Etomidate protects retinal ganglion cells from hydrogen peroxide-induced injury via Nrf2/HO-1 pathway

AIM:To determine whether etomidate(ET)has a protective effect on retinal ganglion cells(RGCs)injured with hydrogen peroxide(H_(2)O_(2))and to explore the potential mechanism underlying the antioxidative stress effect of ET.METHODS:Cultured RGCs were identified by double immunofluorescent labeling of microtubule-associated protein 2 and Thy1.1.An injury model of H_(2)O_(2)-induced RGCs oxidative stress was established in vitro.Cells were pretreated with different concentrations of ET(1,5,and 10μmol/L)for 4h,followed by further exposure to H_(2)O_(2)at 1000μmol/L.Cell counting kit 8 and Annexin V/propidium iodide assays were applied to detect the viabilities and apoptosis rates of the RGCs at 12,24,and 48h after H_(2)O_(2)stimulation.The levels of nitric oxide,malondialdehyde,and glutathione in culture media were measured at these time points.Quantitative reverse transcription polymerase chain reaction(qRT-PCR)and Western blot were performed to observe the effects of ET on the messenger RNA and protein expression of inducible nitric oxide synthase(iNOS),nuclear factor erythroid 2-related factor 2(Nrf2),heme oxygenase 1(HO-1),glutathione peroxidase 1 and the level of conjugated acrolein in RGCs at 12,24,and 48h after H_(2)O_(2)stimulation and in the retina at 12h after optic nerve transection(ONT).RESULTS:The applications of 5 and 10μmol/L of ET significantly increased the viability of RGCs.Results from qRT-PCR indicated a decrease in the expression of iNOS and an increase in the expressions of Nrf2 and HO-1 in ETpretreated RGCs at 12,24 and 48h after H_(2)O_(2)stimulation,as well as in ET-treated retinas at 12h after ONT.Western blot analysis revealed a decrease in the expression of iNOS and levels of conjugated acrolein,along with an increase in the expressions of Nrf2 and HO-1 in ET-pretreated RGCs in vitro and ET-treated retinas in vivo.CONCLUSION:ET is a neuroprotective agent in primary cultured RGCs injured by H_(2)O_(2).The effect of ET is dosedependent with the greatest effect being at 10μmol/L.ET plays an antioxidant role by inhibiting iNOS,up-regulating Nrf2/HO-1,decreasing the production of acrolein,and increasing the scavenge of acrolein.

Etomidate versus Remimazolam in Elderly Patients Undergoing Painless Gastroenteroscopy

Objective:To compare the hemodynamic stability of etomidate and remimazolam during painless gastroscopy and evaluate the safety of remimazolam in elderly patients undergoing gastroscopy.Methods:A total of 100 elderly patients aged 65–80 years,with American Society of Anesthesiologists(ASA)physical status I–II,who underwent painless gastrointestinal endoscopy were included in this study.The patients were randomly assigned to receive either 0.2 mg/kg of remimazolam(Group R)or 0.3 mg/kg of etomidate(E group)in combination with alfentanil for anesthesia induction.Results:The mean arterial pressure(MAP)and heart rate(HR)were significantly higher in the E group compared to Group R(P<0.05).Ephedrine was administered more frequently in the Group R(30%)than in the Group E(10%),with a statistically significant difference(P=0.023).The incidence of myoclonus was markedly lower in the Group R(0%)compared to the Group E(60%,P<0.01).Conclusion:During gastroenteroscopy with alfentanil,remimazolam was associated with lower MAP and HR compared to etomidate.Patients receiving remimazolam experienced a higher incidence of post-induction hypotension.Nonetheless,the safety and efficacy of remimazolam were comparable to those of etomidate,supporting its suitability as a sedative for ASA I–II elderly patients undergoing gastrointestinal endoscopy.

