tailieunhanh - Báo cáo khoa học: "Etomidate, pharmacological adrenalectomy and the critically ill: a matter of vital importance"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Etomidate, pharmacological adrenalectomy and the critically ill: a matter of vital importance. | Available online http content 10 4 161 Commentary Etomidate pharmacological adrenalectomy and the critically ill a matter of vital importance Roxanna Bloomfield and David W Noble Intensive Care Unit Aberdeen Royal Infirmary Foresterhill Aberdeen UK Corresponding author David W Noble Published 29 August 2006 This article is online at http eontent 10 4 161 2006 BioMed Central Ltd Critical Care 2006 10 161 doi cc5020 See related research by Mohammad et al. http content 10 4 R105 Abstract Etomidate is a potent suppressant of adrenal steroidogenesis effectively inducing reversible pharmacological adrenalectomy. Recent evidence suggests that for every five patients with septic shock given etomidate without corticosteroid supplementation one patient will die as a consequence. Other critically ill patients are also at possible risk and this risk requires further exploration. Etomidate will also confound investigations into the effects of disease states on adrenal function and should therefore be avoided. A moratorium on the use of etomidate in critically ill patients outside clinical trials may be prudent until its safety is established. Etomidate is a hypnotic with a sixfold better therapeutic index than alternatives such as thiopental or propofol making it an agent of choice for induction of anaesthesia in critically ill haemodynamically unstable patients 1 2 . This together with its favourable pharmacokinetic profile also led to its use by infusion for sedation of ventilated patients in intensive care units ICUs . This practice was largely abandoned more than 20 years ago as a result of etomidate s association with increased mortality which was attributed to profound suppression of adrenal steroidogenesis primarily through its potent inhibition of the enzyme 11 p-hydroxylase 3-5 . In contrast single-bolus administration of etomidate has been considered safe by most commentators 6 but not all 7 and its niche use