S. Schraag et al., THE ROLE OF ASCORBIC-ACID AND XYLITOL IN ETOMIDATE-INDUCED ADRENOCORTICAL SUPPRESSION IN HUMANS, European journal of anaesthesiology, 13(4), 1996, pp. 346-351
Etomidate-induced suppression of cortisol biosynthesis is a result of
a blockade of 11-beta-hydroxylation in the adrenal gland, mediated by
the imidazol radical of etomidate. Since the generation of steroids re
quires reductive and energy rich equivalents, the present study examin
ed whether supplementation with ascorbic acid or xylitol, a major sour
ce of NADPH, could attenuate adrenal suppression by etomidate in human
subjects by promoting the turnover rate of 11-beta-hydroxylase. Durin
g continuous etomidate/alfentanil anaesthesia for pelviscopic surgery
30 female patients received either Ringer's lactate, xylitol (0.25 g k
g(-1) h(-1)) or ascorbic acid (0.5 g h(-1)) intravenously (i.v.). The
plasma concentrations of cortisol, aldosterone and dehydroepiandroster
one (DHEA) were recorded for 5 h after end of surgery and a stimulatio
n with synthetic ACTH was performed. The results showed no evidence of
a clinically relevant attenuating effect of ascorbic acid or xylitol
on etomidate-induced adrenocortical suppression. However, the observed
suppression of cortisol levels was not enough to allow an attenuating
affect to be measured.