title: Etomidate as a rectal induction agent. Part II. A clinical study in children.
abstract: Following the preliminary study in rats, etomidate (Hypnomidate; Janssen) 1,25% in sterile water (pH 3,5) was administered rectally to 40 children aged between 6 months and 5 years to induce general anaesthesia for scheduled minor surgical procedures. The doses given ranged from 3,0 mg/kg to 6,5 mg/kg. The time taken for hypnosis to occur and the incidence of muscle movements were recorded. Cardiovascular and respiratory parameters were monitored. Anaesthesia was maintained with nitrous oxide/oxygen and halothane as needed. The time taken for recovery from anaesthesia was recorded and the children were observed for 24 hours postoperatively. The lowest hypnotic dose was 4,5 mg/kg, when 2 out of 5 children fell asleep. In all children given 6,5 mg/kg hypnosis occurred within 4 minutes. Cardiovascular and respiratory parameters were stable. There did not appear to be any delay in the recovery of the children from inhalational anaesthesia. There was no clinical evidence of irritation of the rectal mucosa by the etomidate solution. This study shows that rectal administration of etomidate 1,25% in sterile water at a dose of approximately 20 times the recommended intravenous dose in children produces a rapid, predictable onset of hypnosis within 4 minutes and allows rapid recovery. This is highly suitable for outpatient anaesthesia in unpremedicated children who will accept neither inhalational nor intravenous induction.
mesh_terms: D000774:Anesthesia, Rectal; D002648:Child; D002675:Child, Preschool; D004341:Drug Evaluation; D005045:Etomidate / Q000008:administration & dosage*; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage*; D007223:Infant
chemical_list: D007093:Imidazoles; D005045:Etomidate