The Effects of Etomidate Anesthesia on Adrenal Insufficiency and Relative Risk of Mortality Associated with Severity of Critical Illness. A Meta-Analysis

Abstract

Background: Etomidate, a preferred anesthetic agent, causes partial insufficiency [PAI] by inhibiting cortisol synthesis. It is controversial whether it increases mortality. The relative risks [rr] of PAI and mortality of was evaluated regarding e severity of illness (Simplified Acute Physiology II, [SAPSII]). Methods: Literature searches were performed within Cochrane Reviews (search etomidate and adrenal), and then on PubMed and SCOPUS (search terms critical care, adrenal insufficiency, glucocorticoid or corticosteroid). Primary outcome was 28-day survival. Secondary outcome was PAI. PRISMA guidelines were implemented. Findings: There were 28 trials of vs comparator anesthetics (4 randomized controlled, 15 retrospective and 9 post hoc) of 8429 patients. PAI, pre-defined in 13 trials, occurred at a rr =1·57 (95%confidence interval (CI):1·43; 1·71, p 50 (rr= 1·2, CI: 1·11; 1·30, p 57 (rr=1·22). No overall clinical benefit was found when corticosteroids were added to etomidate, although a post-hoc evaluation showed survival benefit for SAPS >55. Interpretation: Etomidate causes PAI which lasts for 24 hours. In critically ill patients with SAPS >50 there is a 20% increase in mortality. There is limited evidence that early institution of corticosteroids in those with SAPS >50 may be protective. Funding Statement: The authors declared: None. Declaration of Interests: The authors stated: None. Ethics Approval Statement: PRISMA guidelines were implemented.