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Etomidate and relative adrenal insufficiency in cardiopulmonary bypass surgery: impact on the postoperative hemodynamic status
Critical Care volume 12, Article number: P272 (2008)
Use of etomidate in cardiopulmonary bypass (CPB) surgery is usual practice during the anesthetic induction. The objective of this study was to determine the incidence of relative adrenal insufficiency (RAI) in CPB patients after etomidate administration and the impact on hemodynamic status.
A prospective cohort study was performed on CPB patients who received etomidate or not during the anesthetic induction. Patients were excluded if they had received systemic or inhaled corticosteroids or immunosuppressants, and active preoperative infection. RAI was defined as a rise in serum cortisol ≤ 9 μg/dl after the administration of 250 μg cosyntropin. Cortisol levels were measured preoperatively, immediately before and 30 minutes, 60 minutes and 90 minutes after the administration of cosyntropin (250 μg). We used SPSS version 15.
We studied 65 patients (74% men), mean age 68 ± 11 years. The incidence of RAI was 89.4% in these patients compared with 50% in patients who did not receive etomidate (P = 0.01) (Table 1). Higher postoperative cortisol levels were associated with lower doses of norepinephrine at 4 hours post CPB. Levels of cortisol in etomidate patients were inversely proportional to the needs of norepinephrine. Finally the maximum increase of cortisol levels after ACTH stimulation was directly associated with the systemic resistance index in nonetomidate patients at four postoperative hours.
The use of etomidate was associated with RAI post CPB surgery. Cortisol levels were related to the postoperative hemodynamic profile and the need for vasopressor drugs.
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Lorenzo, L., Brouard, M., Iribarren, J. et al. Etomidate and relative adrenal insufficiency in cardiopulmonary bypass surgery: impact on the postoperative hemodynamic status. Crit Care 12, P272 (2008). https://doi.org/10.1186/cc6493
- Cortisol Level
- Cardiopulmonary Bypass
- Hemodynamic Status