[Effect of an introductory dose of etomidate, methohexital and midazolam on adrenal cortex function before and after...

The adrenocortical function after induction of anaesthesia using either etomidate, methohexital or midazolam was examined in 30 patients undergoing open heart surgery (ACVB). Midazolam and methohexital did not suppress the typical stress response assessed from the magnitude of the ACTH, cortisol and aldosterone levels. The ACTH-test was also normal. In contrast, induction of anaesthesia using etomidate led to a progressive fall in cortisol and aldosterone accompanied by an increase in ACTH. The ACTH-test resulted in only a minor increase in adrenocortical hormones. Thus an induction dose of etomidate, in contrast to methohexital and midazolam, markedly alters the normal function of the adrenal cortex. This side-effect of etomidate lasts for at least 4 hours but is no longer detectable after 24 hours.