依托咪酯应用于静脉麻醉的安全性、有效性、实用性新进展

The safety,effectiveness and practicability of etomidate for intravenous anesthesia

背景依托咪酯是一种包含咪唑基的羧化物类静脉麻醉药。因其有独特的药理特点,对于血流动力学有高风险的患者,依托咪酯是一种较为理想的静脉镇静药。目的了解依托咪酯的药理学、临床应用领域以及副作用及克服副作用的研究成果。内容依据依托咪酯的结构和药理机制,阐述依托咪酯在临床上的应用领域、副作用以及克服部分副作用的方法。趋向近年来,随着对依托咪酯研究不断深入,发现它对肾上腺皮质的抑制作用是可逆的,可以用于麻醉的维持。这些发现增加了依托咪酯在临床上的应用价值。

Background Etomidate,a carboxylated imidazole-containing compound,is chemically different from any other drugs used for intravenous anesthesia.It also has hypnotic property without perturbing hemodynamics.Objective To review the pharmacology,clinical application and side effects of etomidate.Content Pharmacologically,etomidate potentiates γ-aminobutyricacid (GABA)ergic synaptic transmission directly by activating GABAA receptors and indirectly by enhancing the affinity of GABAA receptors to GABA,inhibits biological effects of cortisol,and activates 2B adrenoceptor.Thus,it has been used for several clinical applications,including fast induction of anesthesia,tranquilization,anti-shock,antiseptics,and maintaining normal hemodynamics in major surgeries,etc.Accompanying these therapeutic effects,etomidate-causes some side-effects,such as,inhibition of the synthesis of cortisol,muscle spasm,cognitive deficits,and vomiting.Trend Because of its fast onset property for anesthesia induction and minor effect on cardiovascular system,etomidate has been widely used in major surgeries,however,for the safety issue, the practitioners should be aware of its adverse effects.