Effect on Plasma Cortisol Concentrations of a Single Induction Dose of Etomidate or Thiopentone

Sebel, P.S.; Verghese, C.; Makin, H. L. J.; Fragen, Robert J.; Shanks, ColinA.; Molteni, Agostino

doi:10.1016/s0140-6736(83)90709-2

Cited by 22 publications

(13 citation statements)

References 4 publications

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“…[39][40][41][42] However, decreased plasma cortisol levels have been reported after a single induction dose. [43][44][45][46][47] One prospective, randomized study investigated the effects on adrenocortical function in patients in the emergency department receiving one dose of intravenous etomidate 0.3 mg/kg for intubation. 16 Suppression in cortisol response was statistically significant based on a 4-hour cosyntropin stimulation test (100% normal response in controls vs 30% in the etomidate group, p=0.004) but not the 12-or 24-hour tests.…”

Section: Complicationsmentioning

confidence: 99%

Etomidate for Procedural Sedation in the Emergency Department

et al. 2002

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Section: Complicationsmentioning

confidence: 99%

Etomidate for Procedural Sedation in the Emergency Department

et al. 2002

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“…2,7 Adrenal dysfunction has been shown to occur in patients receiving etomidate for sedation with long-term intravenous (IV) infusions 9-12 as well as with single induction doses. [13][14][15][16] The use of continuous etomidate infusion has further been associated with increased mortality in critically ill patients. 10,11 As a consequence of these findings, etomidate is no longer used for continuous sedative infusion.…”

mentioning

confidence: 99%

“…Single bolus dosing of etomidate and its effects on adrenocortical function have been evaluated in surgical patients undergoing elective operative procedures. [13][14][15][16][17][18] The results of these studies have been conflicting with a strong trend toward the Schenarts et al • ETOMIDATE AND ADRENAL DYSFUNCTION conclusion that etomidate causes adrenocortical dysfunction after a single induction dose. 14,15,17,18 However, there is currently no literature documenting the clinical significance of adrenal dysfunction in this patient population.…”

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Adrenocortical Dysfunction Following Etomidate Induction in Emergency Department Patients

Schenarts

Burton

Riker

2001

Academic Emergency Medicine

168

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Abstract. Objective: To assess adrenocortical function following intravenous etomidate use in emergency department (ED) patients requiring intubation. Methods: This was a prospective, randomized, controlled trial of consecutive patients presenting to the ED requiring intubation. Patients were randomized to receive a single bolus induction dose of either 0.05-0.1 mg/kg midazolam (control group) or 0.3 mg/kg etomidate (etomidate group) during a standardized rapid-sequence intubation (RSI) with succinylcholine. The primary outcome variable was adrenocortical function at 4, 12, and 24 hours post-induction as assessed by measured serum cortisol response to exogenous cosyntropin (cosyntropin stimulation test, CST). Fisher's exact test was used to compare CST results between groups. Results: Thirty-one patients were enrolled: 8 control, 10 etomidate, and 13 excluded from analysis for either incomplete data or steroid use during the study period. The 4-hour CST results were significantly different between study groups, with a normal response in 100% of control patients vs 30% of etomidate patients (p = 0.004). The 12-and 24-hour CSTs did not differ significantly between groups: normal CST in 100% of control patients at 12 and 24 hours vs 100% and 90% among etomidate patients at 12 and 24 hours, respectively (p = 1.0 at 12 and 24 hours). Measured cortisol levels of patients with abnormal CSTs remained within normal laboratory reference ranges. Conclusion: Use of etomidate in ED patients requiring RSI results in adrenocortical dysfunction. However, cortisol levels remain within normal laboratory levels during this period of dysfunction. Adrenocortical dysfunction appears to resolve within 12 hours of a single bolus dose of 0.3 mg/kg etomidate. Key words: etomidate; induction; midazolam; rapid-sequence induction; intubation. ACADEMIC EMERGENCY MEDICINE 2001; 8:1-7 E NDOTRACHEAL intubation is a common procedure performed during the stabilization of emergency department (ED) patients. The majority of these ED patients will require an induction agent during rapid-sequence intubation (RSI). The choice of an appropriate induction agent is a critical decision in this environment. Numerous drugs are available: each with characteristics making it more or less desirable in specific clinical scenarios.Etomidate, a nonbarbiturate, imidazole hypnotic, is notable in the setting of ED induction for its rapid onset of action, short duration, and minimal respiratory depression. ered to be an appropriate induction agent in the setting of elevated intracranial pressure, hemodynamic instability, and myocardial ischemia.

