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Question of the Day
A 55-year-old man develops refractory hypotension after a 8-hour anesthetic consisting of etomidate and sufentanil infusions. Which of the following BEST explains this patient’s hypotension?
Explanation
Etomidate is a reversible inhibitor of 11β-hydroxylase, which is critical to adrenocortical steroid synthesis. Thus, etomidate suppresses corticosteroid synthesis and leads to primary adrenal suppression, which typically manifests as refractory hypotension. Increases in patient mortality can be observed after a single dose of etomidate, which may be related to adrenal suppression.
References:
Wagner RL, White PF, Kan PB, Rosenthal MH, Feldman D. Inhibition of adrenal steroidogenesis by the anesthetic etomidate. N Engl J Med. 1984;310(22):1415-1421. doi:10.1056/NEJM198405313102202 Komatsu R, You J, Mascha EJ, Sessler DI, Kasuya Y, Turan A. Anesthetic induction with etomidate, rather than propofol, is associated with increased 30-day mortality and cardiovascular morbidity after noncardiac surgery. Anesth Analg. 2013;117(6):1329-1337. doi:10.1213/ANE.0b013e318299a516 Etomidate
OA Series: May 2025