Etomidate affects the anti-oxidant pathway to protect retinal ganglion cells after optic nerve transection

Our previous studies revealed that etomidate, a non-barbiturate intravenous anesthetic agent, has protective effects on retinal ganglion cells within 7 days after optic nerve transection. Whether this process is related to anti-oxidative stress is not clear. To reveal its mechanism, we established the optic nerve transection injury model by transecting 1 mm behind the left eyeball of adult male Sprague-Dawley rats. The rats received an intraperitoneal injection of etomidate(4 mg/kg) once per day for 7 days. The results showed that etomidate significantly enhanced the number of retinal ganglion cells retrogradely labeled with Fluorogold at 7 days after optic nerve transection. Etomidate also significantly reduced the levels of nitric oxide and malonaldehyde in the retina and increased the level of glutathione at 12 hours after optic nerve transection. Thus, etomidate can protect retinal ganglion cells after optic nerve transection in adult rats by activating an anti-oxidative stress response. The study was approved by the Animal Ethics Committee at Air Force Medical University, China(approval No. 20180305) on March 5, 2018.

Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery:A randomized clinical trial

BACKGROUND The ideal depth of general anesthesia should achieve the required levels of hypnosis,analgesia,and muscle relaxation while minimizing physiologic responses to awareness.The choice of anesthetic strategy in patients with coronary heart disease(CHD)undergoing major noncardiac surgery is becoming an increasingly important issue as the population ages.This is because general anesthesia is associated with a risk of perioperative cardiac complications and death,and this risk is much higher in people with CHD.AIM To compare hemodynamic function and cardiovascular event rate between etomidate-and propofol-based anesthesia in patients with CHD.METHODS This prospective study enrolled consecutive patients(American Society of Anesthesiologists grade II/III)with stable CHD(New York Heart Association class I/II)undergoing major noncardiac surgery.The patients were randomly allocated to receive either etomidate/remifentanil-based or propofol/remifentanil-based general anesthesia.Randomization was performed using a computer-generated random number table and sequentially numbered,opaque,sealed envelopes.Concealment was maintained until the patient had arrived in the operating theater,at which point the consulting anesthetist opened the envelope.All patients,data collectors,and data analyzers were blinded to the type of anesthesia used.The primary endpoints were the occurrence of cardiovascular events(bradycardia,tachycardia,hypotension,ST-T segment changes,and ventricular premature beats)during anesthesia and cardiac troponin I level at 24 h.The secondary endpoints were hemodynamic parameters,bispectral index,and use of vasopressors during anesthesia.RESULTS The final analysis included 40 patients in each of the propofol and etomidate groups.The incidences of bradycardia,hypotension,ST-T segment changes,and ventricular premature beats during anesthesia were significantly higher in the propofol group than in the etomidate group(P<0.05 for all).The incidence of tachycardia was similar between the two groups.Cardiac troponin I levels were comparable between the two groups both before the induction of anesthesia and at 24 h after surgery.When compared with the etomidate group,the propofol group had significantly lower heart rates at 3 min after the anesthetic was injected(T1)and immediately after tracheal intubation(T2),lower systolic blood pressure at T1,and lower diastolic blood pressure and mean arterial pressure at T1,T2,3 min after tracheal intubation,and 5 min after tracheal intubation(P<0.05 for all).Vasopressor use was significantly more in the propofol group than in the etomidate group during the induction and maintenance periods(P<0.001).CONCLUSION In patients with CHD undergoing noncardiac major surgery,etomidate-based anesthesia is associated with fewer cardiovascular events and smaller hemodynamic changes than propofol-based anesthesia.

General Anesthesia with Laryngeal Mask Airway: Etomidate VS Propofol for Hemodynamic Stability

Background: Propofol is the most popular induction agent for laryngeal mask airway (LMA) insertion in current anaesthesia practice however associated hypotension has been reported as its major disadvantage. Etomidate, which produces less hypotension, can be considered as an alternative agent for LMA insertion. Objectives: The objective of this study was to compare the hemodynamic effects of etomidate with propofol for induction of general anaesthesia (GA) for LMA. Ease of inserting LMA was also looked at. Material and Methods: It was a prospective randomized double blinded study. All ASA I and II patients of 15 - 60 years of age undergoing general anaesthesia with LMA for elective surgeries were included. Patients were induced with intravenous (I/V) fentanyl and induction agent either etomidate or propofol according to group randomization. LMA was inserted after 30 seconds. Intra-operative heart rate (HR), sys tolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), number of attempts and duration of LMA insertion were monitored. Results: There was no difference in the heart rate between the two groups. A significant drop was found for systolic blood pressure (SBP) in propofol group while diastolic blood pressure (DBP) was decreased in both the groups. In propofol group, successful insertion of LMA was achieved on the first attempt in 93.3% of patient as compared to 36.7% in etomidate group. Conclusion: Use of etomidate for induction of laryngeal mask anesthesia can prevent the hypotension following induction;however it may delay the insertion of laryngeal mask airway.

