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Weiss B, Schiefenhövel F, Grunow JJ, Krüger M, Spies CD, Menk M, Kruppa J, Grubitzsch H, Sander M, Treskatsch S, Balzer F. Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery-Results of a Retrospective, before-after Study. J Clin Med 2021; 10:jcm10132908. [PMID: 34209919 PMCID: PMC8269440 DOI: 10.3390/jcm10132908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Björn Weiss
- Department of Anesthesiology and Intensive Care Medicine (Campus Charité Mitte, Campus Virchow-Klinikum), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.W.); (F.S.); (J.J.G.); (M.K.); (C.D.S.); (M.M.)
| | - Fridtjof Schiefenhövel
- Department of Anesthesiology and Intensive Care Medicine (Campus Charité Mitte, Campus Virchow-Klinikum), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.W.); (F.S.); (J.J.G.); (M.K.); (C.D.S.); (M.M.)
- Institute of Health, Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany;
| | - Julius J. Grunow
- Department of Anesthesiology and Intensive Care Medicine (Campus Charité Mitte, Campus Virchow-Klinikum), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.W.); (F.S.); (J.J.G.); (M.K.); (C.D.S.); (M.M.)
| | - Michael Krüger
- Department of Anesthesiology and Intensive Care Medicine (Campus Charité Mitte, Campus Virchow-Klinikum), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.W.); (F.S.); (J.J.G.); (M.K.); (C.D.S.); (M.M.)
| | - Claudia D. Spies
- Department of Anesthesiology and Intensive Care Medicine (Campus Charité Mitte, Campus Virchow-Klinikum), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.W.); (F.S.); (J.J.G.); (M.K.); (C.D.S.); (M.M.)
| | - Mario Menk
- Department of Anesthesiology and Intensive Care Medicine (Campus Charité Mitte, Campus Virchow-Klinikum), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.W.); (F.S.); (J.J.G.); (M.K.); (C.D.S.); (M.M.)
| | - Jochen Kruppa
- Institute of Health, Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany;
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Michael Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Gieβen, Justus-Liebig University Gieβen, 35390 Gieβen, Germany;
| | - Sascha Treskatsch
- Department of Anesthesiology and Operative Intensive Care Medicine (Campus Benjamin Franklin), Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany;
| | - Felix Balzer
- Department of Anesthesiology and Intensive Care Medicine (Campus Charité Mitte, Campus Virchow-Klinikum), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (B.W.); (F.S.); (J.J.G.); (M.K.); (C.D.S.); (M.M.)
- Institute of Health, Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany;
- Correspondence: ; Tel.: +49-30-450-651-166
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