In Reply:-Thank you for your interest in our publication, “Oral Transmucosal Etomidate (OTET) in Volunteers. [1]” We agree that oral administration may be an effective route of etomidate administration. As noted in our article, it was impossible to distinguish how much absorption of etomidate from OTET occurred via the transmucosal route versus the gastrointestinal route. Further study is needed to elucidate this. However, work with animals in our lab has shown that etomidate is highly permeable through the canine buccal mucosa. [2]It is likely that a significant proportion of etomidate from OTET will be absorbed by the transmucosal route. Therefore, we would expect the onset of effect to be quicker with OTET compared to the oral solution. Again, this hypothesis needs further study. We agree with Dr. Lauretti that etomidate is distasteful. We noted in our article that the taste of OTET became significantly worse with increasing dose. Further development of OTET will necessitate flavor modification.

James B. Streisand, M.D.

Genzyme Corporation; One Kendall Square; Cambridge, Massachusetts

(Accepted for publication June 13, 1998.)

Streisand JB, et al: Oral transmucosal etomidate in volunteers Anesthesiology 1998; 88:89-95
Zhang J, Maland L, Hague B, Niu S, Robertson S, Coleman D, Stanley TH, Streisand JB: Buccal absorption of etomidate from a solid formulation in dogs. Anesth Analg 1998; 86:1116-22