Effect of low-dose ketamine pretreatment to etomidate on serum cortisol levels in critically ill cardiac patients: A Randomized clinical trial

Abstract

Background: This study aimed to evaluate the effect of low-dose ketamine pretreatment to etomidate on serum cortisol levels in critically ill cardiac patients with acute anemia undergoing upper endoscopy and ColonoscopyPatients and Methods: Sixty adult cardiac patients, ≥ 18 years, who underwent upper endoscopy and Colonoscopy to manage acute anemia in the cardiac intensive care units were enrolled. Patients were randomly divided into two groups: Group (E): received etomidate 0.2 mg/kg IV followed by etomidate 0.05 mg/kg IV, and Group (KE): received ketamine 0.5 mg/kg IV, then etomidate 0.1 mg/kg IV, followed by etomidate 0.05 mg/kg IV. The primary outcome was Serum cortisol level at 6 hours after the procedure. The secondary outcomes: Estimated change in serum cortisol level (6-hours postoperative value compared to preoperative one), the incidence of any adverse effects, patient satisfaction, and total etomidate dose. Results: The mean postoperative cortisol level significantly reduced in group E than group KE; (295.60±49.218) mcg/dL versus (461.00 ±67.946) mcg/dL respectively With 95% CI = 351.94 to 404.66. In addition, the estimated serum cortisol reduction level was also significant between groups; In group E, the estimated cortisol level decreased nearly 53% from 632.40±35.066 mcg/dL to 295.60±49.218 mcg/dL six hours postoperative. While in group KE, the estimated cortisol level decreased only 27% from 639.13±43.035 mcg/dL to 461.00±67.946 mcg/dL.Conclusions: low-dose ketamine pretreatment to etomidate can successfully control etomidate-induced adrenocortical suppression and minimize the decrease in serum cortisol level in critically ill cardiac patients with no additional adverse effects.Trial Registration: This study is registered on ClinicalTrials.gov (NCT04857450; principal investigator: Mostafa Mohammed Elsaid Elhamamsy; registration date: 23/04/ 2021).