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Adrenal inhibition following a single dose of etomidate in intubated traumatic brain injury victims.

https://arctichealth.org/en/permalink/ahliterature120802
Source
CJEM. 2012 Sep;14(5):270-82
Publication Type
Article
Date
Sep-2012
Author
Patrick Archambault
Clermont E Dionne
Gilles Lortie
François LeBlanc
Anik Rioux
Geneviève Larouche
Author Affiliation
Departments of Emergency Medicine and Anesthesiology, Centre de Santé et de Services Sociaux Alphonse-Desjardins-Centre Hospitalier Affilié Universitaire de Lévis, Lévis, QC, Canada. patrick.m.archambault@gmail.com
Source
CJEM. 2012 Sep;14(5):270-82
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adrenal Glands - drug effects
Adrenal Insufficiency - blood - chemically induced - epidemiology
Adrenocorticotropic Hormone - blood
Adult
Aged
Anesthetics, Intravenous - administration & dosage - adverse effects
Brain Injuries - blood - therapy
Dose-Response Relationship, Drug
Etomidate - administration & dosage - adverse effects
Female
Follow-Up Studies
Humans
Incidence
Intubation, Intratracheal
Male
Middle Aged
Quebec - epidemiology
Risk factors
Young Adult
Abstract
Etomidate is frequently used to intubate traumatic brain injury (TBI) victims, even though it has been linked to adrenal insufficiency (AI) in some populations. Few studies have explored the risk of prolonged etomidate-induced AI among TBI victims.
To determine the risk and the length of AI induced by etomidate in patients intubated for moderate and severe TBI.
Participants in this observational study were moderate to severe intubated TBI victims aged = 16 years. The anesthetic used (etomidate versus others) was determined solely by the treating emergency physician. Adrenocorticotropic hormone (ACTH) stimulation tests (250 µg) were performed 24, 48, and 168 hours after intubation. AI was defined as an increase in serum cortisol 1 hour post-ACTH test (delta cortisol) of less than 248.4 nmol/L.
Forty subjects (participation 42.6%) underwent ACTH testing. Fifteen received etomidate, and 25 received another anesthetic. There were no statistically significant differences between groups as to the cumulative incidence of AI at any measurement time. However, at 24 hours, exploratory post hoc analyses showed a significant decrease in delta cortisol (adjusted means: etomidate group: 305.1 nmol/L, 95% CI 214.7-384.8 versus other anesthetics: 500.5 nmol/L, 95% CI 441.8-565.7). This decrease was not present at 48 and 168 hours.
In TBI victims, although a single dose of etomidate does not increase the cumulative incidence of AI as defined, it seems to decrease the adrenal response to an ACTH test for 24 hours. The clinical impacts of this finding remain to be determined.
PubMed ID
22967694 View in PubMed
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