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Adrenocortical suppression by a single induction dose of etomidate
Klinische Wochenschrift
|November 2, 1984
Summary
A single dose of etomidate anesthesia significantly impairs adrenal function, causing a decrease in serum cortisol. Thiopentone, however, led to a cortisol increase, highlighting etomidate's potential for adrenal insufficiency.
Area of Science:
- Anesthesiology
- Endocrinology
- Pharmacology
Background:
- Adrenocortical function is crucial during surgical procedures.
- Etomidate and thiopentone are commonly used anesthetic induction agents.
- Understanding their impact on the adrenal cortex is vital for patient safety.
Purpose of the Study:
- To compare the effects of etomidate and thiopentone on adrenocortical function after a single induction dose.
- To assess serum cortisol and plasma ACTH levels in patients undergoing elective surgery.
Main Methods:
- Prospective controlled trial involving 29 patients undergoing elective surgery.
- Administration of a single induction dose of either etomidate or thiopentone.
- Monitoring of serum cortisol and plasma ACTH levels for 5 hours post-induction.
Main Results:
- Serum cortisol significantly increased in the thiopentone group but decreased and remained low in the etomidate group.
- Plasma ACTH levels increased significantly more after etomidate, indicating adrenal unresponsiveness.
- Significant differences in cortisol levels between groups were observed from 120 to 240 minutes post-induction.
Conclusions:
- A single intravenous bolus of etomidate (0.26 mg/kg) induces significant, albeit temporary, adrenal insufficiency.
- This effect occurs even in patients without pre-existing endocrine abnormalities.
- Etomidate's impact on adrenocortical function warrants careful consideration in clinical practice.