Influence of propofol or etomidate combined with remifentanil in painless gastroscopy on inflammatory stress response

Objective:To study the influence of propofol or etomidate combined with remifentanil in painless gastroscopy on inflammatory stress response.Methods: 117 patients with suspected gastritis who underwent painless gastroscopy in our hospital between July 2015 and August 2016 were divided into propofol group (n=67) and etomidate group (n=50) according to the anesthesia schemes. Propofol group received propofol combined with remifentanil anesthesia, and etomidate group received etomidate combined with remifentanil anesthesia. The differences in serum levels of inflammatory factors, stress hormones and oxidative stress indicators were compared between the two groups before the examination (T0), immediately after the examination (T1) and 15 min after the examination (T2).Results: At T0, there were no significant differences in serum levels of inflammatory factors, stress hormones or oxidative stress indexes between the two groups (P>0.05). At T1 and T2, serum inflammatory factors IL-1, IL-6 and CRP levels of etomidate group were lower than those of propofol group;serum stress hormones Cor, NE and E levels were lower than those of propofol group;serum oxidation indexes AOPPs and LHP levels were lower than those of propofol group while anti-oxidation indexes CAT and SOD levels were higher than those of propofol group (P<0.05). Conclusion: Etomidate for painless gastroscopy is better than propofol in maintaining depth of anesthesia and reducing operation trauma.

Clinical Observation of Dexmedetomidine Combined with the Mixture of Propofol and Etomidate on Painless Gastroscopy in Children

Objective:To observe the anesthetic effect of dexmedetomidine combined with the mixture of propofol and etomidate on painless gastroscopy in children.Methods:A total of 80 pediatric patients who underwent painless gastroscopy in the Guangxi Minzu Hospital from January 2019 to September 2020 were randomly divided into two groups,A and B,with 40 patients in each group.Group A was given A mixture of etomidate 20 mg and propofol 0.2g,Dexmedetomidine was pumped into group B 10min before surgery,0.4 g/kg.HR,SBP,DBP,SpO2 and BIS were continuously monitored after entering the room.The doses of propofol and etomidate were recorded,as well as the time of waking and leaving the hospital.Adverse reactions such as hypotension,hypoxemia,nausea,vomiting and dizziness were recorded too.Results:Compared with group A,the dosage of propofol and etomidate in group B was significantly reduced(P<0.001),the time of waking and out of the chamber were significantly shortened(P<0.001),the body movement in the incidence of intraoperative was significantly reduced(P<0.001),and the nausea,vomiting and dizziness in the incidence of postoperative were significantly reduced(P<0.05).Conclusion:Dexmedetomidine combined with propofol and etomidate mixture can be safely used in painless gastroscopy in children,which can significantly reduce the dosage of propofol and etomidate,reduce the occurrence of adverse reactions,and shorten the time of resuscitation and discharge.

