Adrenal suppression etomidate

Etomidate, adrenal suppression, 32.249 Etoposide, 27.477 Etretinate, ossification, 12.127 Euxyl K 400, contact allergy, 16.150... 

An additional systematic review/meta-analysis [26 ] on post-etomidate adrenal suppression has been published. After application of strict exclusion criteria, 10 studies were identified as being appropriate topic and quality (average Jadad score 5.5 (range 4-7). Out of these, seven evaluated mortality (of which five were prospective) and seven determined etomidate effect on the adrenal axis (all using a corticotrophin stimulation test). When evaluating effect of etomidate on mortality (n = 865), the relative risk of death was attributed to etomidate use was 1.2 (95% Cl 1.02-1.24), which was retained after sensitivity analysis. Likewise, the effect on adrenal suppression with etomidate (n=1303), seven studies identified an RR of adrenal suppression of 1.33 (95% Cl 1.22-1.4). Overall, accounting for confounders, RR of mortality was 1.19 and of adrenal suppression was 1.64 (p< 0.0001). The authors did not advocate complete cessation of etomidate based on these results but to adopt a more thoughtful approach. They also commented on the paucity of results and studies with adequate quality. 

Inhibition of adrenocortical synthetic function. Etomidate inhibits the activity of ll-p-hydroxylase, an enzyme necessary for the synthesis of cortisol, aldosterone, 17-hydroxyprogesterone, and corticosterone. Even after a single dose, adrenal suppression persists for 5-8 hours. Although the clinical significance of short-term suppression of cortisol synthesis is unknown, maintenance infusions for anaesthesia cannot be recommended. 

Etomidate causes a high incidence of pain on injection, myoclonic activity, and postoperative nausea and vomiting. The involuntary muscle movements are not associated with electroencephalographic epileptiform activity. Etomidate may also cause adrenocortical suppression via inhibitory effects on steroidogenesis, with decreased plasma levels of cortisol after a single dose. Prolonged infusion of etomidate in critically ill patients may result in hypotension, electrolyte imbalance, and oliguria because of its adrenal suppressive effects. 

Adrenal suppression, etomidate, 32.249 diabetes melUtus, antih5fpertensive drugs,... 

The main indication for etomidate is induction of anesthesia. It has no analgesic properties. It has little respiratory and cardiovascular depressant properties. However it can seriously suppress adrenal function. 

Adrenal steroids chronic corticosteroid therapy with the equivalent of prednisolone 10 mg daily within the previous 3 months suppresses the hypothalamic-pituitary-adrenal system. Without steroid supplementation perioperatively the patient may fail to respond appropriately to the stress of surgery and become hypotensive (see Ch. 34). A single dose of etomidate depresses the hypothalamic-pituitary-adrenal axis for a few hours but this is not associated with an adverse outcome. 

The main adverse effects with etomidate are pain on injection and muscle twitching during induction, both of which can be reduced by using an opioid analgesic. It also causes suppression of the adrenal cortex. 

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