Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305695, USA; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA.
Br J Anaesth. 2018 Mar;120(3):501-508. doi: 10.1016/j.bja.2017.11.079. Epub 2017 Dec 2.
We tested the primary hypothesis that corticosteroid administration after etomidate exposure reduces a composite of in-hospital mortality and cardiovascular morbidity after non-cardiac surgery.
We evaluated ASA physical status III and IV patients who had non-cardiac surgery with general anaesthesia at the Cleveland Clinic. Amongst 4275 patients in whom anaesthesia was induced with etomidate, 804 were also given steroid intraoperatively, mostly dexamethasone at a median dose of 6 mg. We successfully matched 582 steroid patients with 1023 non-steroid patients. The matched groups were compared on composite of in-hospital mortality and cardiovascular morbidity using a generalized-estimating-equation model. Secondly, the matched groups were compared on length of hospital stay using a Cox proportional hazard model, and were descriptively compared on intraoperative blood pressures using a standardized difference.
There was no significant association between intraoperative steroid administration after anaesthetic induction with etomidate and the composite of in-hospital mortality or cardiovascular morbidity; the estimated common odds ratio across the two components of the composite was 0.86 [95% confidence interval (CI): 0.64, 1.16] for steroid vs non-steroid, P=0.33. The duration of postoperative hospitalisation was significantly shorter amongst steroid patients [median (Q1, Q3): 6 (3, 10) days] than non-steroid patients [7 (4, 11) days], with an estimated hazard ratio of 0.89 (0.80, 0.98) for steroid vs non-steroid, P=0.01. Intraoperative blood pressures were similar in steroid and non-steroid patients.
Steroid administration after induction of anaesthesia with etomidate did not reduce mortality or cardiovascular morbidity.
我们检验了首要假设，即在依托咪酯暴露后给予皮质类固醇可降低非心脏手术后院内死亡率和心血管发病率的复合指标。
我们评估了在克利夫兰诊所接受全身麻醉下非心脏手术的 ASA 身体状况 III 级和 IV 级患者。在 4275 例接受依托咪酯诱导麻醉的患者中，804 例患者术中给予皮质类固醇，其中大多数为地塞米松，中位剂量为 6mg。我们成功匹配了 582 例皮质类固醇患者和 1023 例非皮质类固醇患者。使用广义估计方程模型比较复合院内死亡率和心血管发病率的匹配组。其次，使用 Cox 比例风险模型比较匹配组的住院时间，并使用标准化差异描述性比较术中血压。
麻醉诱导后依托咪酯术中给予皮质类固醇与院内死亡率或心血管发病率的复合指标之间没有显著关联；复合指标两个组成部分的估计共同优势比为皮质类固醇与非皮质类固醇患者的 0.86 [95%置信区间 (CI)：0.64，1.16]，P=0.33。皮质类固醇患者的术后住院时间明显短于非皮质类固醇患者[中位数 (Q1，Q3)：6 (3，10)天比 7 (4，11)天]，皮质类固醇与非皮质类固醇患者的估计风险比为 0.89 (0.80，0.98)，P=0.01。皮质类固醇和非皮质类固醇患者的术中血压相似。
在依托咪酯麻醉诱导后给予皮质类固醇并不能降低死亡率或心血管发病率。