[Ca^(2+)]_i change in hippocampal neurons influenced by preconditioning of etomidate fat emulsion following cerebral ischemia in rats

BACKGROUND： It is known that intravenous anesthetic etomidate fat emulsion has cerebral protection. Now many scholars focus on the research of its cerebral protection from molecular biology, but the mechanism of cerebral protection is still fully unclear. OBJECTIVE： To observe the influence of etomidate fat emulsion on the [Ca^2＋]i in hippocampal neurons during the transient cerebral ischemia injury in rats. DESIGN： Randomized controlled observation. SETTING： Weifang Medical College. MATERIALS： This study was carried out in the functional laboratory of Weifang Medical College between October 2005 and March 2006. Twenty-four male healthy Wistar rats, aged 3 to 4 months, were involved. Etomidate fat emulsion was provided by the limited company of En-hua Medical Bloc in Jiangsu Province （code of H200205l l） and the other agents and materials were provided by Laboratory Center of Weifang Medical College. METHODS： The 24 Wistar rats were randomized into 3 groups： sham-operation group, model group and etomidate preconditioning group, with 8 rats in each. Rat models of transient cerebral ischemia injury were made by the ligation of bilateral carotid arteries combined with descending blood pressure in the latter two groups. Before ischemia （ligation of bilateral common carotid artery）, rats in the etomidate preconditioning group were intraperitoneally injected with 12 mg/kg etomidate fat emulsion and then persistently intraperitoneally injected with etomidate fat emulsion at 1.0 mg/kg per minute. Rats in the model group were not administrated. Rats in the sham-operation group were only performed bilateral common carotid artery isolation. When rats were modeled, their brain tissues were quickly taken out and detected. MAIN OUTCOME MEASURES： Change of the fluorescence pixel value of the [Ca^2＋]i in each group by the laser scanning confocal microscope. RESULTS： Twenty-four rats were involved in the final analysis. Fluorescence pixel value in the sham-operation group was in the low level. Fluorescence pixel value in the model group was significantly higher than that in the sham-operation group （P 〈 0.01）. Fluorescence pixel value in the etomidate preconditioning group was significantly lower than that in the model group （P 〈 0.01 ）. CONCLUSION： The protection of etomidate fat emulsion to the transient cerebral ischemic injury in rats is associated with the inhibition to the increase of [Ca^2＋]i to some extent.

Determination of enantiomeric impurity of etomidate by high performance liquid chromatography

Objective To determine enantiomeric impurity of etomidate using high performance liquid chromatography. Methods (R)-etomidate and (S)-etomidate were separated on a CHIRALPAK AD-H column. The mobile phase consisted of 20∶80(v/v) isopropanol-n-hexane. The flow rate of the mobile phase was 0.5mL/min. The detected wavelength was 242nm. Results (R)-etomidate and (S)-etomidate could be separated completely under these conditions. The precision of (R)-etomidate was 1.57% (n=3). The limit of detection of (R)-etomidate was 4.25ng/mL. The average percentage content of (S)-etomidate was 0.09% in the samples. Conclusion The method was repeatable and sufficiently sensitive to determine the enantiomeric impurity of etomidate. It allows the quantitation of the impurities at the 0.085% (w/w) level relative to etomidate at a concentration of the test solution of 5mg/mL.

Retrospective Review of Propofol versus Etomidate during Rapid Sequence Intubation in the Emergency Department at a Tertiary Academic Center

Background: Etomidate is the standard induction agent used during rapid sequence intubation (RSI) in the emergency department (ED). Etomidate shortages require providers to utilize alternative agents. The purpose of this study is to compare the safety and procedural outcomes of propofol and etomidate for RSI in the ED. Methods: This was a retrospective chart review of adult patients in the ED who received propofol or etomidate for induction during RSI. The main endpoint was hypotension, defined as a systolic blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg, within the first hour of intubation. Time to intubation, intensive care unit length of stay, hospital length of stay, and in-hospital mortality were also evaluated. Results: Two hundred and seventy five patient charts were reviewed. Of the 98 patients included, 43 patients received propofol and 55 patients received etomidate. Propofol was associated with an increased incidence of hypotension within the first hour of intubation (65.1% vs. 25.5%, p < 0.001). No difference was found in the time to intubation: ≤5 minutes (51.2% vs. 34.6%, p = 0.83). The mortality rate was 11.6% in the propofol group and 27.3% in the etomidate group (p = 0.004). There was no difference in hospital or intensive care unit length of stay between the propofol and etomidate groups (7.7 vs. 9.2 days, p = 0.23;4.2 vs. 6.3 days, p = 0.31). Conclusion: Propofol was a safe and procedurally effective induction agent for RSI. Compared to etomidate, it was associated with an increased rate of hypotension within the first hour of intubation, with no difference in the percent of patients that required an intervention.

