Lebowitz Philip
From the Clinical Anesthesiology, Albert Einstein College of Medicine, and Division of General Anesthesiology, Montefiore Medical Center, Bronx, NY.
J ECT. 2014 Dec;30(4):261-2. doi: 10.1097/YCT.0000000000000157.
Komatsu et al have recently written that the use of etomidate as an anesthetic induction agent for surgery is associated with increased 30-day mortality and cardiovascular morbidity, compared with propofol. Etomidate has long been recognized as suppressing adrenocortical function and, as an infusion over days, has been indicted in increasing intensive care unit patient mortality. Even in single doses, etomidate causes a reduction in cortisol production, although recovery from single-dose suppression is generally prompt. In prospectively evaluating etomidate as an anesthetic for electroconvulsive therapy, Lebowitz et al, in a pilot study, found that 3 times per week, etomidate did not cause adrenocortical suppression that lasted until the following treatment. The steroid responses did not differ from those of methohexital, and no patient demonstrated evidence of cortisol deficiency. Consequently, concerns raised by Komatsu et al about etomidate's safety seem unwarranted when used for electroconvulsive therapy, and their study's conclusions likely relate to issues with their retrospective methodology.
小松等人最近写道，与丙泊酚相比，使用依托咪酯作为手术麻醉诱导剂会增加30天死亡率和心血管疾病发病率。长期以来，依托咪酯一直被认为会抑制肾上腺皮质功能，并且作为数天的输注用药，已被认为会增加重症监护病房患者的死亡率。即使是单次剂量，依托咪酯也会导致皮质醇分泌减少，不过单次剂量抑制后的恢复通常很快。在一项前瞻性评估依托咪酯作为电休克治疗麻醉剂的研究中，莱博维茨等人在一项初步研究中发现，每周3次使用依托咪酯不会导致肾上腺皮质抑制持续到下次治疗。其类固醇反应与甲己炔巴比妥的反应没有差异，且没有患者表现出皮质醇缺乏的迹象。因此，当依托咪酯用于电休克治疗时，小松等人对其安全性提出的担忧似乎没有依据，他们研究的结论可能与他们的回顾性研究方法存在的问题有关。
