Cortisol Lowering Action and Cardiovascular Stability of Etomidate: A Comparison With Propofol in Controlled Hypertensives

Abstract

BACKGROUND:Etomidate suppresses corticosteroid synthesis in the adrenal cortex by reversibly inhibiting the enzyme 11-beta-hydroxylase, leading to primary adrenal suppression. Continuous etomidate infusion for sedation of critically ill trauma patients in intensive care units has been associated with increased mortality due to adrenal suppression. Etomidate has a favorable haemodynamic profile and is the preferred drug in hypertensive patients but is often not used for the fear of adrenal suppression. Propofol is a widely used hypnotic agent used for induction of general anaesthesia. AIM: To study and compare the haemodynamic profile, the extent of adrenal suppression and the side effects of etomidate and propofol. METHOD: Sixty controlled hypertensives, undergoing laparoscopic major gynaecological surgery were randomly allocated in a double blind manner to receive as an inducing agent etomidate (0.3mg/kg) (group E) or propofol (2mg/kg) (group P). Anaesthesia was administered according to the standard institutional protocol and residual neuromuscular block was reversed. All patients were sent to post anaesthetic care unit. Systolic, diastolic , mean blood pressure and heart rates were recorded pre-induction, post induction and at 5 minutes thereafter until 30 minutes. Incidence of pain on injection was noted during induction and myoclonus was observed just after the induction. Incidence of PONV was noted in all cases. Serum cortisol levels were measured pre-operatively, after completion of operation and 24 hours post operatively. RESULTS: Mean blood pressure decreased in 60% patients in group P. 15% patients in this group suffered hypotension immediately after induction and needed bolus iv infusion and /or phenylephrine. No patient in group E needed phenylephrine. Patients receiving etomidate had a lower serum cortisol concentration immediately after the operation than those receiving propofol, but no differences between the groups were observed 24 hours postoperatively. Incidence of pain on injection, myoclonus and PONV were higher in group E but was not statistically significant. CONCLUSION: Induction with etomidate is a better than propofol in controlled hypertensives undergoing laparoscopic major gynaecological surgery with no serious deleterious effects due to decrease in cortisol levels.

Bispectral Index (Bis) Guided Comparison Between Clinical Effects of Etomidate and Fentanyl Versus Dexmedetomidine and Fentanyl for Conscious Sedation in Ercp Procedure

“…The preoperative and 12-hour post-operative serum cortisol in Group-E was also comparable (p-value = 0.734). This finding was consistent with the study done by Srivastava et al [7] There was no significant difference between the two study groups with respect to the level of patient and physician satisfaction.…”

“…Clinical impact of this adrenal suppressive effect is doubtful. [16] However, the serum cortisol levels remain within the normal range and dysfunction resolves within 12-24 hours of using the drug, [7][8][9] as it has been shown in multiple studies. There was no significant difference between the pre-operative and 12-hour postoperative serum cortisol between the two groups.…”

“…Etomidate causes adrenocortical suppression. [7,9] Serum cortisol levels remain within the normal range and dysfunction resolves within 12-24 hours of using the drug. So, estimation of serum cortisol preoperatively and 12 hours later have been included as a parameter of this study.…”

“…An anxiety-free period before and adequate pain relief after the procedure increases the acceptability of ERCP, as a modality of management of various biliary and pancreatic diseases, amongst patients. [6,7] From anaesthetic point of view, patient positioning (Prone/semi-prone), lack of requirement of muscle relaxation and intubation, common adverse effects of gastroscopy (Nausea, vomiting, anxiety, throat bleed) and sharing a common passage (The upper airway) by the gastroenterologist and the anaesthesiologist, has made ERCP a challenge.…”

“…The administration of properly selected anaesthetic agents during ERCP can abolish upper airway reflexes and improve the comfort of patients during the procedure. [7][8][9] An ideal anaesthetic agent for ERCP should have the following properties: [8,9]  Rapid time of onset and recovery.…”