Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027066 (myoclonus)
 4,275 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of etomidate as an anaesthetic induction agent has been hampered significantly by unwanted side effects such as pain on injection and thrombophlebitis. Investigations by Doenicke et al. have shown that the solubilizer propylene glycol is responsible for these side effects and that they can be avoided by the use of a lipid emulsion formulation. It was the goal of the present study to quantitate the reduction of thrombophlebitis and pain on injection following both formulations under double-blind study conditions. METHODS. In 100 patients anaesthesia was induced either with a new galenic formulation of etomidate--etomidate in lipid emulsion formulation (Lipofundin MCT 20%; eto-lip)--or with etomidate in propylene glycol 35% (eto-pg). Both groups received 0.3 mg kg-1 etomidate in double-blind randomized fashion. After the injection of etomidate the venous cannula was removed. The observing anaesthetist was unaware of the study drug used, to guarantee blinded investigation conditions. Discomfort and pain during and following injection were recorded, as was local skin irritation. Venous sequelae were assessed for 7 days following injection to register the occurrence of thrombophlebitis. RESULTS. Demographic data were not different between the two groups. For induction of anaesthesia the same dose of both preparations was necessary, and no difference in heart rate and blood pressure before, during or after anaesthesia induction was observed. Pain on injection (78% vs 14%), myoclonus (24% vs 8%) and local skin reaction (50% vs 6%) were present significantly more often in the eto-pg group (P < 0.01; P < 0.05 respectively, chi-square test) than in the eto-lip group. On the 1st and 2nd postoperative days, examination of the injected vein revealed a significantly higher incidence of symptoms of thrombophlebitis in the group treated with eto-pg (25% vs 3%). CONCLUSION. From these results it is concluded that in terms of vein compatibility the new galenic formulation of etomidate with lipofundin MCT 20% is superior to the propylene glycol preparation while pharmacodynamic properties seem not to be affected.
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PMID:[Anesthesia induction using etomidate in a lipid emulsion]. 848 91

Chronic severe hypercortisolism is associated with life-threatening infections, diabetes and a high surgical mortality rate. Oral medical therapy can inhibit steroidogenesis and reduce the risk of these complications. However, apart from a few reports using an ethyl alcohol formulation of the iv anesthetic etomidate, there is no well-tested parenteral steroidogenesis inhibitor. We used the propylene glycol preparation of etomidate available in the United States to control hypercortisolism in a 39-yr-old man with ectopic ACTH secretion who was unable to take oral medications. Etomidate was administered over a period of 5.5 months. We titrated the dose of etomidate daily using serum cortisol levels, to avoid steroid over replacement and allow for a response to ongoing stress. A reduced dose during a period of acute renal failure achieved adequate control of hypercortisolemia. Suppression of steroidogenesis persisted for at least 14 d and perhaps as long as 6 wk after cessation of the medication. Except for transient myoclonus, the patient tolerated this preparation well. Parenteral propylene glycol containing etomidate can be used safely for a prolonged period to reduce hypercortisolemia in patients unable to take oral medications.
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PMID:Use of a parenteral propylene glycol-containing etomidate preparation for the long-term management of ectopic Cushing's syndrome. 1154 33

Etomidate is a widely used intravenous induction agent that is especially useful for patients at risk for hypotension during anesthesia induction. Side effects limiting its use include adrenocortical suppression, acidosis, myoclonus, venous irritation, and phlebitis. The osmolality of etomidate prepared in propylene glycol appears to play a crucial role in causing phlebitis. The increased use of etomidate during the recent propofol shortage correlated with an increase in reported incidences of postoperative phlebitis and thrombophlebitis at Ochsner Clinic Foundation from October 2009 through April 2010. Several methods aim to prevent such occurrences, including pretreatment with lidocaine (and possibly esmolol), lower doses of etomidate, and injection into larger veins. The most compelling evidence suggests that using a lipid formulation of etomidate instead of the traditional propylene glycol preparation may dramatically decrease venous sequelae.
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PMID:Increase in venous complications associated with etomidate use during a propofol shortage: an example of clinically important adverse effects related to drug substitution. 2173 54