Etomidate is the induction agent of choice in haemodynamically unstable patients. However, a single induction dose causes adrenocortical suppression lasting approximately how long?

• A 2–4 hours
• B 6–12 hours
• C 24–72 hours ✓
• D 7–10 days

Explanation

Etomidate inhibits 11-beta-hydroxylase (and to a lesser extent 17-alpha-hydroxylase), blocking cortisol and aldosterone synthesis. A single induction dose (0.3 mg/kg) suppresses the HPA axis for 24–72 hours. This is clinically significant in septic shock patients, where relative adrenal insufficiency may worsen vasopressor requirements. The CORTICUS and other trials found that septic patients given etomidate for intubation had higher rates of adrenal insufficiency but controversial impact on mortality. Many intensivists limit etomidate to haemodynamically unstable non-septic patients or provide stress-dose hydrocortisone supplementation.

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

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