title: Adrenal inhibition following a single dose of etomidate in intubated traumatic brain injury victims.
abstract: BACKGROUND
  Etomidate is frequently used to intubate traumatic brain injury (TBI) victims, even though it has been linked to adrenal insufficiency (AI) in some populations. Few studies have explored the risk of prolonged etomidate-induced AI among TBI victims.
  
  
  OBJECTIVE
  To determine the risk and the length of AI induced by etomidate in patients intubated for moderate and severe TBI.
  
  
  METHODS
  Participants in this observational study were moderate to severe intubated TBI victims aged ≥ 16 years. The anesthetic used (etomidate versus others) was determined solely by the treating emergency physician. Adrenocorticotropic hormone (ACTH) stimulation tests (250 μg) were performed 24, 48, and 168 hours after intubation. AI was defined as an increase in serum cortisol 1 hour post-ACTH test (delta cortisol) of less than 248.4 nmol/L.
  
  
  RESULTS
  Forty subjects (participation 42.6%) underwent ACTH testing. Fifteen received etomidate, and 25 received another anesthetic. There were no statistically significant differences between groups as to the cumulative incidence of AI at any measurement time. However, at 24 hours, exploratory post hoc analyses showed a significant decrease in delta cortisol (adjusted means: etomidate group: 305.1 nmol/L, 95% CI 214.7-384.8 versus other anesthetics: 500.5 nmol/L, 95% CI 441.8-565.7). This decrease was not present at 48 and 168 hours.
  
  
  CONCLUSIONS
  In TBI victims, although a single dose of etomidate does not increase the cumulative incidence of AI as defined, it seems to decrease the adrenal response to an ACTH test for 24 hours. The clinical impacts of this finding remain to be determined.
authors.affiliation: Departments of Emergency Medicine and Anesthesiology, Centre de Santé et de Services Sociaux Alphonse-Desjardins-Centre Hospitalier Affilié Universitaire de Lévis, Lévis, QC, Canada. patrick.m.archambault@gmail.com
authors.forename: Patrick
authors.initials: P
authors.lastname: Archambault
authors.forename: Clermont E
authors.initials: CE
authors.lastname: Dionne
authors.forename: Gilles
authors.initials: G
authors.lastname: Lortie
authors.forename: François
authors.initials: F
authors.lastname: LeBlanc
authors.forename: Anik
authors.initials: A
authors.lastname: Rioux
authors.forename: Geneviève
authors.initials: G
authors.lastname: Larouche
mesh_terms: D000311:Adrenal Glands / Q000187:drug effects*; D000309:Adrenal Insufficiency / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001930:Brain Injuries / Q000097:blood / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D000324:Adrenocorticotropic Hormone; D005045:Etomidate