ABSTRACT
BACKGROUND: The consequences of inhibition of cortisol synthesis by a single dose of etomidate on subsequent vasopressor drug usage and the duration of relative adrenal insufficiency (RAI) after cardiac surgery are not known. METHODS: This was a prospective, randomized, double-blinded controlled trial of 100 patients undergoing elective cardiac surgery and receiving either etomidate or propofol at induction of anaesthesia. A short corticotropin test was performed 12, 24, and 48 h after anaesthesia induction. RAI was defined as a response <250 nmol litre(-1). RESULTS: The mean (sd) norepinephrine infusion rate during the first 48 postoperative hours was 0.11 (0.01) and 0.11 (0.01) µg kg(-1) min(-1) in the etomidate and propofol groups, respectively (P=0.89). Time to norepinephrine withdrawal was similar between the groups. The incidence of RAI was higher in the etomidate group at 12 h (100% vs 41%, P<0.001) and 24 h (85% vs 25%, P<0.001). CONCLUSIONS: A single bolus of etomidate blunts the hypothalamic-pituitary-adrenal axis response for more than 24 h in patients undergoing elective cardiac surgery, but this was not associated with an increase in vasopressor requirements.
Subject(s)
Cardiac Surgical Procedures , Etomidate/pharmacology , Hemodynamics/drug effects , Hypnotics and Sedatives/pharmacology , Adrenal Insufficiency/blood , Adrenal Insufficiency/chemically induced , Adrenocorticotropic Hormone/blood , Aged , Anesthetics, Intravenous , Blood Pressure/drug effects , Cardiopulmonary Bypass , Double-Blind Method , Elective Surgical Procedures , Endpoint Determination , Etomidate/adverse effects , Female , Humans , Hypnotics and Sedatives/adverse effects , Kaplan-Meier Estimate , Male , Middle Aged , Norepinephrine/administration & dosage , Norepinephrine/therapeutic use , Propofol , Prospective Studies , Respiratory Function Tests , Vasoconstrictor Agents/administration & dosage , Vasoconstrictor Agents/therapeutic useABSTRACT
We report on a case of anti-N-Methyl-D-Aspartate receptor antibody encephalitis, and review cases and series previously published in the literature. Anti-N-Methyl-D-Aspartate receptor antibody encephalitis usually occurs in young female patients with no past medical history, in whom an ovarian teratoma is often detected. They subacutely develop predominantly psychiatric symptoms, followed by severe neurological disorders requiring transfer to the intensive care unit and prolonged ventilatory support. Complete or substantial recovery depends on early diagnosis, removal of the teratoma and immunotherapy. Our purpose is to focus intensivists' attention on this potentially lethal disorder, which should always be considered in young women admitted to the intensive care unit with characteristic neuropsychiatric disorders.
