[Experiences with "etomidate pro infusione" in heart surgery interventions with extracorporeal circulation]

The results of experimental studies with etomidate demonstrating positive hemodynamic effects as well as a decrease in intracranial pressure induced a study using etomidate during cardiac surgery. This randomized study including 506 patients should prove the influence of etomidate on the rate of psychic disturbances after cardiac surgery. Patients treated with etomidate received a loading dose of 1 mg/kg b.w. etomidate within 15 minutes followed by a continuous infusion of 1 mg/kg b.w./h until the end of ECC. Patients without etomidate were the control group. Psychic disturbances were observed in 25% of the control group and in 30% of the etomidate group. In both groups of patients there was a fair number of patients with perioperative cardiopulmonary problems (artificial ventilation longer than 24 hours; catecholamine therapy: epinephrine greater than 5 micrograms/min longer than 3 hours): 8% in the control group and 20% in the etomidate group. These results indicate that etomidate does not beneficially influence the rate of psychic disturbances after open-heart surgery; it may induce, however, cardiopulmonary side effects after cardiac surgery. The results of recent studies indicating drug induced adrenal insufficiency are discussed.