Etomidate is selected for induction in a haemodynamically unstable trauma patient. Which unique side effect of etomidate mandates particular concern in septic patients requiring prolonged ICU care?

• A Malignant hyperthermia triggering
• B Prolonged neuromuscular blockade
• C Thrombocytopaenia from direct platelet destruction
• D Adrenocortical suppression via 11-beta-hydroxylase inhibition ✓

Explanation

Etomidate inhibits 11-beta-hydroxylase (CYP11B1), the enzyme responsible for the final step in cortisol and aldosterone synthesis. Even a single induction dose causes reversible adrenocortical suppression for up to 24 hours. In critically ill or septic patients, blunted cortisol response is associated with higher mortality, making etomidate controversial in this population. This does not preclude single-dose use in haemodynamically unstable patients, but repeat dosing or continuous infusion is contraindicated. Etomidate does not trigger malignant hyperthermia.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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