The Changes in Cortisol Levels during Cardiac Surgery: A Randomized Double-Blinded Study between Two Induction Agents Etomidate and Thiopentone
Manee Raksakietisak MD*, Chutimart Ngamlamiad MD*, Thitiganya Duangrat MD*, Suvit Soontarinka MD*, Kasana Raksamani MD*
Affiliation : * Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To study the changes in cortisol levels during and after cardiac surgery after an inductive dose of either etomidate
or thiopentone and their consequences.
Material and Method: A prospective, randomized, double-blinded study was conducted in 26 patients undergoing elective
cardiac surgery. They received either etomidate or thiopentone for induction. Serum cortisol levels were measured
preoperatively, and then at 2-, 4-, 8-, and 24-hour. All of the patients received standard anesthesia and surgery. The data
also included patients perioperative management and outcome.
Results : There is no difference in patients’ characteristics. The baseline plasma morning cortisols in the two groups were
comparable (11.77.5 mcg/dL in etomidate group vs. 12.08.2 mcg/dL in thiopentone group). In both groups, during surgery,
the cortisol levels rose to higher levels and reached peak levels at four to eight hours and related to surgical stress. At all
times, the etomidate group had lower cortisol levels but only at 8-hour, the etomidate group had significantly lower cortisol
level (39.914.2 vs. 65.920.0 mcg/dL). At 24 hours, in both groups, cortisol levels were lower than at 8-hour but did not
return to normal baseline levels. There were no differences in the dose of inotropic use and ICU stay. However, surprisingly
the etomidate group had shorter hospital stay.
Conclusion : A single dose of etomidate used for induction in elective cardiac patients can partially and reversibly inhibit
of the cortisol synthesis for, at least, 24 hours, but its association with any hemodynamic consequences cannot be concluded.
Registration: ClinicalTrials.gov as NCT01495949.
Keywords : Cortisol, Adrenal insufficiency, Cardiac surgery, Etomidate
