• L Seravalli, F Pralong, J-P Revelly, Y A Que, M Chollet, and R Chioléro.
• Service de médecine intensive adulte et centre des brûlés, CHU de Vaudois, 1011 Lausanne, Switzerland. Laurent.Seravalli@ne.ch
• Ann Fr Anesth Reanim. 2009 Sep 1;28(9):743-7.

ObjectiveA single bolus dose of etomidate decreases cortisol synthesis by inhibiting the 11-beta hydroxylase, a mitochondrial enzyme in the final step of cortisol synthesis. In our institution, all the patients undergoing cardiac surgery receive etomidate at anesthesia induction. The purpose of this study was to assess the incidence of adrenocortical dysfunction after a single dose of etomidate in selected patients undergoing major cardiac surgery and requiring high-dose norepinephrine postoperatively.Study DesignRetrospective descriptive study in the surgical ICU of a university hospital.Patients And MethodsSixty-three patients presented acute circulatory failure requiring norepinephrine (>0,2 microg/kg/min) during the 48 hours following cardiac surgery. Absolute adrenal insufficiency was defined as a basal cortisol below 414 nmo/l (15 microg/dl) and relative adrenal insufficiency as a basal plasma cortisol between 414 nmo/l (15 microg/dl) and 938 nmo/l (34 microg/dl) with an incremental response after 250 microg of synthetic corticotropin (measured at 60 minutes) below 250 nmol/l (9 microg/dl).ResultsFourteen patients (22%) had normal corticotropin test results, 10 (16%) had absolute and 39 (62%) relative adrenal insufficiency. All patients received a low-dose steroid substitution after the corticotropin test. Substituted patients had similar clinical outcomes compared to patients with normal adrenal function.ConclusionA high incidence of relative adrenal failure was observed in selected cardiac surgery patients with acute postoperative circulatory failure.

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