Adrenocortical function in critically ill patients 24 h after a single dose of etomidate.
We compared the effects of single doses of etomidate and thiopentone on adrenocortical function in a randomised controlled clinical trial involving 35 critically ill patients who needed a general anaesthetic. Just before induction of anaesthesia, a baseline blood cortisol sample was taken. Twenty-four hours later we performed a short adrenocorticotrophic hormone stimulation test. No patient had a low cortisol level (< 160 nmol.l-1) at any time during the study. Baseline, pre-ACTH and post-ACTH cortisol levels were similar in the two groups. However, significantly more patients in the etomidate group had an ACTH-stimulated cortisol increment < 200 nmol.l-1. The clinical significance of these findings is not clear, but we conclude that single doses of etomidate may interfere with cortisol synthesis for at least 24 h in the critically ill.
Absalom
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Department of Anaesthesia, Ipswwich Hospital, Ipswich 1p1 5 PD, UK.
Pledger
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Kong
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D000293:Adolescent; D000302:Adrenal Cortex / Q000187:drug effects* / Q000503:physiopathology; D000304:Adrenal Cortex Function Tests; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D005045:Etomidate / Q000494:pharmacology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D013874:Thiopental / Q000494:pharmacology
D018686:Anesthetics, Intravenous; D000324:Adrenocorticotropic Hormone; D013874:Thiopental; D006854:Hydrocortisone; D005045:Etomidate