Faculty Collaboration Database

Etomidate use and postoperative outcomes among cardiac surgery patients. Anesthesiology 2014 Mar;120(3):579-89

Date

12/04/2013

Pubmed ID

24296761

Pubmed Central ID

PMC3944222

DOI

10.1097/ALN.0000000000000087

Scopus ID

2-s2.0-84895426080 (requires institutional sign-in at Scopus site)   35 Citations

Abstract

BACKGROUND: Although a single dose of etomidate can cause relative adrenal insufficiency, the impact of etomidate exposure on postoperative outcomes is unknown. The objective of this study was to examine the association between a single induction dose of etomidate and clinically important postoperative outcomes after cardiac surgery.

METHODS: The authors retrospectively examined the association between etomidate exposure during induction of anesthesia and postoperative outcomes in patients undergoing cardiac surgery from January 2007 to December 2009 by using multivariate logistic regression analyses and Cox proportional hazards regression analyses. Postoperative outcomes of interest were severe hypotension, mechanical ventilation hours, hospital length of stay, and in-hospital mortality.

RESULTS: Sixty-two percent of 3,127 patients received etomidate. Etomidate recipients had a higher incidence of preoperative congestive heart failure (23.0 vs. 18.3%; P = 0.002) and a lower incidence of preoperative cardiogenic shock (1.3 vs. 4.0%; P < 0.001). The adjusted odds ratio for severe hypotension and in-hospital mortality associated with receiving etomidate was 0.80 (95% CI, 0.58-1.09) and 0.75 (95% CI, 0.45-1.24), respectively, and the adjusted hazard ratio for time to mechanical ventilation removal and time to hospital discharge was 1.10 (95% CI, 1.00-1.21) and 1.07 (95% CI, 0.97-1.18), respectively. Propensity score analysis did not change the association between etomidate use and postoperative outcomes.

CONCLUSIONS: In this study, there was no evidence to suggest that etomidate exposure was associated with severe hypotension, longer mechanical ventilation hours, longer length of hospital stay, or in-hospital mortality. Etomidate should remain an option for induction of anesthesia in cardiac surgery patients.

Author List

Wagner CE, Bick JS, Johnson D, Ahmad R, Han X, Ehrenfeld JM, Schildcrout JS, Pretorius M

Author

Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Anesthetics, Intravenous
Cardiac Surgical Procedures
Etomidate
Female
Hospital Mortality
Humans
Hypotension
Length of Stay
Male
Middle Aged
Odds Ratio
Postoperative Complications
Proportional Hazards Models
Respiration, Artificial
Retrospective Studies
Time Factors
Treatment Outcome