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Fentanyl pretreatment modifies anaesthetic induction with etomidate
R J Stockham1, T H Stanley, N L Pace
1Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City 84132.
Anaesthesia and Intensive Care
|May 1, 1988
Summary
Fentanyl pretreatment effectively reduces etomidate induction side effects like myoclonus and pain, but higher doses increase apnea. 500 micrograms of fentanyl is suggested as an ideal dose for fit patients.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Etomidate is an induction agent for anesthesia.
- Hemodynamic changes and side effects can occur during anesthesia induction.
- Fentanyl is an opioid analgesic often used perioperatively.
Purpose of the Study:
- To evaluate hemodynamic changes and side effects of etomidate induction.
- To determine the optimal pre-induction fentanyl dose to mitigate etomidate's adverse effects.
- To assess the impact of varying fentanyl doses on patient response during induction and intubation.
Main Methods:
- 60 ASA Class I or II patients were studied.
- Patients were randomized into four groups receiving different pre-induction fentanyl doses (0, 100, 250, 500 micrograms) or saline.
- Anesthesia was induced with etomidate (0.3 mg/kg) five minutes after fentanyl administration.
Main Results:
- Increasing fentanyl doses significantly reduced myoclonus and injection pain (P<0.002).
- Apnea incidence increased with higher fentanyl doses (53% to 100%).
- Fentanyl pretreatment dose-dependently prevented increases in systolic blood pressure and heart rate during induction-intubation (P<0.01).
Conclusions:
- Higher pre-induction fentanyl doses minimize etomidate-related side effects and hemodynamic instability.
- The optimal fentanyl dose of 500 micrograms balances efficacy in reducing side effects with increased apnea risk.
- 500 micrograms of fentanyl is recommended as an ideal pretreatment dose for etomidate induction in fit patients.