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The effect of etomidate induction on plasma cortisol levels in children undergoing cardiac surgery
1Department of Anesthesia and Reanimation, University of Başkent, School of Medicine, Ankara, Turkey.
Insights
Etomidate effectively suppresses elevated cortisol levels during anesthesia induction in pediatric patients with congenital heart disease. This study found etomidate safe for managing the stress response in these children undergoing cardiopulmonary bypass.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Cardiology
- Endocrinology
Background:
- Congenital heart defects often necessitate complex surgical interventions like cardiopulmonary bypass.
- Cardiopulmonary bypass can trigger a significant stress response, leading to elevated cortisol levels.
- Managing this stress response is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the impact of a single etomidate induction dose on plasma cortisol and adrenocorticotropic hormone (ACTH) levels.
- To assess the safety and efficacy of etomidate in pediatric patients with congenital heart disease undergoing surgery.
Main Methods:
- A prospective, randomized study conducted at a university hospital.
- Thirty pediatric patients undergoing cardiopulmonary bypass were randomized into two groups.
- One group received etomidate and fentanyl for induction, while the other received ketamine and fentanyl. Plasma cortisol and ACTH levels were measured at five time points.
Main Results:
- Etomidate significantly reduced plasma cortisol levels post-induction and throughout cardiopulmonary bypass.
- Cortisol levels in the etomidate group remained significantly lower compared to the ketamine group during critical surgical phases.
- No significant differences in adrenocorticotropic hormone (ACTH) levels were reported between groups.
Conclusions:
- Etomidate is an effective agent for mitigating the cortisol increase associated with the stress response during cardiopulmonary bypass in children with congenital heart defects.
- The findings suggest etomidate can be safely administered for anesthesia induction in this vulnerable pediatric population.
Objective:
To investigate the effect of a single induction dose of etomidate on plasma cortisol and adrenocorticotrophic hormone (ACTH) levels in pediatric patients with congenital heart disease.
Design:
A prospective, randomized study.
Setting:
A university hospital.
Participants:
Thirty children undergoing cardiopulmonary bypass.
Interventions:
Patients were randomly allocated into two groups to receive etomidate, 0.3 mg/kg, and fentanyl, 1 microg/kg, or ketamine, 1 mg/kg, and fentanyl, 1 microg/kg intravenously, for anesthesia induction. Anesthesia was maintained with 50% nitrous oxide and 0.5% isoflurane in oxygen. Plasma cortisol and ACTH levels were measured on five occasions: preoperatively, after induction of anesthesia, after cross-clamping, at the end of surgery, and 24 hours postoperatively.
Measurements And Main Results:
Plasma cortisol levels of the etomidate group decreased with anesthesia induction and remained significantly low during cardiopulmonary bypass, at the end of operation, and 24 hours postoperatively. Plasma cortisol levels of the etomidate group after the anesthesia induction, during cardiopulmonary bypass, and at the end of the operation were significantly lower than the ketamine group.
Conclusion:
These results show that etomidate is a suitable agent for suppressing the increase in cortisol levels associated with the stress response caused by cardiopulmonary bypass in children with congenital heart defects, and can be used safely.