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[Anesthesia induction using etomidate in a lipid emulsion]

P J Kulka1, F Bremer, J Schüttler

  • 1Klinik für Anästhesiologie und spezielle Intensivmedizin der Rheinischen Friedrich-Wilhelms-Universität Bonn.

Der Anaesthesist
|April 1, 1993
PubMed
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A new lipid emulsion formulation of etomidate significantly reduced pain and thrombophlebitis compared to the propylene glycol formulation. This improved etomidate

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Formulation Science

Background:

  • Etomidate is an anesthetic induction agent with known side effects like injection pain and thrombophlebitis.
  • Propylene glycol, a solubilizer in etomidate formulations, is implicated in these adverse events.
  • Lipid emulsion formulations offer a potential solution to mitigate these side effects.

Purpose of the Study:

  • To quantitatively compare the incidence of thrombophlebitis and pain on injection between a new lipid emulsion etomidate formulation and a conventional propylene glycol formulation.
  • To assess the impact of different etomidate formulations on local skin reactions and venous sequelae.

Main Methods:

  • A double-blind, randomized study involving 100 patients undergoing anesthesia induction.

Related Experiment Videos

  • Patients received either etomidate in lipid emulsion (eto-lip) or etomidate in propylene glycol (eto-pg) at a dose of 0.3 mg/kg.
  • Pain, local skin irritation, and venous sequelae (thrombophlebitis) were assessed post-injection.

    • Main Results:

    • The etomidate in lipid emulsion group (eto-lip) showed significantly lower rates of pain on injection (14% vs 78%), myoclonus (8% vs 24%), and local skin reactions (6% vs 50%) compared to the etomidate in propylene glycol group (eto-pg).
    • Incidence of thrombophlebitis was significantly higher in the eto-pg group (25%) than in the eto-lip group (3%) within 7 days post-injection.
    • No significant differences in hemodynamic parameters (heart rate, blood pressure) were observed between the groups.

    Conclusions:

    • The lipid emulsion formulation of etomidate (eto-lip) demonstrates superior vein compatibility compared to the propylene glycol formulation (eto-pg).
    • The new galenic formulation effectively reduces pain and thrombophlebitis without altering the pharmacodynamic properties of etomidate.
    • This improved formulation offers a safer alternative for etomidate administration during anesthesia induction.