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Induction of general anesthesia requires to be safe and to ensure a proper level of anesthesia. A proper anesthesia is sufficient to guarantee loss of consciousness and amnesia and without being too depth leading to a electroencephalogram (EEG) with burst suppression. The depth of anesthesia is monitored by the bispectral index analyse of the EEG, this allows to detect any under- or over-dose of anesthesia. The monitoring works with an unknown algorithm (patent), which evaluate the state of consciousness in the patient.
Etomidate and propofol are commonly use to ensure general anesthesia. Actually, really few litterature has objective informations about the monitoring of Etomidate. The few existant are the old ones and has just a clinical evaluation of the depth of anesthesia (loss of consciousness, loss of breathing, loss of palpebral reflex). Except the fact that these clinical evaluations come from the brain stem, and in fact are not reliable to assess the cortical activity which is reduced by etomidate.
Therefore, some anesthetists are fearful that etomidate is not sufficient to ensure a proper anesthesia to intubate the patient.
This interventionnal study has two purpose. Firstly, a survey will be conduct about the habits and beliefs when use of etomidate.
Secondly, a prospective study will be conduct to monitore with the bispectral index the depth and duration of anesthesia with etomidate.
Protocol with randomization in one of the 2 arms (0.2 vs. 0.3 mg / kg of etomidate), blind to the investigators.
The right dosage will be prepared at the same time by a colleague anesthetist who will not participate in the study according to the randomization envelope that we will give to him earlier. To remain blind to this dosage, it will be diluted with physiological serum up to 30 ml.
These following procedures will be carried out in order:
- Preparation by a colleague of the adequate dose of etomidate, reduced to 20 cc with physiological serum.
No premedication with benzodiazepines (xanax).
When the BIS rises above 60, the study stops. The anesthesia is then deepened by administration of propofol and is left to the discretion of the anesthesiologist in charge of the room.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Etomidate 0,2 mg/kg | Experimental | 8 patients recruited, to receive an injection of bolus of Etomidate at dosage 0,2 mg/kg, |
|
| Etomidate 0,3 mg/kg | Experimental | 10 patients recruited, to receive an injection of bolus of Etomidate at dosage 0,3 mg/kg |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| induction by Etomidate bolus | Drug | General anesthesia induction by Etomidate bolus with different concentration in either of the two arms. First arm, has the concentration (0,2 mg/kg) commonly used of Etomidate to induce anesthesia. Second arm, has the concentration (0,3 mg/kg) usually proposed in medical literature. |
| Measure | Description | Time Frame |
|---|---|---|
| time to loss of consciousness | Time for loss of consciousness after etomidate administration | During general anesthesia induction |
| time to loss of palpebral reflex | Time to loss of palpebral reflex after etomidate administration | During general anesthesia induction |
| Time for BIS decrease < 60 | Time for BIS decrease < 60 after etomidate administration | During general anesthesia induction |
| Duration of adequate general anesthesia | Time spent with a bis < 60 after etomidate administration | During general anesthesia induction |
| Measure | Description | Time Frame |
|---|---|---|
| Presence of secondary effect of etomidate, about presence of myoclonia | Myoclonia | During first 15 minutes of general anesthesia |
| Measure | Description | Time Frame |
|---|---|---|
| Presence of secondary effect of etomidate, about pain during injection | Pain | During first 15 minutes of general anesthesia |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Céline Boudart, MD | Erasme University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Erasme UH | Brussels | 1070 | Belgium |
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