Involuntary movement etomidate

Propanidid. Propanidid [1421-14-3] (Epontol), C gH2yNO, (7) a derivative of the propyl ester of homo vanillic acid, has been in clinical use in Europe for a number of years. Its main advantage is rapid onset of action and a fast recovery which, like etomidate, is because of rapid metaboHsm by esterases rather than redistribution (108). Excretion is rapid 75 to 90% of the dmg is eliminated as metaboUtes within two hours. Propanidid side effects include hypotension, tachycardia, and hyperventilation followed by apnea, as well as excitatory side effects such as tremor and involuntary muscle movement (109). 

Etomidate Rapid onset and moderately fast recovery Provides cardiovascular stability causes decreased steroidogenesis and involuntary muscle movements... 

Etomidate causes a high incidence of pain on injection, myoclonic activity, and postoperative nausea and vomiting. The involuntary muscle movements are not associated with electroencephalographic epileptiform activity. Etomidate may also cause adrenocortical suppression via inhibitory effects on steroidogenesis, with decreased plasma levels of cortisol after a single dose. Prolonged infusion of etomidate in critically ill patients may result in hypotension, electrolyte imbalance, and oliguria because of its adrenal suppressive effects. 

Etomidate, a non-barbiturate anesthetic, is considered to be safe, especially in patients with hemodynamic instability. The most common complications of using etomidate are venous sequelae, pain on injection (1), and involuntary muscle movements (SED-11, 211) (2). 

In 104 patients, the freqnency of pain on injection of etomidate was 32-53% and was severe in 5-20% of patients (5). The freqnency of involnntary movements was 15-35%. The freqnency of both pain and involuntary muscle movements was least when fentanyl 2.5 pg/kg was given before etomidate. There was no significant relation between pain and muscle movement. A medium-chain triglyceride and soya bean emulsion formulation has been used for anesthetic induction, in an attempt to reduce the unwanted adverse effects of pain on injection and thrombophlebitis (6). 

The most important side effects of etomi-date are involuntary muscle movements and pain at the site of injection (57 -, 58 ). Although one patient with a skin rash (without other symptoms of allergy) after the use of etomidate is described the statement that etomidate causes no allergic reactions still probably holds true, since no skin tests were performed and many other drugs were given. The cardiovascular stability after its use is remarkable (55, 57, 58 ). 

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See also in sourсe #XX -- [ ]

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