Anesthesia for stem cell transplantation in autistic children: A prospective, randomized, double-blind comparison of propofol and etomidate following sevoflurane inhalation

Ma,Yu‑Heng; Li,Yong‑Wang; Ma,Li; Cao,Cai‑Hong; Liu,Xiang‑Dong

doi:10.3892/etm.2015.2176

Anesthesia for stem cell transplantation in autistic children: A prospective, randomized, double-blind comparison of propofol and etomidate following sevoflurane inhalation

Authors:
- Yu‑Heng Ma
- Yong‑Wang Li
- Li Ma
- Cai‑Hong Cao
- Xiang‑Dong Liu
View Affiliations

Affiliations: Department of Anesthesiology, Second Artillery General Hospital of PLA, Beijing 100088, P.R. China, Department of Gynecology and Obstetrics, Second Artillery General Hospital of PLA, Beijing 100088, P.R. China
Published online on: January 13, 2015 https://doi.org/10.3892/etm.2015.2176
Pages: 1035-1039

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The objective of the present study was to comparatively investigate the feasibility and safety of etomidate and propofol use following sevoflurane inhalation in autistic children during the intrathecal transplantation of stem cells. The patients selected were 60 autistic children with American Society of Anesthesiologists physical status Ⅰ, who were aged between two and 12 years and scheduled for stem cell transplantation. The children received an inhalation induction of 8% sevoflurane, followed by intravenous injection of etomidate (0.2 mg/kg) in group E and propofol (2 mg/kg) in group P (n=30/group). Supplemental doses of 0.1 mg/kg etomidate or 1 mg/kg propofol were used until a deep sedation was obtained. The heart rate (HR), mean arterial pressure, oxygen saturation, respiratory rate, Ramsay sedation score (RSS) and recovery time were monitored continuously. Following anesthesia, blood pressure and HR measurements were significantly decreased in group P compared with the baseline (P<0.01) and group E values at the same time‑points (P<0.05). The occurrence of adverse effects, such as respiratory depression, bradycardia, hypotension and pain on injection, was significantly higher in group P than that in group E, whereas the incidence of myoclonus in group E was significantly higher than that in group P (P<0.01). No significant differences in anesthesia induction, surgery duration, recovery time, RSS and physician satisfaction were observed between the two groups. In conclusion, sevoflurane‑etomidate combinations resulted in more stable hemodynamic responses and relatively fewer adverse effects compared with propofol injection following sevoflurane inhalation and may therefore be more suitable for the induction of short‑term anesthesia in autistic children during stem cell transplantation.

