Endocrinological Changes following Etomidate, Midazolam, or Methohexital for Minor Surgery

Crozier, T. A.; Beck, Dietmar; Schlaeger, M.; Wuttke, W.; Kettler, D.

doi:10.1097/00000542-198705000-00006

Cited by 82 publications

(36 citation statements)

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“…3,13 It has to be noted, however, that all patients entering the present study protocol received oral premedication with benzodiazepines (20 mg chlorazepate) the night prior to surgery and three hours before the operation, which per se affects perioperative ACTH and cortisol plasma concentrations. 14 We conclude that premedication with clonidine administered at a dose insufficient to inhibit the surgery induced stimulation of sympathoadrenergic pathways, accentuates the hyperglycemic response to surgery most likely mediated through its inhibitory effect on insulin secretion. We further hypothesize that the hyperglycemic action of low dose clonidine is overlaid by the suppression of the sympathoadrenergic response to surgery if larger doses are administered.…”

Section: Statisticsmentioning

confidence: 81%

Low dose clonidine premedication accentuates the hyperglycemic response to surgery

Lattermann

Schricker

Georgieff

et al. 2001

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To investigate the influence of low dose clonidine premedication on perioperative glucose homeostasis.M Me et th ho od ds s: : Sixteen patients undergoing abdominal hysterectomy for benign uterine myoma were randomly assigned to receive either iv clonidine (1 µg·kg 1 ) 30 min before induction of general anesthesia (clonidine, n=8) or saline (control, n=8). Plasma concentrations of glucose, insulin, cortisol, epinephrine and norepinephrine were measured before, during and two hours after surgery. At the same time heart rate, mean arterial pressure and cardiac output were recorded.R Re es su ul lt ts s: : In both groups, glucose concentrations significantly increased during and after surgery. Intraoperative glucose plasma concentration in the clonidine group was higher than in the control group (clonidine: 6.8 ± 0.6 mmol·L 1 vs control: 5.7 ± 0.8 mmol·L 1 , P < 0.05). This was accompanied by a lower insulin plasma concentration (clonidine: 3.9 ± 1.9 µU·mL 1 vs control: 6.5 ± 2.8 µU·mL 1 , P <0.05). Heart rate, mean arterial pressure and cardiac output remained unchanged throughout the study period without any differences between the groups. While norepinephrine plasma concentrations increased in the control group only (P <0.05), the plasma concentrations of epinephrine and cortisol increased in both groups (P <0.05). Clonidine significantly attenuated the cortisol response as reflected by lower intra-and postoperative cortisol plasma concentrations than in the control group (P <0.05).C Co on nc cl lu us si io on n: : Premedication with clonidine 1 µg·kg 1 accentuates the hyperglycemic response to lower abdominal surgery caused by the decrease in insulin plasma concentrations.Objectif : Explorer l influence d une prémédication avec une faible dose de clonidine sur l homéostase périopératoire du glucose.Méthode : Seize patientes devant subir une hystérectomie abdominale pour un myome utérin bénin ont été réparties au hasard et ont reçu de la clonidine iv (1 µg·kg 1 ) 30 min avant l induction de l anesthésie générale (groupe clonidine, n = 8) ou une solution salée (groupe témoin, n = 8). Les concentrations plasmatiques de glucose, d insuline, de cortisol, d épinéphrine et de norépinéphrine ont été mesurées pendant l intervention et deux heures après. Au même moment, la fréquence cardiaque, la tension artérielle moyenne et le débit cardiaque ont été enregistrés. Résultats :Dans les deux groupes, les concentrations de glucose ont significativement augmenté pendant et après l opération. La concentration plasmatique peropératoire dans le groupe clonidine a été plus élevée que celle du groupe témoin (clonidine : 6,8 ± 0,6 mmol·L 1 vs témoin : 5,7 ± 0,8 mmol·L 1 , P < 0,05). Ce changement s est accompagné d une concentration plus faible d insuline plasmatique (clonidine : 3,9 ± 1,9 µU·mL 1 vs témoin : 6,5 ± 2,8 µU·mL 1 , P < 0,05). La fréquence cardiaque, la tension artérielle moyenne et le débit cardiaque sont demeurés inchangés tout au long de l étude et ce, sans différence intergroupe. Les conce...

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Section: Statisticsmentioning

confidence: 81%

Low dose clonidine premedication accentuates the hyperglycemic response to surgery

Lattermann

Schricker

Georgieff

et al. 2001

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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“…Cosyntropin stimulation testing has been used in this setting by other investigators. 14,15,18 In contrast to previous authors, we used a previously described and accepted definition of CST response to evaluate CST results. 19 One advantage to CST assessment is the evaluation of cortisol production at the level of the adrenal gland.…”

Section: Discussionmentioning

confidence: 99%

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

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confidence: 99%

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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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“…Both diazepam and midazolam have also been shown to inhibit cortisol production from isolated bovine adrenocortical cells in vitro [90]. Midazolam, which has an imidazole ring in addition to its benzodiazepine structure, was found to decrease the cortisol response to peripheral surgery [91] and major upper abdominal surgery [92] and may also have a direct effect on ACTH secretion [91].…”

Section: Intravenous Induction Agentsmentioning

confidence: 99%