title: Etomidate and the Risk of Complications After Cardiac Surgery: A Retrospective Cohort Analysis.
abstract: OBJECTIVE
  To compare incidence of atrial arrhythmia, duration of care, and major complications after cardiac surgery between patients who received etomidate and those who received other induction agents.
  
  
  METHODS
  Retrospective cohort study utilizing propensity score matching.
  
  
  METHODS
  A single academic, tertiary care hospital.
  
  
  METHODS
  Eight thousand nine hundred seventy-eight patients undergoing coronary artery bypass grafting (CABG), valve, or combined valve/CABG surgery requiring cardiopulmonary bypass between January 2005 and December 2010.
  
  
  METHODS
  Patients were divided into those who received etomidate at anesthetic induction and those who received another induction agent. Patients given etomidate were propensity-score matched to patients given other induction agents in a 2:1 ratio.
  
  
  RESULTS
  Of 8,978 patients who underwent CABG, valve, or combined valve/surgery, 6,313 received etomidate and 2,665 received other induction agents. Among these, the authors successfully matched 4,094 etomidate patients with 2,524 non-etomidate patients. The authors did not find a significant association between receiving etomidate and odds of experiencing postoperative atrial arrhythmia (odds ratio [98.3% confidence interval] of 1.07 [0.92, 1.23], p = 0.29). Etomidate was not associated significantly with either intensive care unit or hospital stay. Etomidate was associated significantly with use of packed red blood cells (odds ratio [99.6% confidence interval] of 1.32 [1.02, 1.70], p = 0.002), but not with use of fresh frozen plasma, platelets, or cryoprecipitate. None of the other complications differed significantly between the groups.
  
  
  CONCLUSIONS
  Etomidate was not associated with increased incidence of postoperative atrial arrhythmia or increased intensive care unit or hospital stay.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
authors.forename: Ryu
authors.initials: R
authors.lastname: Komatsu
authors.affiliation: Departments of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH; Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Natalya
authors.initials: N
authors.lastname: Makarova
authors.affiliation: Departments of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH; Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Jing
authors.initials: J
authors.lastname: You
authors.affiliation: Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.affiliation: Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH.
authors.forename: David G
authors.initials: DG
authors.lastname: Anthony
authors.affiliation: Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kasuya
authors.affiliation: Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Edward G
authors.initials: EG
authors.lastname: Soltesz
authors.affiliation: Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH. Electronic address: turana@ccf.org.
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D005045:Etomidate; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012189:Retrospective Studies; D012306:Risk
chemical_list: D006993:Hypnotics and Sedatives; D005045:Etomidate
keywords: anesthesia; arrhythmias; atrial fibrillation; cardiac; etomidate; postoperative complications