A severely ill patient was maintained on an infusional anaesthetic agent. On the 2nd day he staed detiorating. The probable culprit may be
A i.e. Etomidate; B i.e. Propofol Increased infection and moality in a group of patients sedated with etomidate infusion in an ICU was associated with low coisol levelsQ and is attributed to etomidate induced supression of adrenal coisal synthesisQ. Etomidate is a dose dependent but reversible inhibitor of 11 - hydroxylase in the adrenal coex and is more potent than metyrapone. This enzyme is required for both mineralocoicoid and coicosteroid production. Minor adrenocoical supressive effects (i.e. impaired response to ACTH) follow induction doses or sho infusion doses. Propofol is not recommended for sedation of critically ill pediatric patients in ICU. The drug has been associated with higher moality d/t propofol infusion syndrome. Its essential features are metabolic acidosis, multiple organ failure, hemodynamic instability, hepatomegaly, and rhabdomyolysis. Very rarely, it may occur in adults, and in patients undergoing long term propofol infusion (> 48 hours) for sedation at high doses (>5 mg/ kg/ hr).
Etiomidate
Propofol
Opioid
Barbiturate