Cortisol Level After Repeated Doses of Etomidate
Condition: Adrenocortical Abnormality
MeSH terms: Congenital Abnormalities
Study type: Interventional

Summary: 
      The aim of this study is to investigate the effect of repeated doses of etomidate on the
      adrenocortical synthesis of corticosteroids in patients aged 18 to 65, ASA status I to III
      scheduled to electroconvulsive therapy every 2 days for 3 to 4 weeks.

      Anesthesia protocol is standardized with 0.5 mg/kg propofol, 0.3 mg/kg etomidate and 0.5
      mg/kg succinylcholine.

      Blood samples for cortisol dosage are performed immediately before the first session
      (baseline cortisol), 24 hours after the first session, 24 hours after the third session and
      24 hours after the sixth session. All blood samples are performed at 9 and collected in
      normal tube.

      sample were analysed using the Electrochimiluminescence ECLIA -Cobas - Roche. The normal
      value are between 6.2-19.4 µg/dL . Sample analysis was performed by a biochemist blinded to
      clinical detail.
    

Detailed description: 
      The aim of this study is to investigate the effect of repeated doses of etomidate on the
      adrenocortical synthesis of corticosteroids in patients scheduled to electroconvulsive
      therapy under general anesthesia

      Patients aged 18 to 65, ASA status I to III and scheduled to electroconvulsive therapy under
      general anesthesia every 2 days for 3 to 4 weeks, are included in this prospective
      observational study. Patients with previously documented adrenocortical insufficiency or
      under corticosteroid medication are not included Anesthesia protocol is standardized with 0.5
      mg/kg propofol, 0.3 mg/kg etomidate and 0.5 mg/kg succinylcholine. Induction of anesthesia is
      performed after 3 minutes of preoxygenation with 6 l/min fresh gas flow with 100% inspired
      fraction of oxygen. The patients are maintained in facial mask ventilation until recovery.
      During the procedure heart rate, non-invasive blood pressure, pulsed oximetry and end tidal
      carbon dioxyde are monitored.

      Blood samples for cortisol dosage are performed immediately before the first session
      (baseline cortisol = C0), 24 hours after the first session (cortisol after a single dose of
      etomidate = C1), 24 hours after the third session (cortisol after 3 doses of etomidate = C3)
      and 24 hours after the sixth session (cortisol after six doses of etomidate = C6). All blood
      samples are performed at 9 and collected in normal tube.

      Blood samples were centrifuged (4000 tours during 10 minutes) and congealed at -20°. All
      congealed samples were analyzed at the end of the recruitment, using the
      Electrochimiluminescence ECLIA -Cobas - Roche. The normal value are between6.2-19.4 µg/dL .
      Sample analysis was performed by a biochemist blinded to clinical detail.

      For every end point time, heart rate and blood pressure are noted. Blood samples for
      glycaemia, sodium, potassium and bicarbonates are performed at the same rate.

      End point criteria and statistical analysis:

      Delta-1-cortisol is defined as the difference between C0 and C1 Delta-3-cortisol is defined
      as the difference between C0 and C3 Delta-6-cortisol is defined as the difference between C0
      and C6 We planned to enroll 30 patients during the twelve months.

      Wilcoxon test for depended data will be used to compare:
    

Intervention name(s): adrenocortical function
Intervention type(s): Diagnostic Test
Intervention description(s): Blood samples for cortisol dosage are performed and 24 hours after the sixth session. All blood samples are performed at 9 and collected in normal tube.
Blood samples for glycaemia, sodium, potassium and bicarbonates are performed at the same rate.
Intervention model: Single Group Assignment
Intervention model description: The aim of this study is to investigate the effect of repeated doses of etomidate on the adrenocortical synthesis of corticosteroids in patients scheduled to electroconvulsive therapy every 2 days for 3 to 4 weeks.
Anesthesia protocol is standardized with 0.5 mg/kg propofol, 0.3 mg/kg etomidate and 0.5 mg/kg succinylcholine.
Blood samples for cortisol dosage are performed immediately before the first session, 24 hours after the first session, 24 hours after the third session and 24 hours after the sixth session. All blood samples are performed at 9 AM.
Samples were analyzed at the end of the recruitment, using the Electrochimiluminescence ECLIA -Cobas - Roche. The normal value are between 6.2-19.4 µg/dL.
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: ethomidate adrenocortical insufficiency