Etomidate Adrenal Suppression — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGeneral AnaesthesiaEtomidate Adrenal SuppressionFRCA Final

A 65-year-old man (ASA III) with ischaemic heart disease is on the operating table for emergency laparotomy. His most recent echocardiogram shows an ejection fraction of 30%. During induction with etomidate 0.3 mg/kg, what is the most important side effect of this agent to be aware of?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Adrenal suppression

Etomidate causes transient adrenal suppression by inhibiting 11-beta-hydroxylase, the enzyme required for cortisol synthesis. A single induction dose suppresses cortisol production for approximately 24-48 hours. While this was not shown to worsen outcomes after a single dose in the CORTICUS study sub-analysis, it remains a concern in septic patients where endogenous cortisol response is critical. Despite this, etomidate remains valued for its haemodynamic stability in patients with cardiac dysfunction.

Reference: RCOA – 2023 – Final FRCA curriculum: IV induction agent pharmacology; Sprung CL – 2008 – CORTICUS trial