THE EFFECT OF ETOMIDATE INDUCTION ON PLASMA-CORTISOL LEVELS IN CHILDREN UNDERGOING CARDIAC-SURGERY

Objective: To investigate the effect of a single induction dose of eto midate on plasma cortisol and adrenocorticotrophic hormone (ACTH) leve ls in pediatric patients with congenital heart disease. Design: A pros pective, randomized study. Setting: A university hospital. Participant s: Thirty children undergoing cardiopulmonary bypass. Interventions: P atients were randomly allocated into two groups to receive etomidate, 0.3 mg/kg, and fentanyl, 1 mu g/kg, or ketamine, 1 mg/kg, and fentanyl , 1 mu g/kg intravenously, for anesthesia induction. Anesthesia was ma intained with 50% nitrous oxide and 0.5% isoflurane in oxygen. Plasma cortisol and ACTH levels were measured on five occasions: preoperative ly, 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 anesthes ia induction and remained significantly low during cardiopulmonary byp ass, at the end of operation, and 24 hours postoperatively. Plasma cor tisol levels of the etomidate group after the anesthesia induction, du ring cardiopulmonary bypass, and at the end of the operation were sign ificantly lower than the ketamine group. Conclusion: These results sho w that etomidate is a suitable agent for suppressing the increase in c ortisol levels associated with the stress response caused by cardiopul monary bypass in children with congenital heart defects, and can be us ed safely. Copyright (C) 1998 by W.B. Saunders Company.