Cortisol Levels in a Catatonic Patient Treated Daily With Electroconvulsive Therapy Using Etomidate Narcosis.

To the Editor: F or almost a decade since 1972, etomidate has been a very popular anesthetic especially in emergency medicine and in the treatment of critically ill patients. The substance owed its initial popularity to a good safety profile. Because of its rapid metabolism, it hardly affects the characteristics of the circulatory system, causing neither any respiratory depression nor increase in intracranial pressure. Its hypnotic effect results from an agonistic interaction with the γ-aminobutyric acid receptor. In 1983, etomidate was found to cause adrenal depression, especially a temporary suppression of cortisol levels. Because of an inhibition of the 11-β-hydroxylase, the conversion of 11-desoxycortisol to cortisol is reduced. After several studies, however, there is still a debate as to the clinical relevance of this interaction. Nevertheless, the use of etomidate in critically ill patients was banned. Given that the somatic condition of electroconvulsive therapy (ECT) patients is generally quite good, the concerns raised may not be pertinent here. And because of its aforementioned advantages and only moderate suppression of seizure intensity as compared with propofol or thiopental, etomidate still remains one of the most popular narcotics for ECT treatment. A recent study by Wang et al found a decrease