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[Hemodynamic effects of etomidate in the child: a study of the dose-effect relation]
M Sfez1, Y Le Mapihan, J L Gaillard
1Département d'Anesthésie-Réanimation, Hôpital Jean-Verdier, Bondy, France.
Insights
Increasing etomidate dosage in children may decrease systolic index (SI) and increase systemic vascular resistance (SVR). Lowering etomidate doses is recommended if SI reduction is observed during anesthesia.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacodynamics
Background:
- Etomidate is commonly used for pediatric anesthesia induction.
- Understanding its hemodynamic effects at varying doses is crucial for patient safety.
- Limited data exists on the dose-dependent hemodynamic impact of etomidate in healthy children.
Purpose of the Study:
- To investigate the hemodynamic effects of escalating etomidate dosages in pediatric patients.
- To determine the relationship between etomidate dose and cardiovascular parameters like heart rate, mean arterial pressure, aortic flow, systolic index, and systemic vascular resistance.
Main Methods:
- Eighteen healthy children (3-8 years) undergoing anesthesia were randomly assigned to receive etomidate boluses of 0.125, 0.25, or 0.5 mg/kg.
- Hemodynamic parameters including heart rate (HR), mean arterial pressure (MAP), Doppler aortic flow (DAF), systolic index (SI), and systemic vascular resistances (SVR) were monitored.
- Spearman's rank correlation test was employed to analyze the relationship between etomidate dosage and hemodynamic variables.
Main Results:
- A significant inverse correlation was found between increasing etomidate dosage and systolic index (SI).
- A significant positive correlation was observed between increasing etomidate dosage and systemic vascular resistance (SVR).
- No significant changes in heart rate (HR) or mean arterial pressure (MAP) were explicitly detailed in relation to dose escalation, but SI and SVR changes suggest potential cardiovascular impact.
Conclusions:
- Higher etomidate doses are associated with decreased systolic index and increased systemic vascular resistance in pediatric anesthesia.
- Clinicians should consider reducing etomidate dosage if a decrease in systolic index is observed to mitigate potential adverse hemodynamic effects.
- Further research may be warranted to explore the clinical implications of these findings and optimize etomidate dosing strategies in children.
Abstract:
In order to determine haemodynamic effects of increasing etomidate dosage, 18 healthy anaesthetized children aged 3 to 8 years were randomly given etomidate as a bolus: 0.125 mg/kg (group I; n = 6), 0.25 mg/kg (group II; n = 6) or 0.5 mg/kg (group III; n = 6). Heart rate (HR), mean arterial pressure (MAP). Doppler aortic flow (DAF) and equivalents for systolic index (SI) and systemic vascular resistances (SVR) variations after etomidate administration were compared. Spearman's rank correlation test shows a significant relationship between increasing etomidate dosage and both decreased SI and increased SVR. This suggests to decrease dosage when reducing SI is unlikely.