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The role of ascorbic acid and xylitol in etomidate-induced adrenocortical suppression in humans

Published online by Cambridge University Press:  04 August 2006

S. Schraag ,
M. Pawlik ,
U. Mohl ,
B. O. Böhm  and
M. Georgieff
S. Schraag
Affiliation:
Clinic of Anaesthesiology, University of Ulm Medical School, Steinhovelstraße 9, D-89075 Ulm, Germany
M. Pawlik
Affiliation:
Clinic of Anaesthesiology, University of Ulm Medical School, Steinhovelstraße 9, D-89075 Ulm, Germany
U. Mohl
Affiliation:
Clinic of Anaesthesiology, University of Ulm Medical School, Steinhovelstraße 9, D-89075 Ulm, Germany
B. O. Böhm
Affiliation:
Medical Clinic Endocrinology Section, University of Ulm Medical School, Steinhovelstraße 9, D-89075 Ulm, Germany
M. Georgieff
Affiliation:
Clinic of Anaesthesiology, University of Ulm Medical School, Steinhovelstraße 9, D-89075 Ulm, Germany
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Abstract

Etomidate-induced suppression of cortisol biosynthesis is a result of a blockade of 11-beta-hydroxylation in the adrenal gland, mediated by the imidazol radical of etomidate. Since the generation of steroids requires reductive and energy rich equivalents, the present study examined whether supplementation with ascorbic acid or xylitol, a major source of NADPH, could attenuate adrenal suppression by etomidate in human subjects by promoting the turnover rate of 11-beta-hydroxylase. During continuous etomidate/alfentanil anaesthesia for pelviscopic surgery 30 female patients received either Ringer's lactate, xylitol (0.25 g kg−1 h−1) or ascorbic acid (0.5 g h−1) intravenously (i.v.). The plasma concentrations of cortisol, aldosterone and dehydroepiandrosterone (DHEA) were recorded for 5 h after end of surgery and a stimulation with synthetic ACTH was performed. The results showed no evidence of a clinically relevant attenuating effect of ascorbic acid or xylitol on etomidate-induced adrenocortical suppression. However, the observed suppression of cortisol levels was not enough to allow an attenuating affect to be measured.

Keywords

anaestheticsintravenousetomidateascorbic acidxylitoladrenal
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 13 , Issue 4 , April 1996 , pp. 346 - 351
Copyright
1996 European Society of Anaesthesiology

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