Moore R A, Allen M C, Wood P J, Rees L H, Sear J W
Anaesthesia. 1985 Feb;40(2):124-30. doi: 10.1111/j.1365-2044.1985.tb10702.x.
This study investigated the effects of etomidate on endocrine responses to anaesthesia and surgery. Patients undergoing abdominal hysterectomy received standard anaesthetics of either etomidate for induction with etomidate infusion, or thiopentone and halothane. Etomidate suppressed the secretion of cortisol and aldosterone for between 8 and 22 hours after the end of the etomidate infusion; 11-deoxycortisol secretion was not suppressed during the etomidate infusion, but rose postoperatively; 17 alpha-hydroxyprogesterone suppression also lasted only as long as the etomidate infusion. There were no effects on plasma oestradiol, ACTH, or prolactin, but growth hormone concentrations were elevated in the etomidate group. Etomidate was concluded to have influenced adrenocortical function only, where it probably inhibits 11 beta-hydroxylation, 17 alpha-hydroxylation and other intramitochondrial hydroxylation reactions. There were no clinical sequelae attributable to adrenocortical suppression. The relationship of chemical structure of etomidate and other phenylated imidazoles to inhibition of steroidogenesis is discussed.
本研究调查了依托咪酯对麻醉和手术内分泌反应的影响。接受腹部子宫切除术的患者接受标准麻醉，诱导用药为依托咪酯并持续输注依托咪酯，或硫喷妥钠和氟烷。依托咪酯输注结束后，其对皮质醇和醛固酮分泌的抑制作用持续8至22小时；在依托咪酯输注期间，11-脱氧皮质醇分泌未受抑制，但术后升高；17α-羟孕酮的抑制作用也仅在依托咪酯输注期间持续。对血浆雌二醇、促肾上腺皮质激素或催乳素无影响，但依托咪酯组生长激素浓度升高。研究得出结论，依托咪酯仅影响肾上腺皮质功能，可能抑制11β-羟化、17α-羟化及其他线粒体内羟化反应。未发现肾上腺皮质抑制的临床后遗症。文中讨论了依托咪酯及其他苯基化咪唑的化学结构与抑制类固醇生成的关系。