The Variation in Plasma Cortisol Levels in Response to Anesthetic Induction with Etomidate or Ketamine in Children Undergoing Intracardiac Repair of Tetralogy of Fallot on Cardiopulmonary Bypass

Objective: To compare the effect of a single induction dose of etomidate or ketamine on plasma cortisol levels in children with Tetralogy of Fallot (TOF) undergoing intra-cardiac repair on cardiopulmonary bypass (CPB). Design: A prospective randomized trial. Setting: Cardiac center of a tertiary care hospital. Participants: Thirty children with TOF undergoing intra-cardiac repair on CPB. Interventions: After random allocation of the children into two groups, the children either received etomidate 0.2 mg/kg or ketamine 2 mg/kg intravenously for anesthetic induction along with fentanyl 2 mcg/kg and midazolam 100 mcg/kg. Endotracheal intubation was accomplished with rocuronium bromide in the dose of 1 mg/kg. Anesthesia was maintained with sevoflurane in air-oxygen, titrated to response and supplemental vecuronium bromide for muscle relaxation, fentanyl chloride for pain relief. Serum cortisol was measured on three occasions, at preinduction, at the end of surgery and at 24 hours postoperatively. Measurements and Main Results: Baseline plasma cortisol (Normal 5 - 25 mcg/dl) in the etomidate group (19.91 ± 3.51 mcg/dl) decreased significantly at the end of surgery (5.78 ± 2.0 mcg/dl) and rose to significantly higher than baseline values at 24 hours (27.31 ± 8.30 mcg/dl). The baseline cortisol levels in the ketamine group (20.91 ± 3.19 mcg/dl) increased significantly at the end of surgery (44.02 ± 5.49 mcg/dl) and remained significantly higher than baseline at 24hours (45.93 ± 3.05 mcg/dl). Plasma cortisol levels in the etomidate group at end of surgery, and at 24 hours post-operatively, were significantly lower than the ketamine group. Conclusions: This study shows that etomidate is a suitable and safe agent for suppression of the increase in serum cortisol associated with the use of CPB in children with TOF undergoing intra-cardiac repair.

The Effects of Etomidate and Propofol Induction on Hemodynamic and Endocrine Response in Patients Undergoing Coronary Artery Bypass Graft Surgery on Cardiopulmonary Bypass

Aim: To compare the effects of propofol and etomidate induction on hemodynamic parameters and serum cortisol levels in patients with normal left ventricular function undergoing elective coronary artery bypass graft surgery on cardiopulmonary bypass. Material and Method: After approval from the Institute Ethics committee hundred American Society of Anesthesiologists (ASA) grade II or III patients undergoing scheduled coronary artery bypass surgery on cardiopulmonary bypass were enrolled in the study. Patients were allocated randomly to receive either propofol or etomidate for anesthesia induction. Anesthesia was maintained in both groups with sevoflurane, vecuronium bromide for muscle relaxation (0.1 mg/kg, boluses) and fentanyl up to a total dose of 20 mcg/kg. Result: The baseline serum cortisol values were within normal limits in both the groups. The serum cortisol levels in the propofol group increased more than two fold, whereas the values in the etomidate group decreased by close to fifty percent on weaning from cardiopulmonary bypass (CPB). There was no significant difference in serum cortisol levels in the two groups at twenty-four hours after induction, although the values were close to double the baseline levels. Hemodynamically, etomidate group was more stable than propofol group following induction of anesthesia (P < 0.05). Conclusion: The surge in serum cortisol levels on the initiation of CPB seen after the use of propofol is prevented by the use of etomidate. Serum cortisol levels in both groups are well above the baseline at twenty-four hours without any untoward effects. Etomidate provides more stable hemodynamic parameters when used for induction of anesthesia as compared to propofol.

