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Effect of Etomidate on Hemodynamics and Adrenocortical Function After Cardiac Surgery

Information source: University Hospital Inselspital, Berne
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Coronary Artery Disease; Mitral Valve Regurgitation

Intervention: Etomidate (Drug); Propofol (Drug); Hydrocortisone (Drug); NaCl 0.9% (Drug); Tetracosactin (Other)

Phase: Phase 4

Status: Completed

Sponsored by: University Hospital Inselspital, Berne

Official(s) and/or principal investigator(s):
Stephan M Jakob, Professor, Principal Investigator, Affiliation: University Hospital Inselspital, Berne

Summary

The purpose of this study is to evaluate the effect of a single dose of etomidate for patients undergoing cardiac surgery with the use of cardiopulmonary bypass (CPB) on post-CPB adrenocortical responsiveness, on requirements of hemodynamic support, and on use of intensive care resources.

Clinical Details

Official title: Effect of an Anesthetic Induction Dose of Etomidate on Hemodynamics and Adrenocortical Function After Cardiac Surgery

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Primary outcome:

Incidence of absolute and relative adrenal insufficiency

Cumulative requirements of vasoactive drugs during surgery and in the intensive care unit (ICU)

Secondary outcome:

Incidence of failure to wean off cardiopulmonary bypass on first intention

Serum lactate

Time to extubation

Length of stay (LOS) in the intensive care unit (ICU), intermediate care unit (IMC), and hospital

Association of results with preoperative risk, stress-dose hydrocortisone replacement, type of surgery

Eligibility

Minimum age: 18 Years. Maximum age: 80 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Male or female patients undergoing elective

- coronary artery bypass graft (primary or re-operation)

- mitral valve reconstruction/replacement for mitral valve regurgitation

- Age between 18 and 80 years (extremes included)

- Subject itself has signed the informed consent

- No clinically relevant deviation from the laboratory's reference range of

biochemistry, hematology, or urinalysis testing Exclusion Criteria:

- Participation in another ongoing interventional trial

- Known adrenocortical insufficiency

- Use of etomidate or propofol within 1 week preoperatively

- Use of glucocorticoids within 6 month preoperatively

- Known sensitivity to etomidate, propofol, or emulgator

- Severe hepatic dysfunction (bilirubin > 3mg/dl)

- Severe renal dysfunction (plasma creatinine > 180mikromol/l)

- Sepsis, endocarditis or other chronic inflammatory disease

- Manifest insulin-dependent diabetes mellitus

- Positive HIV serology

- Hemodynamically significant carotid stenosis requiring treatment

- Serious illnesses: endocrine, neurological, psychiatric, metabolic disturbances

- Pregnancy or breast-feeding female; females will be subject to pregnancy testing

- Requirement of rapid sequence induction

- Emergency surgery

- History of asthma

Locations and Contacts

Departments of Intensive Care Medicine and Anesthesiology, Bern, BE 3010, Switzerland
Additional Information

Related publications:

Malerba G, Romano-Girard F, Cravoisy A, Dousset B, Nace L, Lévy B, Bollaert PE. Risk factors of relative adrenocortical deficiency in intensive care patients needing mechanical ventilation. Intensive Care Med. 2005 Mar;31(3):388-92. Epub 2005 Feb 10.

Weis F, Kilger E, Roozendaal B, de Quervain DJ, Lamm P, Schmidt M, Schmölz M, Briegel J, Schelling G. Stress doses of hydrocortisone reduce chronic stress symptoms and improve health-related quality of life in high-risk patients after cardiac surgery: a randomized study. J Thorac Cardiovasc Surg. 2006 Feb;131(2):277-82.

den Brinker M, Joosten KF, Liem O, de Jong FH, Hop WC, Hazelzet JA, van Dijk M, Hokken-Koelega AC. Adrenal insufficiency in meningococcal sepsis: bioavailable cortisol levels and impact of interleukin-6 levels and intubation with etomidate on adrenal function and mortality. J Clin Endocrinol Metab. 2005 Sep;90(9):5110-7. Epub 2005 Jun 28.

Absalom A, Pledger D, Kong A. Adrenocortical function in critically ill patients 24 h after a single dose of etomidate. Anaesthesia. 1999 Sep;54(9):861-7.

Annane D. ICU physicians should abandon the use of etomidate! Intensive Care Med. 2005 Mar;31(3):325-6. Epub 2005 Jan 27.

Duthie DJ, Fraser R, Nimmo WS. Effect of induction of anaesthesia with etomidate on corticosteroid synthesis in man. Br J Anaesth. 1985 Feb;57(2):156-9.

Fellows IW, Bastow MD, Byrne AJ, Allison SP. Adrenocortical suppression in multiply injured patients: a complication of etomidate treatment. Br Med J (Clin Res Ed). 1983 Dec 17;287(6408):1835-7.

Fellows IW, Byrne AJ, Allison SP. Adrenocortical suppression with etomidate. Lancet. 1983 Jul 2;2(8340):54-5.

Wagner RL, White PF, Kan PB, Rosenthal MH, Feldman D. Inhibition of adrenal steroidogenesis by the anesthetic etomidate. N Engl J Med. 1984 May 31;310(22):1415-21.

Allolio B, Stuttmann R, Fischer H, Leonhard W, Winkelmann W. Long-term etomidate and adrenocortical suppression. Lancet. 1983 Sep 10;2(8350):626.

Crozier TA, Beck D, Wuttke W, Kettler D. [Relation of the inhibition of cortisol synthesis in vivo to plasma etomidate concentrations]. Anaesthesist. 1988 May;37(5):337-9. German.

Watt I, Ledingham IM. Mortality amongst multiple trauma patients admitted to an intensive therapy unit. Anaesthesia. 1984 Oct;39(10):973-81.

Kenyon CJ, McNeil LM, Fraser R. Comparison of the effects of etomidate, thiopentone and propofol on cortisol synthesis. Br J Anaesth. 1985 May;57(5):509-11.

Kilger E, Weis F, Briegel J, Frey L, Goetz AE, Reuter D, Nagy A, Schuetz A, Lamm P, Knoll A, Peter K. Stress doses of hydrocortisone reduce severe systemic inflammatory response syndrome and improve early outcome in a risk group of patients after cardiac surgery. Crit Care Med. 2003 Apr;31(4):1068-74.

Loisa P, Uusaro A, Ruokonen E. A single adrenocorticotropic hormone stimulation test does not reveal adrenal insufficiency in septic shock. Anesth Analg. 2005 Dec;101(6):1792-8.

Neumann R, Worek FS, Blümel G, Zimmermann GJ, Fehm HL, Pfeiffer UJ. Cortisol deficiency in metomidate anesthetized bacteremic pigs: results in circulatory failure--beneficial effect of cortisol substitution. Acta Anaesthesiol Scand. 1989 Jul;33(5):379-84.

Starting date: November 2006
Last updated: March 3, 2010

Page last updated: August 23, 2015

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