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“…13,16,17 In these and other studies, 14,15 the observed depressed cortisol levels remain within normal laboratory reference ranges, confusing the interpretation of these findings. The present group of etomidate ED RSI patients had similar depressed cortisol levels at 4 hours post-induction.…”

Section: Discussionmentioning

confidence: 79%

“…[13][14][15][16][17][18] The results of these studies have been conflicting with a strong trend toward the…”

mentioning

confidence: 99%

Untitled

2001

Academic Emergency Medicine

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Abstract. Objective: To assess adrenocortical function following intravenous etomidate use in emergency department (ED) patients requiring intubation. Methods: This was a prospective, randomized, controlled trial of consecutive patients presenting to the ED requiring intubation. Patients were randomized to receive a single bolus induction dose of either 0.05-0.1 mg/kg midazolam (control group) or 0.3 mg/kg etomidate (etomidate group) during a standardized rapid-sequence intubation (RSI) with succinylcholine. The primary outcome variable was adrenocortical function at 4, 12, and 24 hours post-induction as assessed by measured serum cortisol response to exogenous cosyntropin (cosyntropin stimulation test, CST). Fisher's exact test was used to compare CST results between groups. Results: Thirty-one patients were enrolled: 8 control, 10 etomidate, and 13 excluded from analysis for either incomplete data or steroid use during the study period. The 4-hour CST results were significantly different between study groups, with a normal response in 100% of control patients vs 30% of etomidate patients (p = 0.004). The 12-and 24-hour CSTs did not differ significantly between groups: normal CST in 100% of control patients at 12 and 24 hours vs 100% and 90% among etomidate patients at 12 and 24 hours, respectively (p = 1.0 at 12 and 24 hours). Measured cortisol levels of patients with abnormal CSTs remained within normal laboratory reference ranges. Conclusion: Use of etomidate in ED patients requiring RSI results in adrenocortical dysfunction. However, cortisol levels remain within normal laboratory levels during this period of dysfunction. Adrenocortical dysfunction appears to resolve within 12 hours of a single bolus dose of 0.3 mg/kg etomidate. Key words: etomidate; induction; midazolam; rapid-sequence induction; intubation. ACADEMIC EMERGENCY MEDICINE 2001; 8:1-7 E NDOTRACHEAL intubation is a common procedure performed during the stabilization of emergency department (ED) patients. The majority of these ED patients will require an induction agent during rapid-sequence intubation (RSI). The choice of an appropriate induction agent is a critical decision in this environment. Numerous drugs are available: each with characteristics making it more or less desirable in specific clinical scenarios.Etomidate, a nonbarbiturate, imidazole hypnotic, is notable in the setting of ED induction for its rapid onset of action, short duration, and minimal respiratory depression. 1,2 Etomidate is consid- ered to be an appropriate induction agent in the setting of elevated intracranial pressure, hemodynamic instability, and myocardial ischemia. [1][2][3][4][5][6][7] These features distinguish etomidate as an excellent choice for ED RSI patients. As a consequence, etomidate is increasingly utilized for ED RSI with one recent survey documenting its use as the preferred induction agent in 23% of academic EDs. 8 A frequently cited disadvantage to the use of etomidate during RSI is adrenocortical dysfunction. 2,7 Adrenal dysfunction has been ...

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Effect on Plasma Cortisol Concentrations of a Single Induction Dose of Etomidate or Thiopentone

Cited by 22 publications

References 4 publications

Etomidate for Procedural Sedation in the Emergency Department

Etomidate for Procedural Sedation in the Emergency Department

Adrenocortical Dysfunction Following Etomidate Induction in Emergency Department Patients

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