Etomidate infusion and adrenocortical function. A study in elective surgery.

Area of Science:

• Anesthesiology
• Endocrinology

Background:

• Adrenocortical suppression is a potential side effect of anesthetic agents.
• Etomidate and thiopentone are commonly used anesthetic agents.

Purpose of the Study:

• To investigate the effect of etomidate and thiopentone infusions on the adrenocortical response to corticotropin stimulation.
• To compare the impact of these two anesthetic agents on adrenal function post-surgery.

Main Methods:

• A short tetracosactrin (Synacthen) test was administered to 11 patients undergoing abdominal hysterectomy.
• Patients received either etomidate or thiopentone infusion for anesthesia maintenance, with pethidine as the narcotic.
• Adrenocortical response was assessed following corticotropin stimulation.

Main Results:

• Etomidate infusion (median 28.5 ug/kg/min) completely inhibited the adrenocortical response to corticotropin stimulation for at least 24 hours post-surgery.
• No significant suppression of the adrenocortical response was observed in patients receiving thiopentone infusion.

Conclusions:

• Etomidate causes profound and prolonged suppression of the adrenocortical response to corticotropin.
• Due to its significant impact on adrenal function, etomidate is not recommended for routine induction and maintenance of anesthesia.