Effect of Vitamin C on adrenal suppression following etomidate for rapid sequence induction in trauma patients

Abstract

Rapid Sequence Intubation (RSI) is a standard technique and as a choice method for airway management in the emergency department. Etomidate is a short-acting hypnotic drug that is widely used in the emergency room and is the first choice in RSI in patients with heart disease and hypovolemic shock (due to have stable hemodynamics), although it can cause adrenal insufficiency. Methods: In this study, 51 patients referred to the emergency department of Imam Reza Hospital who had the inclusion criteria were included in the study.Inclusion criteria were trauma patients referred to the emergency department who did not have the exclusion criteria. In both groups, serum cortisol levels were measured before injection.Then, in the first group, serum cortisol levels were checked again 6 hours after etomidate injection, but in the second group, one gram of vitamin C injected before the etomidate injection, then etomidate injected and then 6 hours after etomidate injection the serum level of cortisol remeasured and then compared between the two groups. Results: There were 24 patients (47.1%) in the group without vitamin C injection and 27 patients (52.9%) in the group with vitamin C injection. 17 patients in the etomidate group receiving vitamin C injections were male and 10 were female. There was no significant difference in terms of sex distribution between the two groups of patients. The median age of patients receiving etomidate without vitamin C injection was 64.5 years with a minimum age of 14 years and a maximum age of 89 years. The median age of patients receiving the etomidate group with vitamin C injection was 65 years with a minimum age of 16 years and a maximum age of 86 years. There was no statistically significant difference in age between the two groups (P = 0.770).