title: The etomidate requirement is decreased in patients with obstructive jaundice.
abstract: BACKGROUND
  Patients with obstructive jaundice have increased sensitivity to inhaled anesthetics. In rodent brain, bilirubin can enhance γ-aminobutyric acid A/glycinergic synaptic transmission. Etomidate is a nonbarbiturate hypnotic that induces sedation through γ-aminobutyric acid A receptors in the central nervous system. We tested the hypothesis that patients with obstructive jaundice have an altered sensitivity to etomidate.
  
  
  METHODS
  The study design was a comparison of etomidate requirements to reach a Bispectral Index of 50 in patients with obstructive jaundice versus patients with chronic cholelithiasis and normal bilirubin levels. Etomidate was infused at 30 μg/kg/min until this end point was reached.
  
  
  RESULTS
  The etomidate requirement in the obstructive jaundice group was lower than that in the control group (150±46 μg/kg vs 206±74 μg/kg, P=0.007). The average decrease in etomidate requirement was 56 μg/kg (95% confidence interval: 16-96 μg/kg). In addition, we found a significant negative correlation between serum total bilirubin and etomidate requirement with Pearson r of -0.545, and 95% confidence interval for r value (-0.791 to -0.148). All subjects were hemodynamically stable during the study.
  
  
  CONCLUSIONS
  Etomidate requirements to reach a level of anesthesia defined by a Bispectral Index of 50 are reduced in patients with obstructive jaundice.
authors.affiliation: Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Rd., No. 225, Shanghai, China.
authors.forename: J C
authors.initials: JC
authors.lastname: Song
authors.forename: Y M
authors.initials: YM
authors.lastname: Sun
authors.forename: M Z
authors.initials: MZ
authors.lastname: Zhang
authors.forename: L Q
authors.initials: LQ
authors.lastname: Yang
authors.forename: T Z
authors.initials: TZ
authors.lastname: Tao
authors.forename: W F
authors.initials: WF
authors.lastname: Yu
mesh_terms: D000368:Aged; D000758:Anesthesia; D001663:Bilirubin / Q000097:blood; D002769:Cholelithiasis / Q000378:metabolism; D056805:Consciousness Monitors; D023381:Endpoint Determination; D005045:Etomidate / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D041781:Jaundice, Obstructive / Q000378:metabolism*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D018401:Sample Size
chemical_list: D006993:Hypnotics and Sedatives; D001663:Bilirubin; D005045:Etomidate