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New Concerns Over Safety of Commonly Used Anesthetic

Authors report increased risk of death in patients receiving etomidate (December 13)

A study published in the December issue of Anesthesia & Analgesia suggests that patients receiving the widely used anesthesia drug etomidate for surgery may be at increased risk of mortality and cardiovascular events.

The new findings add to safety concerns over the use of etomidate as an anesthetic and sedative drug. “There is accumulating evidence for an association between mortality and etomidate use, both in critically ill patients and now in [non-critically ill] patients undergoing noncardiac surgery,” according to an accompanying editorial.

Researchers at the Cleveland Clinic assessed the risk of adverse outcomes in patients receiving etomidate for the induction of anesthesia. Rates of death and cardiovascular events in approximately 2,100 patients receiving etomidate were compared with those in a matched group of 5,200 patients receiving induction with a different intravenous anesthetic, propofol.All patients had severe but noncritical medical conditions (American Society of Anesthesiologists [ASA] physical status III or IV) and were undergoing noncardiac surgery.

The results showed significantly higher risks in patients receiving etomidate. The etomidate group had a 250% increase in the risk of death within 30 days. (The absolute risk of death was 6.5% with etomidate versus 2.5% with propofol.) Patients receiving etomidate also had a 50% increase in the risk of major cardiovascular events.

The results are “striking and troubling,” but the study is not the first to raise safety concerns over etomidate, the accompanying editorial observes. Previous reports have suggested an increased risk of death in patients receiving etomidate in emergency situations or during critical illnesses, particularly sepsis. However, subsequent randomized trials did not show an increased risk of death in critically ill patients receiving etomidate.

Source: Wolters Kluwer Health; December 13, 2013.

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