Etomidate and adrenal suppression

[MmacFN]

Hey all.

There has been many discussions about the capacity of a single RSI dose of etomidate to suppress the adrenals for up to 12 hours.

Now the question i have is this:

How many of you consider a predose hydrocortisone before you give etomidate in a sepsis situation?

Would you EVER dose hydrocortisone without first having a high-dose cosyntropin stimulation test in these patients? Have you seen it done?

Whats the general concensus?

[Nitecap]

Hey all.

There has been many discussions about the capacity of a single RSI dose of etomidate to suppress the adrenals for up to 12 hours.

Now the question i have is this:

How many of you consider a predose hydrocortisone before you give etomidate in a sepsis situation?

Would you EVER dose hydrocortisone without first having a high-dose cosyntropin stimulation test in these patients? Have you seen it done?

Whats the general concensus?

You stated that the dose of etomidate would suppress the adrenals 12hrs. That dose of hydrocortisone would giving you coverage for that 12hrs of etomidate induced suppression.However it will itself suppress via negative feedback mechanisms the the release of either ACTH from the Anterior Pituitary or suppress the release of Corticotropin releasing harmone(CRH) from the hypothallamus How much steroid it takes to cause negative feedback inhibition I have no idea. Throwing in the sepsis which causes hypocortisolism this pt should probrably already be on steroids. In the ICU pts are started on steroids all the time without stimulation tests.

[Tranman]

Yes we routinely dose patients in the OR with hydrocortisone without a high-dose cosyntropin stimulation test. But it's usually not out of concern of adrenal suppression by etomidate.

We usually do this out of concern of adrenal suppression by virtue of patients being on steriods for varying reasons. Hope that makes sense.