Journal ArticleDOI
Inhibition of Adrenal Steroidogenesis by the Anesthetic Etomidate
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TLDR
Physicians should be aware that etomidate inhibits adrenal steroidogenesis, and they should consider treating selected patients with corticosteroids if etamidate is used.Abstract:
The use of the intravenous anesthetic etomidate for prolonged sedation has been associated with low levels of plasma cortisol and increased mortality. We measured the cortisol and aldosterone responses to ACTH stimulation in five patients receiving etomidate, and we also studied the direct effects of etomidate on enzymes in the rat steroidogenic pathway. One patient who was receiving a 20-hour infusion of etomidate (1.3 to 1.5 mg per kilogram of body weight per hour) had marked adrenocortical suppression that was still evident four days after etomidate was discontinued. Four surgical patients receiving etomidate during their operations were all found to have adrenal suppression four hours after the operation; mean (+/- S.D.) increases in cortisol and aldosterone after ACTH stimulation were only 1.8 +/- 0.5 micrograms per deciliter and 0.5 +/- 1.1 ng per deciliter, respectively. In rat adrenal cells, etomidate produced a concentration-dependent blockade of the two mitochondrial cytochrome P-450-dependent enzymes, cholesterol-side-chain cleavage enzyme, and 11 beta-hydroxylase, without evident inhibition of the microsomal enzymes in the glucocorticoid pathway. Physicians should be aware that etomidate inhibits adrenal steroidogenesis, and they should consider treating selected patients with corticosteroids if etomidate is used.read more
Citations
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Journal ArticleDOI
Corticosteroid insufficiency in acutely ill patients.
Mark S. Cooper,Paul M. Stewart +1 more
TL;DR: The authors present an updated, practical approach to the diagnosis and treatment of hypoadrenalism in acutely ill patients, and summarizes the physiology of the corticosteroid response in acute illness.
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Adjunctive Glucocorticoid Therapy in Patients with Septic Shock.
Balasubramanian Venkatesh,Simon Finfer,Jeremy Cohen,Dorrilyn Rajbhandari,Yaseen M. Arabi,Rinaldo Bellomo,Laurent Billot,Maryam Correa,Parisa Glass,Meg Harward,Christopher Joyce,Qiang Li,Colin McArthur,Anders Perner,Andrew Rhodes,Kelly Thompson,Steve Webb,John Myburgh +17 more
TL;DR: Among patients with septic shock undergoing mechanical ventilation, a continuous infusion of hydrocortisone did not result in lower 90‐day mortality than placebo and there were no significant between‐group differences with respect to mortality at 28 days, the rate of recurrence of shock, the number of days alive and out of the ICU, the Recurrence of mechanical ventilation.
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The efficacy of metomidate, clove oil, Aqui-S™ and Benzoak® as anaesthetics in Atlantic salmon (Salmo salar L.) smolts, and their potential stress-reducing capacity
TL;DR: The eugenol-based anaesthetics (clove oil and Aqui-S™) show promise to become effective anaesthetic, with good efficacy at low dosages and with stress-reducing capabilities.
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Addison’s Disease 2001
TL;DR: This review emphasizes the multiple etiologies and the diagnostic steps to be taken with consideration to age at onset and gender and summarizes new genetic insights in the disease.
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Hypothalamic pituitary adrenal function during critical illness: limitations of current assessment methods.
TL;DR: Serum free cortisol measurement is the most reliable method to assess adrenal function in critically ill, hypoproteinemic patients and the routine use of glucocorticoids during critical illness is not justified except in patients in whom adrenal insufficiency was properly diagnosed or others who are hypotensive, septic, and unresponsive to standard therapy.
References
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Journal ArticleDOI
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Journal ArticleDOI
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