Etomidate for anesthesia induction: friends or foe in major cardiac surgery?

Audrey De Jong, Samir Jaber, Audrey De Jong, Samir Jaber

Abstract

Use of etomidate for anesthesia induction is still debated. In the previous issue of Critical Care, Heinrich and colleagues reported that etomidate for anesthesia induction had similar outcome in comparison with other drugs, in a specific population of 3,054 patients ahead of major cardiac surgery. For the authors, the similar outcomes for mortality and length of hospital stay add to the hemodynamic stability and the improved intubation conditions to support keeping etomidate in the emergency drugs armamentarium for induction of anesthesia in patients at risk of hemodynamic failure. This commentary reviews the results and implications of their study.

References

    1. Heinrich S, Schmidt J, Ackermann A, Moritz A, Harig F, Castellanos I. Comparison of clinical outcome variables in patients with and without etomidate facilitated anesthesia induction ahead of major cardiac surgery: a retrospective analysis. Crit Care. 2014;18:R150. doi: 10.1186/cc13988.
    1. Wagner CE, Bick JS, Johnson D, Ahmad R, Han X, Ehrenfeld JM, Schildcrout JS, Pretorius M. Etomidate use and postoperative outcomes among cardiac surgery patients. Anesthesiology. 2014;120:579–589. doi: 10.1097/ALN.0000000000000087.
    1. Jung B, Clavieras N, Nougaret S, Molinari N, Roquilly A, Cisse M, Carr J, Chanques G, Asehnoune K, Jaber S. Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis. Crit Care. 2012;16:R224. doi: 10.1186/cc11871.
    1. Jaber S, Jung B, Corne P, Sebbane M, Muller L, Chanques G, Verzilli D, Jonquet O, Eledjam J-J, Lefrant J-Y. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med. 2010;36:248–255. doi: 10.1007/s00134-009-1717-8.
    1. Asehnoune K, Mahe PJ, Seguin P, Jaber S, Jung B, Guitton C, Chatel-Josse N, Subileau A, Tellier AC, Masson F, Renard B, Malledant Y, Lejus C, Volteau C, Sébille V, Roquilly A. Etomidate increases susceptibility to pneumonia in trauma patients. Intensive Care Med. 2012;38:1673–1682. doi: 10.1007/s00134-012-2619-8.
    1. Molenaar N, Bijkerk RM, Beishuizen A, Hempen CM, de Jong MF, Vermes I, van der Sluijs VG, Girbes AR, Groeneveld AJ. Steroidogenesis in the adrenal dysfunction of critical illness: impact of etomidate. Crit Care. 2012;16:R121. doi: 10.1186/cc11415.
    1. Chan CM, Mitchell AL, Shorr AF. Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis. Crit Care Med. 2012;40:2945–2953. doi: 10.1097/CCM.0b013e31825fec26.
    1. Ray DC, McKeown DW. Effect of induction agent on vasopressor and steroid use, and outcome in patients with septic shock. Crit Care. 2007;11:R56. doi: 10.1186/cc5916.
    1. Jabre P, Combes X, Lapostolle F, Dhaouadi M, Ricard-Hibon A, Vivien B, Bertrand L, Beltramini A, Gamand P, Albizzati S, Perdrizet D, Lebail G, Chollet-Xemard C, Maxime V, Brun-Buisson C, Lefrant JY, Bollaert PE, Megarbane B, Ricard JD, Anguel N, Vicaut E, Adnet F, KETASED Collaborative Study Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet. 2009;374:293–300. doi: 10.1016/S0140-6736(09)60949-1.
    1. Morel J, Salard M, Castelain C, Bayon MC, Lambert P, Vola M, Auboyer C, Molliex S. Haemodynamic consequences of etomidate administration in elective cardiac surgery: a randomized double-blinded study. Br J Anaesth. 2011;107:503–509. doi: 10.1093/bja/aer169.
    1. Reich DL, Hossain S, Krol M, Baez B, Patel P, Bernstein A, Bodian CA. Predictors of hypotension after induction of general anesthesia. Anesth Analg. 2005;101:622–628. doi: 10.1213/01.ANE.0000175214.38450.91.
    1. Jaber S, Amraoui J, Lefrant J-Y, Arich C, Cohendy R, Landreau L, Calvet Y, Capdevila X, Mahamat A, Eledjam J-J. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med. 2006;34:2355–2361. doi: 10.1097/01.CCM.0000233879.58720.87.
    1. De Jong A, Molinari N, Terzi N, Mongardon N, Arnal JM, Guitton C, Allaouchiche B, Paugam-Burtz C, Constantin JM, Lefrant JY, Leone M, Papazian L, Asehnoune K, Maziers N, Azoulay E, Pradel G, Jung B, Jaber S, AzuRéa Network for the Frida-Réa Study Group Early identification of patients at risk for difficult intubation in ICU: development and validation of the MACOCHA score in a multicenter cohort study. Am J Respir Crit Care Med. 2013;187:832–839. doi: 10.1164/rccm.201210-1851OC.
    1. Zed PJ, Abu-Laban RB, Harrison DW. Intubating conditions and hemodynamic effects of etomidate for rapid sequence intubation in the emergency department: an observational cohort study. Acad Emerg Med. 2006;13:378–383. doi: 10.1111/j.1553-2712.2006.tb00313.x.
    1. Ge R, Pejo E, Cotten JF, Raines DE. Adrenocortical suppression and recovery after continuous hypnotic infusion: etomidate versus its soft analogue cyclopropyl-methoxycarbonyl metomidate. Crit Care. 2013;17:R20. doi: 10.1186/cc12494.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe