Endocrinological Changes following Etomidate, Midazolam, or Methohexital for Minor Surgery
Open accessAbstract
Etomidate is known to inhibit adrenocorticosteroid synthesis. The extent and duration of the effects of etomidate (63 +/- 6.4 mg) on spontaneous and stimulated corticosteroid levels, as well as on plasma concentrations of ACTH, beta-endorphin, and catecholamines were examined and compared to those following administration of the new benzodiazepine, midazolam, or of methohexital. Twenty-nine healthy, young, male orthopedic patients were randomized into three groups receiving either etomidate/fentanyl (n = 12), midazolam/fentanyl (n = 8), or methohexital/fentanyl (n = 9). Etomidate caused cortisol levels to decrease from 12.5 +/- 1.2 micrograms/dl preoperatively to 5.9 +/- 0.8 micrograms/dl after operation (P less than 0.001), compared to an increase from 12.0 +/- 1.9 micrograms/dl to 18.5 +/- 2.9 micrograms/dl in the group receiving methohexital. At 6 and 20 h postoperatively, all cortisol levels were normal. The cortisol decrease from 12.5 +/- 1.7 to 7.6 +/- 1.5 caused by midazolam was similar to that following etomidate, but the response to exogenous ACTH was significantly impaired in patients receiving etomidate as compared to those receiving midazolam. ACTH and beta-endorphin levels increased in patients receiving etomidate, presumably as a result of the interruption of negative feedback due to cortisol synthesis inhibition. Midazolam on the other hand prevented the increase of ACTH and beta-endorphin levels. Etomidate completely suppressed spontaneous aldosterone levels (from 33 +/- 6.7 to 7 +/- 2.1 pg/ml), as well as the response to stimulation with exogenous ACTH without affecting serum electrolytes. Etomidate had no influence on plasma catecholamines, but midazolam attenuated the stress-related epinephrine increase.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The effects of high-dose pentobarbital and propofol on adrenal function are more lasting but still reversible and dose-dependent.
“the effect of the metabolic suppressive agents high-dose pentobarbital and propofol were more lasting but still reversible and dose-dependent [74–83].”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [77]
A single dose of etomidate affects adrenal function only within the first 24 hours of injury.
“the effect of a single dose of etomidate on adrenal function was only seen within the first 24 h of injury.”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [77]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
No references could be resolved yet.
Research works printed but not linked: 3
- [14]14. Kettler D, Hasse F, Hensel I: Streßfreie Anästhesie in der Herzchirurgie durch hohe Opiatdosen—Gibt es so etwas?, Anaesthesiologie und Intensivmedizin, 174. Edited by Schara J. Berlin, Springer Verlag, 1986, pp 204–213
- [21]21. Herbert E, Uhler M: Biosynthesis of polyprotein precursors to regulatory peptides (review). Cell 30:1–2, 1982
- [30]30. Haefely W, Pieri L, Polc P, Schaffner R: General pharmacology and neuropharmacology of benzodiazepine derivatives, Handbook of Experimental Pharmacology, 55/II. Edited by Hoffmeister F, Stille G. Berlin, Springer Verlag, 1981, pp 13–262
Cited by
Sorted by citations
Acute secondary adrenal insufficiency after traumatic brain injury: a prospective study
Cohan, P., Wang, C., McArthur, D. L., Cook, S. W., Dusick, J. R., Armin, B., Swerdloff, R., Vespa, P., Muizelaar, J. P., Cryer, H. G., et al. (2005) · Critical Care Medicine · doi:10.1097/01.ccm.0000181735.51183.a7 · Cited by 282 · see citing works
Adrenocortical function in critically ill patients 24 h after a single dose of etomidate
Absalom, Pledger, & Kong (1999) · Anaesthesia · doi:10.1046/j.1365-2044.1999.01003.x · Cited by 241 · see citing works
Adrenocortical Dysfunction Following Etomidate Induction in Emergency Department Patients
Schenarts, C. L., Burton, J. H., & Riker, R. R. (2001) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2001.tb00537.x · Cited by 190 · see citing works
The cortisol stress response induced by surgery: A systematic review and meta‐analysis
Prete, A., Yan, Q., Al‐Tarrah, K., Akturk, H. K., Prokop, L. J., Alahdab, F., Foster, M. A., Lord, J. M., Karavitaki, N., Wass, J. A., et al. (2018) · Clinical Endocrinology · doi:10.1111/cen.13820 · Cited by 192 · see citing works
Peri‐operative steroid supplementation
Nicholson, G., Burrin, J. M., & Hall, G. M. (1998) · Anaesthesia · doi:10.1046/j.1365-2044.1998.00578.x · Cited by 143 · see citing works
Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury
Dusick, J. R., Wang, C., Cohan, P., Swerdloff, R., & Kelly, D. F. (2012) · Pituitary · doi:10.1007/s11102-008-0130-6 · Cited by 121 · see citing works
- Authors
- Crozier, T. A., Beck, D., Schlaeger, M., Wuttke, W., & Kettler, D.
- Affiliations
- Assistant Professor of Anesthesiology, Department of Anesthesiology.
- Resident in Anesthesiology, Department of Anesthesiology.
- Consultant Anesthesiologist, Department of Anesthesiology.
- Professor of Endocrinology, Department of Clinical and Experimental Endocrinology.
- Professor of Anesthesiology, Department of Anesthesiology.
- Venue
- Anesthesiology
- Published
- 1987-05-01
- Volume
- 66
- Issue
- 5
- Pages
- 628-635
- ISSN
- 0003-3022 (ISSN-L)
- OpenAlex
- W2166559823
- Cited by
- 77
- References
- 0
- Citations by year
- 2026: 2 · 2023: 1 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 2 · 2014: 3 · 2012: 3
- FWCI
- 1.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Anesthesiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- etomidate, midazolam, methohexital, cortisol, ACTH, beta-endorphin, aldosterone, catecholamines, negative feedback, fentanyl
- MeSH terms
- Adrenocorticotropic Hormone, Adult, Aldosterone, Anesthesia, beta-Endorphin, Catecholamines, Endorphins, Etomidate, Hormones, Humans, Hydrocortisone, Male, Methohexital, Midazolam, Minor Surgical Procedures
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
