Background Although a single dose of etomidate can cause relative adrenal insufficiency the impact of etomidate exposure on postoperative outcomes is not known. The objective of this study was to examine the association between a single induction dose of etomidate and clinically important postoperative outcomes following cardiac surgery. Methods We retrospectively examined the association between etomidate exposure during anesthetic induction and postoperative outcomes in patients undergoing cardiac surgery from January 2007 to December 2009 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 to 1.09) and 0.75 (95% CI: 0.45 to 1.24) respectively, and the adjusted hazard ratio for time to mechanical ventilation removal and time to hospital discharge were 1.10 (95% CI: 1.00 to 1.21) and 1.07 (95% CI: 0.97 to 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 anesthetic induction in cardiac surgery patients.

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A simulated transesophageal examination of normal cardiac anatomy in concert with a standardized assessment tool permits ample discrimination between expert and novice echocardiographers as defined for this investigation. Future research will examine in detail the role echocardiography simulators should play during echocardiography training including assessment of training level.