November 21, 2013Anesthesia & Analgesia
Etomidate and General Anesthesia
Key result
Etomidate for induction of anesthesia in noncardiac surgery was associated with increased 30-day mortality compared to propofol (6.5% vs 2.5%; OR 2.49, 98.3% CI 1.85-3.35).
Why the study?
Does etomidate increase 30-day mortality compared to propofol in ASA physical status III to IV patients undergoing noncardiac surgery?
Population
31,148 ASA physical status III to IV patients who had noncardiac surgery at the Cleveland Clinic
Comparison
Etomidate for induction of anesthesia vs Propofol for induction of anesthesia
Design
Editorial
Follow-up
30-day
Authors
Discussion
Loading...
Member takes
Implication
The use of etomidate for induction of anesthesia in noncardiac surgery is associated with significantly increased 30-day mortality and cardiovascular morbidity compared to propofol.
Structured PICO
Does etomidate increase 30-day mortality compared to propofol in ASA physical status III to IV patients undergoing noncardiac surgery?
P
Population
31,148 ASA physical status III to IV patients undergoing noncardiac surgery, from which 2,144 receiving etomidate were propensity-matched with 5,233 receiving propofol to assess 30-day mortality.
E
Exposure
Etomidate for induction of anesthesia
C
Comparator
Propofol for induction of anesthesia
O
Outcome
30-day postoperative mortalityhard clinical
Main Result
Odds Ratio: 2.49 (95% CI 1.85–3.35)
Absolute Event Rate: 6.5% vs 2.5%
The use of etomidate for induction of anesthesia in noncardiac surgery is associated with significantly increased 30-day mortality and cardiovascular morbidity compared to propofol.
Limitations
- Nonrandomized design
- Pitfalls associated with collection of data from electronic charts
- Potential for inadvertently excluding important causative factors in the propensity matching
- Single center data
- Could not explore potential mechanisms like adrenal insufficiency
- nonrandomized design
- pitfalls associated with collection of data from electronic charts
- potential for inadvertently excluding important causative factors in the propensity matching
- single center data
Cite This Study
Legrand et al. (2013) conducted an editorial in Noncardiac surgery in ASA physical status III to IV patients (n=31,148). Etomidate vs. Propofol was evaluated on 30-day postoperative mortality (OR 2.49, 95% CI 1.85-3.35). Etomidate for induction of anesthesia in noncardiac surgery was associated with increased 30-day mortality compared to propofol (6.5% vs 2.5%; OR 2.49, 98.3% CI 1.85-3.35).