg^-1 · min^-1 and 0.2 µg · kg^-1 · min^-1; E3: 20 µg · kg^-1 · min^-1 and 0.2 µg · kg^-1 · min^-1), and propofol (P group: 6~10 mg · kg^-1 · h^-1) were administered. Changes in blood flow kinetics and adverse reactions were noted and compared between the four groups.
Results: Both arterial blood pressure (BP) and heart rate (HR) decreased after induction of anesthesia (P < 0.05). Systolic (SBP) and diastolic (DBP) BP changed only slightly, and HRs were slightly infected in E1, E2, and E3. SBP, DBP, and HR during the operation all decreased significantly in P group (P < 0.05). Muscle tremor at the time of induction occurred in 13 cases (11.8%). Following etomidate emulsion anesthesia maintenance, postoperative agitation occurred in seven cases (8.75%), lethargy in 20 cases (25%), and vomiting in 19 cases (23.75%). No adverse reactions were found in P group.
Conclusion: Continuous infusion of etomidate emulsion at 10 µg · kg^-1 · minute^-1 combined with remifentanil during anesthesia has the advantages of hemodynamic stability, quick wake-up, and few adverse reactions. Increasing the dose of etomidate emulsion increases the incidence of adverse reactions.

Keywords: etomidate emulsion, remifentanil, general anesthesia