Total intravenous anesthesia with etomidate. I. A trial in children

Eighty children, aged from 2 weeks to 14 years, were anesthetized using intravenous agents only. Anesthesia was induced by etomidate 0.3 mg/kg together with atropine and fentanyl 2 to 5 microgram/kg. Muscle relaxation was provided by suxamethonium, alcuronium or pancuronium. Unconsciousness was maintained using a continuous infusion of etomidate, initially 0.04-0.05 mg/kg/minute, but adjusted to the apparent requirements of the child. Oxygen, or oxygen/air mixtures were inhaled, or used for ventilation. Maintenance of anesthesia was assessed as good in only 85% of patients, with movement in response to surgery being seen in the remaining 15%. Unsatisfactory anesthesia was particularly associated with lack of experience in the technique, and unparalysed patients. Recovery was generally good, and rapid, with a mean waking time of 4.8 minutes. It is unlikely that this technique will find widespread use. It demands constant observation of the patient, looking for signs of consciousness; and trying to avoid having an awake, paralysed patient, or giving an overdose of etomidate.