Bidirectional regulation of intravenous anes⁃thetic etomidate on TREK-1 potassium channel

OBJECTIVE Two-pore domain potassium channel subtype TREK-1 was widely proved to be activated by inhalational anesthet⁃ics such as chloroform,diethyl ether,halothane,and isoflurane.But little is known about whether TREK-1 was also a potentially important target of intravenous anesthetics.Etomidate is a popularly used intravenous anesthetic with good safety in clinic.The action of etomidate on TREK-1 was seldom reported.METHODS AND RESULTS By using patch-clamp whole-cell recording tech⁃niques,we found for the first time that etomidate could bidirectionally regulate the TREK-1 potassi⁃um channel in CHO/TREK-1 cells.TREK-1 current amplitudes were observed after the administra⁃tion of etomidate at concentrations ranging from 3 to 100μmol·L-1.Etomidate activated TREK-1 current at concentrations of 3,10,and 15μmol·L-1 with maximum activation at 10μmol·L-1.Interest⁃ingly,at higher concentrations from 20 to 100μmol·L-1,etomidate inhibited TREK-1 current in a concentration-dependent way.According to the concentration-response curve,the fitted criti⁃cal concentration of etomidate between TREK-1 activation and inhibition was 20.7μmol·L-1,which close to the result that etomidate had no obvious effect on TREK-1 at 20μmol·L-1.In addition,etomidate 10μmol·L-1 induced a significant mem⁃brane potential hyperpolarization while etomidate 30μmol·L-1 showed obvious membrane potential depolarization.Furthermore,the bidirectional regulation still existed when the extracellular pH of CHO/TREK-1 cells was decreased.CONCLUSION TREK-1 is activated by etomi⁃date at clinically relevant concentrations but inhib⁃ited by supraclinical concentrations of etomidate,which is different to other volatile anesthetics.TREK-1 might be a potential target for anesthetic such as etomidate and the complicated bidirec⁃tional regulation mechanism of etomidate needed to be fully studied in the future.

Effects of etomidate maintenance anesthesia on immunoglobulin and stress response levels in patients with gastric cancer after operation

Objective: To investigate the effect of etomidate maintenance anesthesia on immune function and stress response in patients with gastric cancer after the operation. Methods: 160 patients with gastric cancer in our hospital were randomly divided into control group and observation group, with 80 cases in each group. Both of the groups underwent radical gastrectomy, in which the control group was injected propofol anesthesia, while the observation group was injected etomidate anesthesia. The levels of immunoglobulin A, immunoglobulin M, immunoglobulin G, cortisol(Cor), aldosterone(ALD), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), tumor necrosis factor-α (TNF-α) and hypersensitive C-reactive protein (hs-CRP) were detected and compared before and after treatment. Results: After treatment, the serum levels of immunoglobulin A, immunoglobulin G and immunoglobulin M of the patients in the control group were significantly decreased. But in the observation group, these serum level did not change significantly and were higher compared with the control group. The serum levels of Cor, ALD, SOD, and GSH-Px in both groups after treatment were significantly decreased, while the levels of MDA, TNF-α and hs-CRP were significantly increased. The serum levels of Cor, ALD, MDA, TNF-α, and hs-CRP of patients in the observation group were significantly lower than those in the control group, and the levels of SOD and GSH-Px were significantly higher than those in the control group. Conclusion: Etomidate can enhance the immune function and antioxidant capacity of patients with gastric cancer, alleviate inflammation, and has a good clinical effect. But it is not suitable for patients with severe impairment of adrenocortical function.

Effect of remifentanil combined with etomidate on systemic stress reaction during painless fiberoptic bronchoscopy

