One single dose of etomidate negatively influences adrenocortical performance for at least 24 h in children with meningococcal sepsis

@article{denBrinker2007OneSD,
  title={One single dose of etomidate negatively influences adrenocortical performance for at least 24 h in children with meningococcal sepsis},
  author={Marieke den Brinker and Anita Hokken-Koelega and Jan A. Hazelzet and Frank H de Jong and Wim C. J. Hop and K F M Joosten},
  journal={Intensive Care Medicine},
  year={2007},
  volume={34},
  pages={163 - 168}
}
ObjectiveTo investigate the effect of one single bolus of etomidate used for intubation on adrenal function in children with meningococcal sepsis.DesignRetrospective study conducted between 1997 and 2004.SettingUniversity-affiliated paediatric intensive care unit (PICU).Patients and participantsSixty children admitted to the PICU with meningococcal sepsis, not treated with steroids.InterventionsAdrenal hormone concentrations were determined as soon as possible after PICU admission, and after 12… 
A novel use of etomidate for intentional adrenal suppression to control severe hypercortisolemia in childhood*
  • N. Mettauer, J. Brierley
  • Medicine, Biology
    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
  • 2009
TLDR
The adrenal suppression caused by etomidate, so controversial in the care of the critically ill at present, can be therapeutically used for short-term control of severe hypercortisolemia in children.
Corticosteroid after etomidate in critically ill patients: A randomized controlled trial*
TLDR
It is suggested that critically ill patients without septic shock do not benefit from moderate-dose hydrocortisone administered to overcome etomidate-related adrenal insufficiency.
Etomidate and adrenal insufficiency: the controversy continues
TLDR
The results show that ketamine is a safe and valuable alternative to etomidate for endotracheal intubation in critically ill patients, and should be considered in those with sepsis.
The Effects of Single-Dose Etomidate Versus Propofol on Cortisol Levels in Pediatric Patients Undergoing Urologic Surgery: A Randomized Controlled Trial
TLDR
Compared with propofol, a single induction dose of etomidate suppressed postoperative cortisol levels in healthy children undergoing urologic surgery and was not associated with any changes in clinical outcomes.
The effect of etomidate on adrenal function in critical illness: a systematic review
TLDR
There is an increased rate of AI and mortality in critically ill patients who received etomidate and non-etomidate anesthesia, and this results in an increased risk ratio (RR) for AI.
Effect of Vitamin C on adrenal suppression by etomidate induction in patients undergoing cardiac surgery: A randomized controlled trial
TLDR
Vitamin C effectively inhibits etomidate-induced adrenal suppression in cardiac patients, thereby Etomidate can be used as a safe alternative for induction in cardiac surgery under cardiopulmonary bypass when pretreated with Vitamin C.
Opioid and benzodiazepine contributions to etomidate-associated adrenal insufficiency
  • H. Daniell
  • Medicine, Biology
    Intensive Care Medicine
  • 2008
TLDR
There is a need for studies examining the inhibition of adrenal function induced by contributions of etomidate or other rapid acting anesthetic agents in combination with opioids, benzodiazepines, and other analgesic and sedative medications, in order to identify the safest, most effective, and most convenient combinations of these drugs.
Etomidate in sepsis: understanding the dilemma.
TLDR
Understanding the history of this controversy, and reviewing the most recent research into etomidate use in sepsis may help clinicians decide whether or not to use the drug in routine clinical practice.
Opioid and benzodiazepine contributions to etomidate-associated adrenal insufficiency
TLDR
In patients receiving continuous infusion of sedatives/analgesics following the single dose of etomidate, their baseline cortisol levels remained unchanged over time while their cortisol response to ACTH stimulation and serum 11 b-deoxycortisol levels were significantly altered within 48 h, suggesting that sedatives other than etomidates and opioids may blunt the baseline secretion of cortisol through a central mechanism.
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A single bolus infusion of etomidate could be a major risk factor for the development of relative adrenocortical deficiency in ICU patients for at least 24 h after administration, and female gender is an independent protective factor.
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