Effect of Vitamin C on adrenal suppression by etomidate induction in patients undergoing cardiac surgery: A randomized controlled trial

Ann Card Anaesth. Jul-Sep 2016;19(3):410-7. doi: 10.4103/0971-9784.185522.

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 24 th 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 1 st postinduction hour. In Group-II, cortisol was consistently lower for 1 st 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.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adrenal Glands / drug effects*
  • Adrenal Glands / physiopathology
  • Antioxidants / pharmacology
  • Ascorbic Acid / pharmacology*
  • Cardiac Surgical Procedures*
  • Double-Blind Method
  • Drug Interactions
  • Etomidate / pharmacology*
  • Female
  • Humans
  • Hydrocortisone / blood
  • Hypnotics and Sedatives / pharmacology
  • Male
  • Middle Aged
  • Prospective Studies

Substances

  • Antioxidants
  • Hypnotics and Sedatives
  • Ascorbic Acid
  • Hydrocortisone
  • Etomidate