Anaesthetic induction with etomidate in cardiac surgery: A randomised controlled trial

BACKGROUND: Etomidate is perceived as preserving haemodynamic stability during induction of anaesthesia. It is also associated with adrenocortical dysfunction. The risk/benefit relationship is controversial. OBJECTIVES: We tested the hypotheses that single-dose etomidate increases cumulative vasopressor requirement, time to extubation and length of stay in the ICU. DESIGN: Double-blind randomised controlled trial. SETTING: Bern University Hospital, Switzerland, from November 2006 to December 2009. PATIENTS: There were 90 patients undergoing coronary artery bypass grafts (CABG) and 40 patients undergoing mitral valve surgery (MVS). Reasons for noninclusion were known adrenocortical insufficiency, use of etomidate or propofol within 1 week preoperatively, use of glucocorticoids within 6 months preoperatively, severe renal or liver dysfunction, or carotid stenosis. INTERVENTIONS: CABG patients were allocated randomly to receive either etomidate 0.15 mg kg−1 with placebo, propofol 1.5 mg kg−1 with placebo or etomidate 0.15 mg kg−1 with hydrocortisone (n = 30 in each arm). Risk stratification (low vs. high) was achieved by block randomisation. MVS patients received either etomidate 0.15 mg kg−1 or propofol 1.5 mg kg−1 (n = 20 in each arm). MAIN OUTCOME MEASURES: Cumulative vasopressor requirements, incidence of adrenocortical insufficiency, length of time to extubation and length of stay in ICU. RESULTS: Cumulative vasopressor requireme...
Source: European Journal of Anaesthesiology - Category: Anesthesiology Tags: Cardiac anaesthesia Source Type: research