Faut-il encore utiliser l'étomidate ?

Translated title of the contribution: Should etomidate still be used?

J. F. Payen, M. Vinclair, C. Broux, P. Faure, O. Chabre

Research output: Contribution to journalShort surveypeer-review

Abstract

Etomidate blocks the cortisol synthesis by specifically inhibiting the activity of 11β-hydroxylase, resulting in a primary adrenal insufficiency. Therefore, a serum accumulation of 11β-deoxycortisol and a low secretion of serum cortisol must be required as diagnostic criteria to assign that adrenal impairment to the drug. These requirements have been rarely fulfilled in studies exploring the contribution of etomidate to the adrenal insufficiency despite numerous causes of adrenal derangement. In critically ill patients without sepsis, a single dose of etomidate results in a wide adrenal inhibition, reversible in 48 h after etomidate administration. Although there are still uncertainties as to whether etomidate directly affects mortality and morbidity, it seems preferable to avoid the use of etomidate in patients with severe sepsis and septic shock. In patients with severe traumatic brain injury, arterial hypotension is one of major factors of poor outcome and can be prevented with the use of etomidate for facilitating tracheal intubation. Substitutive opotherapy with low doses of hydrocortisone should be assessed after a single dose of etomidate for critically ill patients.

Translated title of the contributionShould etomidate still be used?
Original languageFrench
Pages (from-to)915-919
Number of pages5
JournalAnnales francaises d'anesthesie et de reanimation
Volume27
Issue number11
DOIs
StatePublished - Nov 1 2008

Keywords

  • Adrenal inhibition
  • Cortisol
  • Etomidate
  • ICU

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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