To the Editor:-I read with interest the article published by Streisand et al. [1]described as the first study in humans of oral transmucosal etomidate. They developed a solid dosage form of etomidate for oral transmucosal administration in humans. All adult male volunteers received unflavored lozenges in four different strengths: 12.5, 25, 50, and 100 mg. The authors found that drowsiness and light sleep occurred in a dose-related manner 10-20 min after administration and lasted for 30-60 min. They also suggested that some etomidate was absorbed through the buccal mucosa, although they could not discard the gastrointestinal route. I am happy that their results were also in agreement with our results, [2]where we administered 1.3 mg/kg etomidate to children as a premedication. Because we used the liquid formulation (10 mg/ml), we set our population between 10-15 kg. We observed that 1.3 mg/kg oral etomidate was as effective as oral 0.5 mg/kg midazolam for handling children with the benefit of faster discharge. The dose we used (1.3 mg/kg) seems to be in accordance with the highest dose used by Streisand et al., [1]if we consider that an average healthy male adult weighs approximately 75 kg ([almost equal to] 1.4 mg/kg). We agree that oral etomidate can be an alternative, although we also observed that the children did not enjoy the taste, and we also contacted the company, asking for them to prepare a more concentrated solution with a nicer taste for oral administration.

Gabriela R. Lauretti, M.D., M.Sc., Ph.D.

Department of Surgery, Orthopedics, and Traumatology; Disc Anesthesiology; Faculty of Medicine of Ribeirao Preto; University of Sao Paulo; Sao Paula, Brazil;

(Accepted for publication June 13, 1998.)

Streisand JB, Jaarsma RL, Gray MA, Badger MJ, Maland L, Nordbrock E, Stanley TH: Oral transmucosal etomidate in volunteers. Anesthesiology 1998; 88:89-95
Lauretti GR, Garcia LV, Reis MP: Comparison between oral etomidate administration versus oral midazolam as a premedicant for pediatric day case anesthesia. Anesthesiology 1995; 83:A1135