Inhibiting effect of etomidate or propofol combined with remifentanil hydrochloride on adrenal cortex function in severe burn patients : a randomized, double-blind and controlled trial

Abstract

Background: Etomidate is widely used for anesthetic induction in clinical practice. Adrenal insufficiency induced by etomidate has been demonstrated. However, a variety of studies present that etomidate plays an important role in patients with severe burn injuries.Methods: Forty patients with severe burns were randomly divided into etomidate group (Group E) and propofol group (Group P). Etomidate, propofol and remifentanil hydrochloride were used for anesthesia induction and maintenance. General patient characteristics, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) value were measured and recorded at the baseline (t0), before the intubation (t1), 1, 3, 5, and 30 min following the intubation (t2–5), and the end of the surgery (t6). Before induction of anesthesia and at 30 min, 2h, 24h, and 48h after end of surgery (T0, T1, T2, T3 and T4), artery blood (2 ml) was collected and the concentrations of adrenocorticotropic hormone (ACTH), cortisol (Cor) and aldosterone (ALD) were measured.Results: There were no significant difference in general patient characteristics between the two groups (P>0.05). The MAP values decreased significantly, the HR values decreased at the t1 and there was a statistical difference between the two groups; There was no statistical difference between the two groups at each time point. The patient's ACTH levels in two groups decreased significantly compared with that at preanesthesia, and the levels at T4 were apparently higher than T3 in Group E. The patient's Cor levels in Group E significantly decreased at T2, while that in Group P have no significant change. The differences were not statistical significance between the two groups. The patient's ALD levels in Group E were significantly lower than before induction; while the levels in Group P have no significant change at each time point; the levels in Group P were apparently higher than group E at T2, T3 and T4.Conclusion: Propofol and etomidate for anesthesia induction and maintenance could cause hemodynamic changes, but the effect of etomidate was lighter. The propofol and etomidate both suppress adrenal cortex function, that inhibitory effect of etomidate was greater than propofol, therefore etomidate had a certain beneficial effect.