[Etomidate versus etomidate and hydrocortisone for anesthesia induction in abdominal surgical interventions].
The imidazole derivative etomidate has been shown to block (reversibly) adrenocortical steroid synthesis. Long-term sedation with etomidate has been associated with adrenocortical insufficiency and increased mortality in severely ill patients. The significance of adrenocortical blockade after a single induction dose of etomidate remains a matter of debate. This study was designed to analyze the role of glucocorticoid deficiency after a single induction dose of etomidate for major surgery. In a prospective controlled double-blind study, 20 consecutive patients scheduled for colorectal surgery were randomly allocated to either hydrocortisone substitution or placebo (glucose 5%). Hydrocortisone was given as a continuous infusion in a dose of 100 mg dissolved in 5% glucose over 10 h. We combined general anesthesia and epidural anesthesia (L3-4) using bupivacaine (0.5%). Induction of anesthesia: etomidate (0.2-0.3 mg/kg), fentanyl (0.1-0.2 mg), pancuronium (2 mg), and succinyl-choline (1.0-1.5 mg/kg), with endotracheal intubation and mechanical ventilation. Anesthesia was maintained at N2O/O2 2:1 and fluothane (0.4-0.6 vol%). At the end of surgery patients were extubated after oxygenation. In all patients blood pressure, heart rate, central venous pressure, and ECG were monitored continuously, both intra- and postoperatively. During induction, patients received 1,000 ml 0.9% NaCl, followed by continuous administration of 0.9% NaCl, 6 ml/kg per hour intraoperatively and 40 ml/kg per 24 hours post-operatively.(ABSTRACT TRUNCATED AT 250 WORDS)
Stuttmann
R
R
Abteilung für Anaesthesie, Universität Köln.
Allolio
B
B
Becker
A
A
Doehn
M
M
Winkelmann
W
W
D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000188:drug therapy; D000368:Aged; D000758:Anesthesia; D002986:Clinical Trials as Topic; D003106:Colon / Q000601:surgery*; D004311:Double-Blind Method; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011897:Random Allocation
D006854:Hydrocortisone; D005045:Etomidate
Etomidat versus Etomidat und Hydrokortison zur Narkoseeinleitung bei abdominalchirurgischen Eingriffen.