The effect of etomidate induction on plasma cortisol levels in children undergoing cardiac surgery

Abstract Objective: To investigate the effect of a single induction dose of etomidate on plasma cortisol and adrenocorticotrophic hormone (ACTH) levels in pediatric patients with congenital heart disease. Design: A prospective, randomized study. Setting: A university hospital. Participants: Thirty children undergoing cardiopulmonary bypass. Interventions: Patients were randomly allocated into two groups to receive etomidate, 0.3 mg/kg, and fentanyl, 1 μ g/kg, or ketamine, 1 mg/kg, and fentanyl, 1 pg/kg intravenously, for anesthesia induction. Anesthesia was maintained with 50% nitrous oxide and 0.5% isoflurane in oxygen. Plasma cortisol and ACTH levels were measured on five occasions: preoperatively, after induction of anesthesia, after cross-clamping, at the end of surgery, and 24 hours postoperatively. Measurements and Main Results: Plasma cortisol levels of the etomidate group decreased with anesthesia induction and remained significantly low during cardiopulmonary bypass, at the end of operation, and 24 hours postoperatively. Plasma cortisol levels of the etomidate group after the anesthesia induction, during cardiopulmonary bypass, and at the end of the operation were significantly lower than the ketamine group. Conclusion: These results show that etomidate is a suitable agent for suppressing the increase in cortisol levels associated with the stress response caused by cardiopulmonary bypass in children with congenital heart defects, and can be used safely.