Effect of Vitamin C on Serum Cortisol after Etomidate Induction of Anesthesia

سال انتشار: 1395
نوع سند: مقاله ژورنالی
زبان: انگلیسی
مشاهده: 431

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شناسه ملی سند علمی:

JR_SBMU-1-1_001

تاریخ نمایه سازی: 6 اسفند 1398

چکیده مقاله:

Background: Etomidate is suitable for induction of anesthesia, especially in elderly patients and patients who have cardiovascular compromise. Vitamin C has been introduced as a treatment option to decrease Etomidate induced adrenal insufficiency but its actual effect is still controversial. Objective is to determine the effect of vitamin C on reduction of serum cortisol after Etomidate induction of anesthesia.Materials and Methods: In a randomized clinical trial, 40 patients of the American Society of Anesthesiologists (ASA) class I and II, aged between 25 to 70 years old, candidate for elective laparotomy were selected. One hour before induction of surgery, 1 gram of intravenous vitamin C were administered to the patients in vitamin C group. Two blood samples were obtained 5 minutes before induction and then another sample 4 hours after induction with Etomidate after surgery. All samples were measured for serum free cortisol, ACTH, and C-reactive protein (CRP).Results: There were no significant differences between duration of surgery, pre-operative and post-operative blood pressure and heart rate in two groups (p> 0.05). Serum cortisol was significantly declined in control group from 16.2±6.3 μg/dl in pre-operative to 8.5±4.2 in post-operative (p=0.0005), but not in vitamin C group from 17.5±5.6 in pre-operative to 16.8±6.4 in post-operative (p=0.75). ACTH levels increased non-significantly from pre-operative to post-operative period in both vitamin C (pre-operative: 52.1±15 vs. post-operative: 56.4±18 pg/ml) (p=0.48) and in control group (pre-operative: 50.5±16 vs. post-operative: 56.2±20).Conclusion: Etomidate could significantly decrease post-operative serum free cortisol and induce adrenocortical suppression and CRP increase. This effect could be reversed by using vitamin C premedication to maintain serum cortisol at pre-operative level.

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نویسندگان

Navid Nooraei

Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Mohammad Fathi

Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Leila Edalat

Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Faranak Behnaz

Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Seyed Amir Mohajerani

Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Ali Dabbagh

Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran