Skip to main content

Interaction between etomidate and beta tumoral necrosis factor on hemodynamic response after cardiac surgery


The use of etomidate is a risk factor for relative adrenal insufficiency in patients undergoing cardiopulmonary bypass (CPB) [1]. The objective was to determine the possible interaction between etomidate and beta tumoral necrosis factor (TNFβ) polymorphism on hemodynamics after CPB.


A prospective cohort study on CPB patients who received etomidate or not during anesthetic induction during 2008 to 2011. Demographic and postoperative variables were collected. We tested the Hardy-Weinberg equilibrium in order to avoid selection bias. V18 SPSS was used.


We studied 433 patients undergoing CPB, 285 (65.8%) men and 148 (34.2%) women, 66 ± 6 years, EuroSCORE I 5.3 ± 4%. TNFβ was in Hardy-Weinberg equilibrium (χ2: 0.6; P = 0.42). A total of 254 (58.7%) patients received etomidate, 152 out of them required vasoactive drugs. Homozygous G was defined as unfavorable TNFβ versus the A allele [2]. Using the general linear model after adjusting for sex and amines dose at 4 hours, an independent association was observed between the systemic vascular resistance index (SVRI) at 4 hours and the use of etomidate (F: 18; P < 0.001): 1,849 (95% CI: 1,673 to 2,024) versus 2,493 (95% CI: 2,258 to 2,729) dinas.seg/cm5.m2, the presence of homozygous G (F: 6.5; P = 0.01), and also showed a significant etomidate-homozygous G interaction (F: 22.8: P < 0.001): 1,687 (95% CI: 1,350 to 2,023) versus 3,041 (95% CI: 2,589 to 3,492) dinas seg/cm5. m2 (Figure 1).

figure 1

Figure 1


Etomidate use is associated with lower postoperative SVRI which is increased in the presence of G homozygosity for TNFβ polymorphism.


  1. Iribarren JL, et al: J Cardiothorac Surg. 2010, 5: 26-10.1186/1749-8090-5-26.

    PubMed Central  Article  PubMed  Google Scholar 

  2. Iribarren , et al: Interact Cardiovasc Thorac Surg. 2008, 7: 1071-4. 10.1510/icvts.2008.177501.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Iribarren, J., Jimenez, J., Perez, N. et al. Interaction between etomidate and beta tumoral necrosis factor on hemodynamic response after cardiac surgery. Crit Care 19 (Suppl 1), P496 (2015).

Download citation

  • Published:

  • DOI:


  • General Linear Model
  • Emergency Medicine
  • Prospective Cohort
  • Cardiopulmonary Bypass
  • Prospective Cohort Study