INHIBITION OF ADRENAL STEROIDOGENESIS BY THE ANESTHETIC ETOMIDATE
INHIBITION OF ADRENAL STEROIDOGENESIS BY THE ANESTHETIC ETOMIDATE
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DOI：
10.1056/nejm198405313102202
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发表时间：
1984-01-01
影响因子：
158.5
通讯作者：
FELDMAN, D
中科院分区：
文献类型：
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作者：
WAGNER, RL;WHITE, PF;FELDMAN, D
静脉注射麻醉剂依托咪酯延长镇静时间与血浆皮质醇水平低和死亡率增加有关。测定5例接受依托咪酯治疗的患者的皮质醇和醛固酮对ACTH刺激的反应，并研究依托咪酯对速率类固醇生成途径中酶的直接影响。一名接受依托咪酯20小时输注（1.3-1.5 mg/kg体重/小时）的患者在停用依托咪酯4天后仍有明显的肾上腺皮质抑制。4例术中使用依托咪酯的手术患者术后4 h均出现肾上腺抑制；促ACTH刺激后皮质醇和醛固酮的平均升高仅为1.8 +-。0.5 .mu。G /dl和0.5。分别为1.1 ng/dl。在大鼠肾上腺细胞中，依托咪酯对2线粒体细胞色素p -450依赖性酶、胆固醇侧链切割酶和11 - β产生浓度依赖性阻断。-羟化酶，没有明显抑制糖皮质激素途径的微粒体酶。医生应该意识到依托咪酯抑制肾上腺甾体生成，如果使用依托咪酯，他们应该考虑用皮质类固醇治疗选定的患者。
The use of the i.v. anesthetic etomidate for prolonged sedation was associated with low levels of plasma cortisol and increased mortality. The cortisol and aldosterone responses to ACTH stimulation were measured in 5 patients receiving etomidate, and the direct effects of etomidate on enzymes in the rate steroidogenic pathway were studied. One patient who was receiving a 20-h infusion of etomidate (1.3-1.5 mg/kg body wt per h) had marked adrenocortical suppression that was still evident 4 days after etomidate was discontinued. Four surgical patients receiving etomidate during their operations all had adrenal suppression 4 h after the operation; mean increases in cortisol and aldosterone after ACTH stimulation were only 1.8 .+-. 0.5 .mu.g/dl and 0.5 .+-. 1.1 ng/dl, respectively. In rat adrenal cells, etomidate produced a concentration-dependent blockade of the 2 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.