Etomidate anaesthesia in patients with cirrhosis of the liver: pharmacokinetic data

Five patients undergoing endoscopic injection of oesphageal varices were anaesthetised with etomidate 0.2 mg/kg followed by an infusion at a rate of 20 μg/kg/minute. Fentanyl 100–200 μg was also given intravenously and the patients' lungs were ventilated with oxygen in air. The postinfusion plasma etomidate concentration was described by a three compartment model with a mean half‐life of 540 minutes (SEM 66.9) and volume of distribution of 8.9 litres/kg (SEM 0.6). Clearance was 12.7 ml/kg/minute (SEM 2.3). Compared to results in the literature obtained from normal patients, these cirrhotic patients had normal clearance rates, but the distribution volume and elimination half‐life were twice as great. This suggests that cirrhotic patients metabolise etomidate normally, but the volume of distribution is doubled, thus resulting in prolonged elimination half‐lives.