Haemodynamic consequences of etomidate administration in elective cardiac surgery: a randomized double-blinded study

Area of Science:

• Anesthesiology
• Endocrinology
• Cardiovascular Surgery

Background:

• The impact of etomidate-induced cortisol synthesis inhibition on vasopressor use and relative adrenal insufficiency (RAI) duration post-cardiac surgery remains unclear.
• Cardiac surgery patients often require anesthetic agents that may affect adrenal function.

Purpose of the Study:

• To investigate the effects of a single etomidate dose on vasopressor requirements and the duration of RAI following elective cardiac surgery.

Main Methods:

• A prospective, randomized, double-blinded controlled trial involving 100 patients undergoing elective cardiac surgery.
• Patients received either etomidate or propofol at anesthesia induction.
• Short corticotropin tests were conducted at 12, 24, and 48 hours post-induction to assess RAI.

Main Results:

• The incidence of RAI was significantly higher in the etomidate group at 12 hours (100% vs. 41%) and 24 hours (85% vs. 25%).
• Mean norepinephrine infusion rates and time to norepinephrine withdrawal were similar between etomidate and propofol groups.
• Etomidate blunted the hypothalamic-pituitary-adrenal axis response for over 24 hours.

Conclusions:

• A single etomidate bolus significantly increases the incidence and duration of relative adrenal insufficiency after cardiac surgery.
• Despite blunted adrenal response, etomidate did not lead to increased vasopressor requirements in this patient population.