Effect of Vitamin C on adrenal suppression by etomidate induction in patients undergoing cardiac surgery: A randomized controlled trial.
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Date
2016-07
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Abstract
Introduction: Etomidate is usually preferred in the induction of cardiac compromised patients due to
its relative cardiovascular stability. However, the use of this drug has been limited as etomidate induces
suppression of cortisol biosynthesis as a result of blockade of 11‑beta‑hydroxylation in the adrenal
gland, mediated by the imidazole radical of etomidate. This study was carried out to observe the effect
of Vitamin C on adrenal suppression after etomidate induction in patients undergoing cardiac surgery.
Materials and Methods: A total of 78 patients were randomly distributed into two groups. Group‑I received
oral Vitamin C (500 mg) twice daily and Group‑II received antacid tablet as placebo twice daily instead of
Vitamin C for 7 consecutive days prior to surgery till morning of surgery. Patients of both the groups induced
with etomidate (0.1–0.3 mg/kg). Blood cortisol was estimated at different points of time till 24th postinduction
hour/blood lactate, glucose, hemodynamic parameters, and perioperative outcomes were assessed.
Results: Data of seventy patients (n = 35 in each group) were finally analyzed. Cortisol level is statistically
significantly higher in Group‑I (69.51 ± 7.65) as compared to Group‑II (27.74 ± 4.72) (P < 0.05) in the
1st postinduction hour. In Group‑II, cortisol was consistently lower for 1st 24 postinduction hour. Total adrenaline
requirement was statistically significantly high in Group‑II. Time of extubation, length of Intensive Care Unit
stay arrhythmia was similar in both the groups. Conclusion: Vitamin C effectively inhibits etomidate‑induced
adrenal suppression in cardiac patients, thereby etomidate can be used as a safe alternative for induction
in cardiac surgery under cardiopulmonary bypass when pretreated with Vitamin C.
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Keywords
Adrenal suppression, Cardiac surgery, Cortisol, Etomidate, Vitamin C
Citation
Das Deepanwita, Sen Chaitali, Goswami Anupam. Effect of Vitamin C on adrenal suppression by etomidate induction in patients undergoing cardiac surgery: A randomized controlled trial. Annals of Cardiac Anaesthesia. 2016 July; 19(3): 410-417.