Objective:To study the effect of remifentanil combined with etomidate on systemic stress reaction during painless fiberoptic bronchoscopy.Methods:A total of 84 patients who received painless fiberoptic bronchoscopy in outpatient and ward of our hospital between May 2014 and October 2016 were selected as the research subjects and randomly divided into two groups, observation group of patients accepted remifentanil combined with etomidate anesthesia, control group of patients received surface anesthesia, and in various time periods of inspection (before, during and after inspection), serum was collected respectively to test stress indexes.Results:Before inspection, serum NE, E, ACTH, Cor, PRA, AT-II, ALD, CRP, TNF-α, IL-6 and MCP-1 contents were not significantly different between two groups of patients;during and after inspection, serum NE, E, ACTH, Cor, PRA, AT-II, ALD, CRP, TNF-α, IL-6 and MCP-1 contents of both groups of patients were significantly higher than those before inspection, and serum NE, E, ACTH, Cor, PRA, AT-II, ALD, CRP, TNF-α, IL-6 and MCP-1 contents of observation group were significantly lower than those of control group. Conclusion:Remifentanil combined with etomidate can significantly inhibit the activation of systemic stress reaction and the release of stress hormones during painless fiberoptic bronchoscopy.

Effectof etomidate combined with propofol on stress and inflammatory response in painless gastrointestinal endoscopy

Objective: To study the effect of etomidate combined with propofol on stress and inflammatory response in painless gastrointestinal endoscopy. Methods: A total of 380 subjects who received painless gastrointestinal endoscopy in the hospital were selected as the research subjects and divided into control group and observation group by random number table, 190 cases in each group. Control group received propofol intravenous anesthesia, and observation group received etomidate combined with propofol intravenous anesthesia. The differences in serum levels of stress indexes and inflammatory factors were compared between the two groups 24 h before examination, during examination and 1 h after examination. Results: 24 h before examination, difference in serum levels of stress indexes and inflammatory factors were not statistically significant between the two groups of subjects. During examination and 1 h after examination, serum NE, E, Cor, ALD, AT-Ⅱ, IL-1β, IL-4, IL-6, IL-8, IL-10 and TNF-α contents of both groups were higher than those 24 h before examination, and serum NE, E, Cor, ALD, AT-Ⅱ, IL-1β, IL-4, IL-6, IL-8, IL-10 and TNF-α contents of observation group were lower than those of control group. Conclusion: Etomidate combined with propofol for painless gastrointestinal endoscopy can effectively alleviate the stress and inflammatory response during and early after the examination.

依托咪酯调控miR-204-5p/HOXC8轴对胃癌细胞增殖、凋亡及侵袭的影响

目的探讨依托咪酯(Eto)调节微小RNA(miR)-204-5p/同源盒基因C8(HOXC8)轴对人胃癌细胞增殖、凋亡及侵袭的影响。方法2023年4月—2024年4月于武汉科技大学实验室进行实验,将胃癌细胞MKN45分为对照(Ctrl)组、低剂量Eto组(Eto-L,5μmol/L)、中剂量Eto组(Eto-M,10μmol/L)、高剂量Eto组(Eto-H,20μmol/L)、Eto-H+miR-inhibitor-NC、Eto-H+miR-204-5p inhibitor组。CCK-8法、集落形成实验检测细胞增殖情况,流式细胞术检测MKN45细胞凋亡情况,Transwell实验检测细胞侵袭能力;qRT-PCR检测细胞中miR-204-5p和HOXC8 mRNA表达水平;双荧光素酶实验检测miR-204-5p和HOXC8之间的靶向关系。结果与Ctrl组比较,Eto-L组、Eto-M组、Eto-H组、Eto-H+miR-inhibitor-NC组、Eto-H+miR-204-5p inhibitor组MKN45细胞存活率、集落形成率、细胞侵入率、HOXC8 mRNA水平均显著降低(F/P=33.391/<0.001、29.646/<0.001、44.814/<0.001、45.485/<0.001),细胞凋亡率和miR-204-5p水平显著升高(F/P=78.091/<0.001、22.665/<0.001);与Eto-H+miR-inhibitor-NC组比较,Eto-H+miR-204-5p inhibitor组MKN45细胞存活率、集落形成率、细胞侵入率、HOXC8 mRNA水平均显著升高(q/P=8.099/<0.001、7.587/<0.001、7.768/<0.001、11.162/<0.001),细胞凋亡率和miR-204-5p水平显著降低(q/P=10.254/<0.001、8.596/<0.001);与HOXC8-WT和miR-NC共转染细胞比较,HOXC8-WT和miR-204-5p mimic共转染的MKN45细胞中相对荧光酶活性显著降低(t/P=5.770/<0.001)。结论Eto可能通过上调miR-204-5p、下调HOXC8,减弱胃癌细胞MKN45增殖和侵袭能力,促进细胞凋亡。

依托咪酯不良反应分析及成瘾性风险研究

目的分析依托咪酯在江门市辖区内医疗机构的使用量,不良反应的发生、上报情况。探讨依托咪酯的不良反应影响因素及主要类型,临床上应用依托咪酯是否存在成瘾性风险。方法检索广东省药物警戒与风险管控系统2021年7月1日~2023年6月30日江门市辖区内医疗机构涉及依托咪酯药物的不良反应,进行数据分析、问卷调查和专家研讨会。结果江门市辖区内医疗机构上报依托咪酯不良反应的例数极少,来源于四家医疗机构,但使用量不小。问卷调查发现依托咪酯在联合应用时不良反应的发生率可下降,医务人员普遍认为,临床剂量的依托咪酯作为静脉麻醉诱导和维持全身麻醉的成瘾风险很低。结论在依托咪酯纳入第二类精神药品管理后,医疗机构仍需要密切关注患者多次使用后是否有成瘾性风险的现象,并加强对这类药品的不良反应上报。

丙泊酚与依托咪酯联合麻醉诱导在腹腔镜胆囊切除术患者中的应用研究

目的探讨腹腔镜胆囊切除术(LC)患者采用丙泊酚与依托咪酯联合麻醉诱导取得的效果。方法2021年3月至2023年2月期间于本院接受LC手术的78例患者,按照随机数字表分组。对照组共纳入患者39例,麻醉诱导时使用丙泊酚,研究组共纳入患者39例,麻醉诱导时使用丙泊酚联合依托咪酯。观察并对比两组的血流动力学指标、拔管时间、睁眼时间、定向力恢复时间、应激反应指标、麻醉不良反应情况进行比较。结果麻醉诱导前平均动脉压、心率指标评价中,两组未见明显差异(P>0.05);插管时、插管后5 min、完成手术时平均动脉压、心率指标评价中,与对照组结果相比,研究组结果更高(P<0.05)。与对照组相比,研究组拔管时间、睁眼时间、定向力恢复时间更短(P<0.05)。麻醉前两组去甲肾上腺素、皮质醇指标评对比无差异(P>0.05);切皮时去甲肾上腺素、皮质醇指标评价中,与对照组结果相比,研究组结果更低(P<0.05)。两组不良反应发生率无差异(P>0.05)。结论LC患者在麻醉诱导方案中使用丙泊酚联合依托咪酯能够维持血流动力学指标的稳定性,加快术后康复速度,抑制应激反应,安全性较佳。

依托咪酯与丙泊酚在无痛结肠镜检查中的麻醉效果对比

目的:分析依托咪酯与丙泊酚在无痛结肠镜检查中的麻醉效果。方法:选取北京和睦家医院2022年1月—2023年8月行无痛结肠镜检查的患者120例为研究对象,采取随机数字表法分为对照组与观察组,各60例。对照组静脉注射咪达唑仑、芬太尼与丙泊酚,观察组静脉注射咪达唑仑、芬太尼与依托咪酯进行麻醉。对比两组不同时间点血压、脉搏和血氧饱和度,诱导时间,检查时间,苏醒时间,不良反应发生情况。结果:芬太尼静脉注射后1min(T0),两组收缩压、舒张压、脉搏对比,无统计学差异(P>0.05);内镜插入后5min(T1)、内镜拔出后1min(T2),两组收缩压、舒张压、脉搏降低,观察组高于对照组(P<0.05);T0、T1、T2,两组血氧饱和度对比,无统计学差异(P>0.05)。观察组诱导时间、检查时间以及苏醒时间短于对照组(P<0.05)。两组恶心、呕吐、头晕、肌束震颤、低血压、高血压发生率对比,无统计学差异(P>0.05)。结论:依托咪酯在无痛结肠镜中的麻醉效果优于丙泊酚,可稳定患者血流动力学指标,缩短麻醉与检查时间,且未增加不良反应发生风险。