title: Etomidate use and postoperative outcomes among cardiac surgery patients.
abstract: BACKGROUND
  Although a single dose of etomidate can cause relative adrenal insufficiency, the impact of etomidate exposure on postoperative outcomes is unknown. The objective of this study was to examine the association between a single induction dose of etomidate and clinically important postoperative outcomes after cardiac surgery.
  
  
  METHODS
  The authors retrospectively examined the association between etomidate exposure during induction of anesthesia and postoperative outcomes in patients undergoing cardiac surgery from January 2007 to December 2009 by using multivariate logistic regression analyses and Cox proportional hazards regression analyses. Postoperative outcomes of interest were severe hypotension, mechanical ventilation hours, hospital length of stay, and in-hospital mortality.
  
  
  RESULTS
  Sixty-two percent of 3,127 patients received etomidate. Etomidate recipients had a higher incidence of preoperative congestive heart failure (23.0 vs. 18.3%; P = 0.002) and a lower incidence of preoperative cardiogenic shock (1.3 vs. 4.0%; P < 0.001). The adjusted odds ratio for severe hypotension and in-hospital mortality associated with receiving etomidate was 0.80 (95% CI, 0.58-1.09) and 0.75 (95% CI, 0.45-1.24), respectively, and the adjusted hazard ratio for time to mechanical ventilation removal and time to hospital discharge was 1.10 (95% CI, 1.00-1.21) and 1.07 (95% CI, 0.97-1.18), respectively. Propensity score analysis did not change the association between etomidate use and postoperative outcomes.
  
  
  CONCLUSIONS
  In this study, there was no evidence to suggest that etomidate exposure was associated with severe hypotension, longer mechanical ventilation hours, longer length of hospital stay, or in-hospital mortality. Etomidate should remain an option for induction of anesthesia in cardiac surgery patients.
authors.affiliation: From the Department of Anesthesiology (C.E.W., J.S.B., J.M.E., and M.P.), Department of Biostatistics (X.H. and J.S.S.), Department of Pharmacy (D.J.), Department of Medicine (M.P.), and Department of Cardiac Surgery (R.A.), Vanderbilt University Medical School, Nashville, Tennessee.
authors.forename: Chad E
authors.initials: CE
authors.lastname: Wagner
authors.forename: Julian S
authors.initials: JS
authors.lastname: Bick
authors.forename: Daniel
authors.initials: D
authors.lastname: Johnson
authors.forename: Rashid
authors.initials: R
authors.lastname: Ahmad
authors.forename: Xue
authors.initials: X
authors.lastname: Han
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Schildcrout
authors.forename: Mias
authors.initials: M
authors.lastname: Pretorius
mesh_terms: D000368:Aged; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures; D005045:Etomidate / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000139:chemically induced*; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D005045:Etomidate