View Figures

View References

1	Mefford HC, Batshaw ML and Hoffman EP: Genomics, intellectual disability, and autism. N Engl J Med. 366:733–743. 2012. View Article : Google Scholar : PubMed/NCBI
2	Dantzer R and Kelley KW: Autistic children: a neuroimmune perspective. Brain Behav Immun. 22:804–805. 2008. View Article : Google Scholar : PubMed/NCBI
3	Hughes JR: Update on autism: a review of 1300 reports published in 2008. Epilepsy Behav. 16:569–589. 2009. View Article : Google Scholar : PubMed/NCBI
4	Dove D, Warren Z, McPheeters ML, Taylor JL, Sathe NA and Veenstra-VanderWeele J: Medications for adolescents and young adults with autism spectrum disorders: a systematic review. Pediatrics. 130:717–726. 2012. View Article : Google Scholar : PubMed/NCBI
5	Ichim TE, Solano F, Glenn E, et al: Stem cell therapy for autism. J Transl Med. 5:302007. View Article : Google Scholar : PubMed/NCBI
6	Nathan N and Odin I: Induction of anaesthesia: a guide to drug choice. Drugs. 67:701–723. 2007. View Article : Google Scholar : PubMed/NCBI
7	Forman SA: Clinical and molecular pharmacology of etomidate. Anesthesiology. 114:695–707. 2011. View Article : Google Scholar : PubMed/NCBI
8	Pandit JJ: Intravenous anaesthetic agents. Anaesth Intens Care Med. 12:144–150. 2011. View Article : Google Scholar
9	Toklu S, Iyilikci L, Gonen C, et al: Comparison of etomidate-remifentanil and propofol-remifentanil sedation in patients scheduled for colonoscopy. Eur J Anaesthesiol. 26:370–376. 2009. View Article : Google Scholar : PubMed/NCBI
10	Vinson DR and Bradbury DR: Etomidate for procedural sedation in emergency medicine. Ann Emerg Med. 39:592–598. 2002. View Article : Google Scholar : PubMed/NCBI
11	Xu ZY, Wang X, Si YY, et al: Intravenous remifentanil and propofol for gastroscopy. J Clin Anesth. 20:352–355. 2008. View Article : Google Scholar : PubMed/NCBI
12	Ryu JH, Kim JH, Park KS and Do SH: Remifentanil-propofol versus fentanyl-propofol for monitored anesthesia care during hysteroscopy. J Clin Anesth. 20:328–332. 2008. View Article : Google Scholar : PubMed/NCBI
13	Sams L, Braun C, Allman D and Hofmeister E: A comparison of the effects of propofol and etomidate on the induction of anesthesia and on cardiopulmonary parameters in dogs. Vet Anaesth Analg. 35:488–494. 2008. View Article : Google Scholar : PubMed/NCBI
14	Adesanya AO, Rosero E, Wyrick C, Wall MH and Joshi GP: Assessing the predictive value of the bispectral index vs patient state index on clinical assessment of sedation in postoperative cardiac surgery patients. J Crit Care. 24:322–328. 2009. View Article : Google Scholar : PubMed/NCBI
15	Seid M, Sherman M and Seid AB: Perioperative psychosocial interventions for autistic children undergoing ENT surgery. Int J Pediatr Otorhinolaryngol. 40:107–113. 1997. View Article : Google Scholar : PubMed/NCBI
16	Ho WM, Yen CM, Lan CH, et al: Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study. BMC Gastroenterol. 12:1642012. View Article : Google Scholar : PubMed/NCBI
17	Miner JR, Danahy M, Moch A and Biros M: Randomized clinical trial of etomidate versus propofol for procedural sedation in the emergency department. Ann Emerg Med. 49:15–22. 2007. View Article : Google Scholar
18	Sokolove PE, Price DD and Okada P: The safety of etomidate for emergency rapid sequence intubation of pediatric patients. Pediatr Emerg Care. 16:18–21. 2000. View Article : Google Scholar : PubMed/NCBI
19	Bendel S, Ruokonen E, Pölönen P and Uusaro A: Propofol causes more hypotension than etomidate in patients with severe aortic stenosis: a double-blind, randomized study comparing propofol and etomidate. Acta Anaesthesiol Scand. 51:284–289. 2007. View Article : Google Scholar : PubMed/NCBI
20	Sellgren J, Ejnell H, Elam M, Pontén J and Wallin BG: Sympathetic muscle nerve activity, peripheral blood flows, and baroreceptor reflexes in humans during propofol anesthesia and surgery. Anesthesiology. 80:534–544. 1994. View Article : Google Scholar : PubMed/NCBI
21	Schaeuble J, Heidegger T, Gerig HJ, Ulrich B and Schnider TW: Comparison of etomidate and propofol for fibreoptic intubation as part of an airway management algorithm: a prospective, randomized, double-blind study. Eur J Anaesthesiol. 22:762–767. 2005. View Article : Google Scholar : PubMed/NCBI
22	Falk J and Zed PJ: Etomidate for procedural sedation in the emergency department. Ann Pharmacother. 38:1272–1277. 2004. View Article : Google Scholar : PubMed/NCBI
23	Hildreth AN, Mejia VA, Maxwell RA, Smith PW, Dart BW and Barker DE: Adrenal suppression following a single dose of etomidate for rapid sequence induction: a prospective randomized study. J Trauma. 65:573–579. 2008. View Article : Google Scholar : PubMed/NCBI
24	Albert SG, Ariyan S and Rather A: The effect of etomidate on adrenal function in critical illness: a systematic review. Intensive Care Med. 37:901–910. 2011. View Article : Google Scholar : PubMed/NCBI
25	Dörr H, Kuhnle U, Holthausen H, Bidlingmaier F and Knorr D: Etomidate: a selective adrenocortical 11 beta-hydroxylase inhibitor. Klin Wochenschr. 62:1011–1013. 1984. View Article : Google Scholar : PubMed/NCBI
26	Henzi I, Walder B and Tramér MR: Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg. 90:186–194. 2000. View Article : Google Scholar : PubMed/NCBI