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[Adrenal function after induction of cardiac surgery patients with an etomidate bolus: a retrospective study]. / Fonction surrénalienne après bolus d'étomidate en chirurgie cardiaque: une étude rétrospective.
Seravalli, L; Pralong, F; Revelly, J-P; Que, Y A; Chollet, M; Chioléro, R.
Afiliación
  • Seravalli L; Service de médecine intensive adulte et centre des brûlés, CHU de Vaudois, 1011 Lausanne, Switzerland. Laurent.Seravalli@ne.ch
Ann Fr Anesth Reanim ; 28(9): 743-7, 2009 Sep.
Article en Fr | MEDLINE | ID: mdl-19683891
ABSTRACT

OBJECTIVE:

A single bolus dose of etomidate decreases cortisol synthesis by inhibiting the 11-beta hydroxylase, a mitochondrial enzyme in the final step of cortisol synthesis. In our institution, all the patients undergoing cardiac surgery receive etomidate at anesthesia induction. The purpose of this study was to assess the incidence of adrenocortical dysfunction after a single dose of etomidate in selected patients undergoing major cardiac surgery and requiring high-dose norepinephrine postoperatively. STUDY

DESIGN:

Retrospective descriptive study in the surgical ICU of a university hospital. PATIENTS AND

METHODS:

Sixty-three patients presented acute circulatory failure requiring norepinephrine (>0,2 microg/kg/min) during the 48 hours following cardiac surgery. Absolute adrenal insufficiency was defined as a basal cortisol below 414 nmo/l (15 microg/dl) and relative adrenal insufficiency as a basal plasma cortisol between 414 nmo/l (15 microg/dl) and 938 nmo/l (34 microg/dl) with an incremental response after 250 microg of synthetic corticotropin (measured at 60 minutes) below 250 nmol/l (9 microg/dl).

RESULTS:

Fourteen patients (22%) had normal corticotropin test results, 10 (16%) had absolute and 39 (62%) relative adrenal insufficiency. All patients received a low-dose steroid substitution after the corticotropin test. Substituted patients had similar clinical outcomes compared to patients with normal adrenal function.

CONCLUSION:

A high incidence of relative adrenal failure was observed in selected cardiac surgery patients with acute postoperative circulatory failure.
Asunto(s)

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Esteroide 11-beta-Hidroxilasa / Insuficiencia Suprarrenal / Glándulas Suprarrenales / Anestésicos Intravenosos / Etomidato / Procedimientos Quirúrgicos Cardíacos Tipo de estudio: Diagnostic_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: Fr Revista: Ann Fr Anesth Reanim Año: 2009 Tipo del documento: Article País de afiliación: Suiza

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Esteroide 11-beta-Hidroxilasa / Insuficiencia Suprarrenal / Glándulas Suprarrenales / Anestésicos Intravenosos / Etomidato / Procedimientos Quirúrgicos Cardíacos Tipo de estudio: Diagnostic_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: Fr Revista: Ann Fr Anesth Reanim Año: 2009 Tipo del documento: Article País de afiliación: Suiza