The Effects of Single-Dose Etomidate Versus Propofol on Cortisol Levels in Pediatric Patients Undergoing Urologic Surgery

Abstract

Compared with propofol, a single induction dose of etomidate suppressed postoperative cortisol levels in healthy children undergoing urologic surgery. This suppression lasted approximately 24 hours and was not associated with any changes in clinical outcomes.

Etomidate versus propofol sedation for complex upper endoscopic procedures: a prospective double-blinded randomized controlled trial

“…First, patient cortisol levels in both groups were not assessed before or after the procedures. However, Du et al 44 demonstrated that a single induction dose of etomidate suppressed postoperative cortisol levels in healthy patients undergoing surgery compared with propofol. However, this suppression lasted approximately 24 hours and was not associated with any changes in clinical outcomes.…”

Steroid administration after anaesthetic induction with etomidate does not reduce in-hospital mortality or cardiovascular morbidity after non-cardiac surgery

“…In cardiac surgical patients, Iribarren and colleagues 22 showed that the patients who received etomidate required a higher dose of vasopressors during the postoperative period than those who received other induction agents, whilst other studies found no difference in vasopressor requirement 20 and outcomes, including mechanical ventilation time and length of ICU and hospital stay, between etomidate and other induction agents. 21,23,24 In non-cardiac surgery, one study demonstrated no differences in intraoperative haemodynamic parameters, vasopressor requirement, 19 and length of hospital stay between etomidate and propofol, although our previous work showed an increased incidence of postoperative cardiovascular morbidities. 5 Information regarding the effect of corticosteroid supplementation after etomidate exposure in an elective surgical population is scarce.…”

“…In a predominantly elective surgical population, a single dose of etomidate suppresses serum cortisol concentration for 6e24 h, 2,19 and the studies that used the cosyntropin stimulation test have shown that relative adrenal insufficiency caused by etomidate lasts up to 24 h. 20,21 Whether etomidate-induced Table 2 Patient and baseline characteristics for patients with and without intraoperative steroid supplementation before and after propensity-score matching. Summary is reported as median [Q1, Q3] or 'N (%)', as appropriate.…”

Effect of Etomidate vs Propofol for Total Intravenous Anesthesia on Major Postoperative Complications in Older Patients

“…Cortisol recovery could be as fast as within 24 hours after a single dose of etomidate according to studies involving patients with heart failure, 20,21 patients who underwent cardiac surgery, 22 patients with morbid obesity, 23 and otherwise healthy children who underwent urologic surgery. 24 An analog of etomidate has been developed to retain the beneficial hemodynamic profile of etomidate without adrenocortical suppression. 25 There is no evidence that corticosteroid supplementation after etomidate can improve outcomes, including 28-day mortality, ventilation days, or duration of intensive care unit stay.…”