Effect of Vitamin C on adrenal suppression following etomidate for rapid sequence induction in trauma patients: A randomized clinical trial

Jafar Panahi; Seyed Pouya Paknezhad; Amir Vahedi; Kavous Shasavainia; Manuchehr Ruhi Laleh; Hassan Soleimanpour

doi:10.21203/rs.3.rs-2143132/v1

October 17, 2022Open Access

Effect of Vitamin C on adrenal suppression following etomidate for rapid sequence induction in trauma patients: A randomized clinical trial

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Why the study?

Etomidate is widely used for rapid sequence intubation but raises concerns about suppressant effects on the adreno-cortical axis, which vitamin C may protect against.

Does Vitamin C prevent adrenal suppression in adult trauma patients undergoing rapid sequence intubation with etomidate?

Structured PICO

Does Vitamin C prevent adrenal suppression in adult trauma patients undergoing rapid sequence intubation with etomidate?

P

Population

51 adult trauma patients requiring rapid sequence intubation (RSI) with etomidate. Excluded: under 18 years old, pregnant women, history of cardiac, renal or endocrine disorders, and history of corticosteroid medication.

I

Intervention

Vitamin C 1 gram (500mg/5cc in two boluses) intravenous administered before RSI with etomidate (0.3 mg/kg) and succinylcholine (1.5 mg/kg).

C

Comparator

10 cc normal saline (two shots of 5 cc) intravenous administered before RSI with etomidate and succinylcholine.

O

Outcome

Serum cortisol level measured three hours after induction.surrogate

Intravenous Vitamin C administered prior to etomidate for rapid sequence intubation in trauma patients significantly attenuates etomidate-induced adrenal suppression.

Limitations

Single center study with limited sample size
Did not study the effect of cortisol level on the outcome of patients
Did not follow the final outcome of patients
Could not match patients in terms of admission time, leading to baseline differences in cortisol due to circadian cycle

Implication

Vitamin C attenuates etomidate-induced cortisol suppression in trauma RSI; supports adjunctive use and larger outcome trials.

Abstract

Background: Etomidate is an imidazol derivative which widely used in emergency department for Rapid Sequence Intubation (RSI). Although it has a safe hemodynamic profile but there are some concerns about its suppressant effects on adreno-cortical axis. Vitamin C as an antioxidant can play a protective role in this issue. Method: In a controlled clinical trial, we studied adult traumatic patients who need RSI with etomidate. In one group underwent RSI with etomidate and cortisol level measured three hours later. In the other group we administrated one gram of vitamin C before etomidate administration and cortisol level measured three hours later. Results: fifty-one patients has been studied. Serum cortisol level was significantly lower after RSI with etomidate in both groups. In Vitamin C group there was a significant higher cortisol level after RSI in comparison to control group. Conclusion: Etomidate can suppress the cortisol level in traumatic patients underwent RSI. Vitamin C can reduce this suppressant effect of etomidate. IRCT registration number: IRCT20090923002496N11 URL of trial registry record: https://en.irct.ir/trial/34586 Date of trial registration: 2019-04-19

Discussion

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Cite This Study

Panahi et al. (2022) studied this question.

synapsesocial.com/papers/6a737c005946a55bc0fb6710 https://doi.org/10.21203/rs.3.rs-2143132/v1

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Effect of Vitamin C on adrenal suppression following etomidate for rapid sequence induction in trauma patients: A randomized clinical trial

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Effect of Vitamin C on adrenal suppression following etomidate for rapid sequence induction in trauma patients: A randomized clinical trial

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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