Cargando…

Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery—Results of a Retrospective, before–after Study

Background: Etomidate is typically used as an induction agent in cardiac surgery because it has little impact on hemodynamics. It is a known suppressor of adrenocortical function and may increase the risk for post-operative infections, sepsis, and mortality. The aim of this study was to evaluate whe...

Descripción completa

Detalles Bibliográficos
Autores principales: Weiss, Björn, Schiefenhövel, Fridtjof, Grunow, Julius J., Krüger, Michael, Spies, Claudia D., Menk, Mario, Kruppa, Jochen, Grubitzsch, Herko, Sander, Michael, Treskatsch, Sascha, Balzer, Felix
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269440/
https://www.ncbi.nlm.nih.gov/pubmed/34209919
http://dx.doi.org/10.3390/jcm10132908
_version_ 1783720580160159744
author Weiss, Björn
Schiefenhövel, Fridtjof
Grunow, Julius J.
Krüger, Michael
Spies, Claudia D.
Menk, Mario
Kruppa, Jochen
Grubitzsch, Herko
Sander, Michael
Treskatsch, Sascha
Balzer, Felix
author_facet Weiss, Björn
Schiefenhövel, Fridtjof
Grunow, Julius J.
Krüger, Michael
Spies, Claudia D.
Menk, Mario
Kruppa, Jochen
Grubitzsch, Herko
Sander, Michael
Treskatsch, Sascha
Balzer, Felix
author_sort Weiss, Björn
collection PubMed
description Background: Etomidate is typically used as an induction agent in cardiac surgery because it has little impact on hemodynamics. It is a known suppressor of adrenocortical function and may increase the risk for post-operative infections, sepsis, and mortality. The aim of this study was to evaluate whether etomidate increases the risk of postoperative sepsis (primary outcome) and infections (secondary outcome) compared to propofol. Methods: This was a retrospective before–after trial (IRB EA1/143/20) performed at a tertiary medical center in Berlin, Germany, between 10/2012 and 01/2015. Patients undergoing cardiac surgery were investigated within two observation intervals, during which etomidate and propofol were the sole induction agents. Results: One-thousand, four-hundred, and sixty-two patients, and 622 matched pairs, after caliper propensity-score matching, were included in the final analysis. Sepsis rates did not differ in the matched cohort (etomidate: 11.5% vs. propofol: 8.2%, p = 0.052). Patients in the etomidate interval were more likely to develop hospital-acquired pneumonia (etomidate: 18.6% vs. propofol: 14.0%, p = 0.031). Conclusion: Our study showed that a single-dose of etomidate is not statistically associated with higher postoperative sepsis rates after cardiac surgery, but is associated with a higher incidence of hospital-acquired pneumonia. However, there is a notable trend towards a higher sepsis rate.
format Online
Article
Text
id pubmed-8269440
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-82694402021-07-10 Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery—Results of a Retrospective, before–after Study Weiss, Björn Schiefenhövel, Fridtjof Grunow, Julius J. Krüger, Michael Spies, Claudia D. Menk, Mario Kruppa, Jochen Grubitzsch, Herko Sander, Michael Treskatsch, Sascha Balzer, Felix J Clin Med Article Background: Etomidate is typically used as an induction agent in cardiac surgery because it has little impact on hemodynamics. It is a known suppressor of adrenocortical function and may increase the risk for post-operative infections, sepsis, and mortality. The aim of this study was to evaluate whether etomidate increases the risk of postoperative sepsis (primary outcome) and infections (secondary outcome) compared to propofol. Methods: This was a retrospective before–after trial (IRB EA1/143/20) performed at a tertiary medical center in Berlin, Germany, between 10/2012 and 01/2015. Patients undergoing cardiac surgery were investigated within two observation intervals, during which etomidate and propofol were the sole induction agents. Results: One-thousand, four-hundred, and sixty-two patients, and 622 matched pairs, after caliper propensity-score matching, were included in the final analysis. Sepsis rates did not differ in the matched cohort (etomidate: 11.5% vs. propofol: 8.2%, p = 0.052). Patients in the etomidate interval were more likely to develop hospital-acquired pneumonia (etomidate: 18.6% vs. propofol: 14.0%, p = 0.031). Conclusion: Our study showed that a single-dose of etomidate is not statistically associated with higher postoperative sepsis rates after cardiac surgery, but is associated with a higher incidence of hospital-acquired pneumonia. However, there is a notable trend towards a higher sepsis rate. MDPI 2021-06-29 /pmc/articles/PMC8269440/ /pubmed/34209919 http://dx.doi.org/10.3390/jcm10132908 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Weiss, Björn
Schiefenhövel, Fridtjof
Grunow, Julius J.
Krüger, Michael
Spies, Claudia D.
Menk, Mario
Kruppa, Jochen
Grubitzsch, Herko
Sander, Michael
Treskatsch, Sascha
Balzer, Felix
Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery—Results of a Retrospective, before–after Study
title Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery—Results of a Retrospective, before–after Study
title_full Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery—Results of a Retrospective, before–after Study
title_fullStr Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery—Results of a Retrospective, before–after Study
title_full_unstemmed Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery—Results of a Retrospective, before–after Study
title_short Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery—Results of a Retrospective, before–after Study
title_sort infectious complications after etomidate vs. propofol for induction of general anesthesia in cardiac surgery—results of a retrospective, before–after study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269440/
https://www.ncbi.nlm.nih.gov/pubmed/34209919
http://dx.doi.org/10.3390/jcm10132908
work_keys_str_mv AT weissbjorn infectiouscomplicationsafteretomidatevspropofolforinductionofgeneralanesthesiaincardiacsurgeryresultsofaretrospectivebeforeafterstudy
AT schiefenhovelfridtjof infectiouscomplicationsafteretomidatevspropofolforinductionofgeneralanesthesiaincardiacsurgeryresultsofaretrospectivebeforeafterstudy
AT grunowjuliusj infectiouscomplicationsafteretomidatevspropofolforinductionofgeneralanesthesiaincardiacsurgeryresultsofaretrospectivebeforeafterstudy
AT krugermichael infectiouscomplicationsafteretomidatevspropofolforinductionofgeneralanesthesiaincardiacsurgeryresultsofaretrospectivebeforeafterstudy
AT spiesclaudiad infectiouscomplicationsafteretomidatevspropofolforinductionofgeneralanesthesiaincardiacsurgeryresultsofaretrospectivebeforeafterstudy
AT menkmario infectiouscomplicationsafteretomidatevspropofolforinductionofgeneralanesthesiaincardiacsurgeryresultsofaretrospectivebeforeafterstudy
AT kruppajochen infectiouscomplicationsafteretomidatevspropofolforinductionofgeneralanesthesiaincardiacsurgeryresultsofaretrospectivebeforeafterstudy
AT grubitzschherko infectiouscomplicationsafteretomidatevspropofolforinductionofgeneralanesthesiaincardiacsurgeryresultsofaretrospectivebeforeafterstudy
AT sandermichael infectiouscomplicationsafteretomidatevspropofolforinductionofgeneralanesthesiaincardiacsurgeryresultsofaretrospectivebeforeafterstudy
AT treskatschsascha infectiouscomplicationsafteretomidatevspropofolforinductionofgeneralanesthesiaincardiacsurgeryresultsofaretrospectivebeforeafterstudy
AT balzerfelix infectiouscomplicationsafteretomidatevspropofolforinductionofgeneralanesthesiaincardiacsurgeryresultsofaretrospectivebeforeafterstudy