Serum Cortisol Levels with Etomidate Induction: A Speculation That Needs To Be Reviewed

Abstract

Context: Hemodynamic stability during induction of anesthesia is always a concern for an anesthesiologist. Propofol remains the most popular induction agent with its favorable characteristics and few drawbacks like decrease in heart rate and blood pressure (BP). Although etomidate provides better hemodynamic stability, its use declined due to reports of adrenocortical suppression.

Aims: We designed a study to compare the effect of anesthetic induction with etomidate versus propofol on serum cortisol levels and hemodynamics.

Settings and design: This was a prospective randomized double-blind comparative study.

Subjects and methods: Sixty ASA PS classes I and II patients scheduled for laparoscopic inguinal hernia repair under general anesthesia were included in the study. Thirty patients received propofol 2 mg.kg^-1 and thirty, etomidate 0.3 mg.kg^-1. Blood samples for serum cortisol were withdrawn preoperatively, immediate postoperatively, and 24 h after surgery. Vitals were monitored throughout.

Statistical analysis used: All data are presented as mean ± standard deviation and proportions. Demographic data were analyzed by Student's t-test, and Chi-square test was used to analyze changes over time. The statistical software SPSS version 25.0 was used for data analysis.

Results: Systolic blood pressure (BP), diastolic BP, and mean BP were more stable in the etomidate group compared to the propofol group. Serum cortisol levels before surgery in both the groups were within normal limits and comparable, followed by a significant decline in the etomidate group and rise in the propofol group in the immediate postoperative period. The levels in the third sample were comparable in both the groups.

Conclusion: Etomidate offers superior hemodynamic compared to propofol. A decrease in serum cortisol level in the etomidate group was transient returning back to normal within 24 h.

Keywords: Adrenocortical suppression; etomidate; hemodynamic stability; propofol; serum cortisol.

Graph 1

Line graphs showing mean heart rate (a), systolic blood pressure (b), diastolic blood pressure (c), and mean blood pressure (d) in the etomidate and propofol groups