title: Haemodynamic consequences of etomidate administration in elective cardiac surgery: a randomized double-blinded study.
abstract: BACKGROUND
  The consequences of inhibition of cortisol synthesis by a single dose of etomidate on subsequent vasopressor drug usage and the duration of relative adrenal insufficiency (RAI) after cardiac surgery are not known.
  
  
  METHODS
  This was a prospective, randomized, double-blinded controlled trial of 100 patients undergoing elective cardiac surgery and receiving either etomidate or propofol at induction of anaesthesia. A short corticotropin test was performed 12, 24, and 48 h after anaesthesia induction. RAI was defined as a response <250 nmol litre(-1).
  
  
  RESULTS
  The mean (sd) norepinephrine infusion rate during the first 48 postoperative hours was 0.11 (0.01) and 0.11 (0.01) µg kg(-1) min(-1) in the etomidate and propofol groups, respectively (P=0.89). Time to norepinephrine withdrawal was similar between the groups. The incidence of RAI was higher in the etomidate group at 12 h (100% vs 41%, P<0.001) and 24 h (85% vs 25%, P<0.001).
  
  
  CONCLUSIONS
  A single bolus of etomidate blunts the hypothalamic-pituitary-adrenal axis response for more than 24 h in patients undergoing elective cardiac surgery, but this was not associated with an increase in vasopressor requirements.
authors.affiliation: Département d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Saint Etienne, F-42055 Saint Etienne, France. jerome.morel@chu-st-etienne.fr
authors.forename: J
authors.initials: J
authors.lastname: Morel
authors.forename: M
authors.initials: M
authors.lastname: Salard
authors.forename: C
authors.initials: C
authors.lastname: Castelain
authors.forename: M C
authors.initials: MC
authors.lastname: Bayon
authors.forename: P
authors.initials: P
authors.lastname: Lambert
authors.forename: M
authors.initials: M
authors.lastname: Vola
authors.forename: C
authors.initials: C
authors.lastname: Auboyer
authors.forename: S
authors.initials: S
authors.lastname: Molliex
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood / Q000139:chemically induced; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D023381:Endpoint Determination; D005045:Etomidate / Q000009:adverse effects / Q000494:pharmacology*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000494:pharmacology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D015742:Propofol; D011446:Prospective Studies; D012129:Respiratory Function Tests; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D014662:Vasoconstrictor Agents; D000324:Adrenocorticotropic Hormone; D009638:Norepinephrine; D015742:Propofol; D005045:Etomidate