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Etomidate-Lipuro is associated with considerably less injection pain in children compared with propofol with added

Y Nyman1, K Von Hofsten, C Palm

  • 1Department of Paediatric Anaesthesia and Intensive Care, Astrid Lindgrens Children's Hospital, Karolinska Hospital, Stockholm, Sweden. yvonne.nyman@karolinska.se

British Journal of Anaesthesia
|August 18, 2006
PubMed

Insights

A new etomidate lipid formulation significantly reduced injection pain in children compared to propofol with lidocaine. This finding suggests a potential shift in pediatric anesthesia practices to improve patient comfort.

Area of Science:

  • Anesthesiology
  • Pediatric Medicine
  • Pharmacology

Background:

  • Propofol commonly causes injection pain in children, even with lidocaine.
  • A novel lipid formulation of etomidate (Etomidate-Lipuro) shows minimal discomfort in adults.
  • Current pediatric anesthesia practices often involve propofol with lidocaine, despite associated pain.

Purpose of the Study:

  • To compare injection pain incidence between Etomidate-Lipuro and propofol with lidocaine in pediatric patients.
  • To evaluate the efficacy of Etomidate-Lipuro in reducing pain during intravenous anesthesia induction.
  • To assess myoclonic muscular activity as a secondary outcome.

Main Methods:

  • Prospective, double-blind, randomized trial involving 110 pediatric patients (aged 2-16 years).
  • Primary endpoint: incidence of injection pain assessed via a four-point scale.
  • Secondary endpoint: occurrence of myoclonic muscular activity assessed via a four-point scale.
  • Interim analysis after 80 patients due to Ethics' Committee request.

Main Results:

  • Study stopped after enrolling 80 patients.
  • Etomidate-Lipuro group showed significantly lower injection pain incidence (5.0%) versus propofol-lidocaine (47.5%, P<0.001).
  • Etomidate-Lipuro was associated with a higher incidence of myoclonic activity (85.0%) compared to propofol-lidocaine (15%, P<0.001).

Conclusions:

  • Etomidate-Lipuro significantly reduces injection pain in children compared to propofol with lidocaine.
  • The findings suggest Etomidate-Lipuro as a preferable alternative for pediatric anesthesia induction.
  • A potential change in clinical practice is warranted to minimize pediatric injection pain.
Abstract

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