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Abstract

Introduction: Etomidate inhibits the conversion of deoxycortisol to cortisol, which may suppress cortisol production for up to 24 hours after administration of a single dose and could exacerbate the vasodilatory state seen in the early post-operative period after cardiac surgery with cardiopulmonary bypass (CPB). Hypothesis: The objective of the study was to compare post-operative vasopressor requirements in cardiac surgery patients receiving etomidate (group E) to patients not receiving etomidate (group N) for induction of anesthesia. Methods: This prospective, single-center observational study evaluated adult patients undergoing cardiac surgery with CPB who required vasopressors post-operatively. Use of vasopressors was defined as a continuous infusion of any of the following: norepinephrine, dopamine, phenylephrine, epinephrine or vasopressin. Time on vasopressors was defined as the time from admission to the Cardiovascular ICU until the last vasopressors was discontinued for 24 consecutive hours. The Clinical Severity Score (CSS), a validated tool used to assess post-cardiac surgery morbidity and mortality based on admission data, was used to compare the groups at baseline. Results: Groups were similar when comparing age, gender, race, renal function, ejection fraction (EF), past medical history and pre-operative medication use. Group E had a significantly higher CSS compared to group N (5 vs. 3, respectively; p =.02). There was no significant difference in time spent on vasopressors between group E and group N (48 hours and 46 hours, respectively; p=0.16). The proportion of patients who required vasopressors for greater than 24 hours was also similar between the two groups (67% in group E vs. 49% in group N, p = 0.10). Conclusions: The results of this investigation in cardiac surgery patients demonstrate that the use of etomidate for induction does not appear to have an effect on vasopressor requirements after surgery. However, a larger, randomized trial evaluating the use of etomidate in cardiac surgery patients is needed to fully understand the effect of etomidate on vasopressor requirements in this patient population.