{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:08:06Z","timestamp":1769728086422,"version":"3.49.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:00:00Z","timestamp":1680307200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:00:00Z","timestamp":1680307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Etomidate is an imidazole derivative that is widely used in the emergency department for Rapid Sequence Intubation (RSI). Although it has a safe hemodynamic profile, there are some concerns about its suppressant effects on the adreno-cortical axis. Vitamin C, as an antioxidant, can play a protective role in this issue.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Method<\/jats:title>\n                <jats:p>In a controlled clinical trial, we studied adult traumatic patients who needed RSI with etomidate. In one group underwent RSI with etomidate and cortisol levels were measured three hours later. In the other group, we administered one gram of vitamin C before etomidate administration, and the cortisol level was measured three hours later.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Fifty-one patients have been studied. The serum cortisol level was significantly lower after RSI with etomidate in both groups. In the Vitamin C group, there was a significantly higher cortisol level after RSI in comparison to the control group.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Etomidate can suppress the cortisol level in trauma patients who undergo RSI. Vitamin C can reduce this suppressant effect of etomidate.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>IRCT registration number: IRCT20090923002496N11, URL of trial registry record: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/en.irct.ir\/trial\/34586\">https:\/\/en.irct.ir\/trial\/34586<\/jats:ext-link>, Date of trial registration: 19\/04\/2019. Full date of the first registration: 30\/05\/2019.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12871-023-02065-5","type":"journal-article","created":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T05:56:13Z","timestamp":1680501373000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Effect of vitamin C on adrenal suppression following etomidate for rapid sequence induction in trauma patients: a randomized clinical trial"],"prefix":"10.1186","volume":"23","author":[{"given":"Jafar Rahimi","family":"Panahi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seyed Pouya","family":"Paknezhad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir","family":"vahedi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavous","family":"Shahsavarinia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuchehr Ruhi","family":"Laleh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hassan","family":"Soleimanpour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,4,1]]},"reference":[{"key":"2065_CR1","doi-asserted-by":"publisher","unstructured":"Dettmer MR, Phillip R, Dellinger. The use of etomidate for rapid sequence induction in septic patients. J Thorac Dis. 2015;7(10):1684\u20136. https:\/\/doi.org\/10.3978\/j.issn.2072-1439.2015.10.22.","DOI":"10.3978\/j.issn.2072-1439.2015.10.22"},{"key":"2065_CR2","doi-asserted-by":"crossref","unstructured":"IMca, Ledingham, Ian Watt.INFLUENCE OF SEDATION ON MORTALITY IN CRITICALLY ILL MULTIPLE TRAUMA PATIENTS.The Lancet., Volume 321, No. 8336, p1270, 4 June 1983.","DOI":"10.1016\/S0140-6736(83)92712-5"},{"key":"2065_CR3","doi-asserted-by":"publisher","unstructured":"JJ, Cies. and Use of Etomidate for Rapid Sequence Intubation (RSI) in Pediatric Trauma Patients: An Exploratory National Survey. Pharmacy 2015, 3,197\u2013209; https:\/\/doi.org\/10.3390\/pharmacy3040197.","DOI":"10.3390\/pharmacy3040197"},{"key":"2065_CR4","doi-asserted-by":"publisher","unstructured":"AJ, Oglesby. Should etomidate be the induction agent of choice for rapid sequence intubation in the emergency department? Emerg Med J. 2004;21:655\u20139. https:\/\/doi.org\/10.1136\/emj.2003.009043.","DOI":"10.1136\/emj.2003.009043"},{"key":"2065_CR5","doi-asserted-by":"crossref","unstructured":"Meyanc\u0131 K\u00f6ksal G, Erbabacan E, Tunal\u0131 Y, Kara\u00f6ren G, Vehid S, \u00d6z H. The effect of single dose etomidate during emergency intubation on hemodynamics and adrenal cortex. Ulus Travma Acil Cerrahi Derg. 2015;21(5):358\u2013365.","DOI":"10.5505\/tjtes.2015.06325"},{"issue":"3","key":"2065_CR6","first-page":"41","volume":"6","author":"S - Charuvi","year":"2020","unstructured":"Charuvi S, Sahajananda H, Dwajani S. Suppression of cortisol levels by a Bolus dose of etomidate in patients undergoing laparoscopic cholecystectomy. J Med Sci. 2020;6(3):41\u20136.","journal-title":"J Med Sci"},{"key":"2065_CR7","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.34172\/ijdrc.2023.e1","volume":"1","author":"H - Soleimanpour","year":"2023","unstructured":"Soleimanpour H. The magical role of vitamin C on adrenal insufficiency subsequent to etomidate administration: ongoing challenges in the management of trauma patients. Int J Drug Res Clin. 2023;1:e1. https:\/\/doi.org\/10.34172\/ijdrc.2023.e1.","journal-title":"Int J Drug Res Clin"},{"key":"2065_CR8","unstructured":"AN, Hildreth MD, Vicente A, Mejia MD, Robert A, Maxwell MD, Smith PW, Benjamin MD, Dart W, MD, and, Barker DE. MD. Adrenal Suppression Following a Single Dose of Etomidate for Rapid Sequence Induction: A Prospective Randomized Study. TheJournalofTRAUMA Injury,Infection,andCriticalCare."},{"key":"2065_CR9","doi-asserted-by":"publisher","unstructured":"Warner KJ1, Cuschieri J, Jurkovich GJ, Bulger EM. Single-dose etomidate for rapid sequence intubation may impact outcome after severe injury. J Trauma. 2009;67(1):45\u201350. https:\/\/doi.org\/10.1097\/TA.0b013e3181a92a70.","DOI":"10.1097\/TA.0b013e3181a92a70"},{"key":"2065_CR10","unstructured":"Fact Sheet for Health Professionals - Vitamin C. Office of Dietary Supplements, US National Institutes of Health. February 11., 2016. Archived from the original on July 30, 2017."},{"key":"2065_CR11","doi-asserted-by":"crossref","unstructured":"Zhao -B, Fei J2, Chen Y, Song Yi-LinYLMaXiao-Qin, Huang J. Er-Zhen Chen and En-Qiang Mao. Vitamin C treatment attenuates hemorrhagic shock related multi-organ injuries through the induction of heme oxygenase-1. BMC Complementary and Alternative Medicine 2014, 14:442","DOI":"10.1186\/1472-6882-14-442"},{"key":"2065_CR12","unstructured":"Boidin MP, Erdmann WE, Faithfull NS. The role of ascorbic acid in etomidate toxicity. Eur J Anaesthesiol. 1986;3(5):417\u201322. PMID: 3023074."},{"key":"2065_CR13","unstructured":"Sun Y, Feng S, Li L, Huang K. Effects of ascorbic acid on etomidate-induced inhibition of adrenocortical function in rabbits. Int J Clin Exp Med. 2017;10(8):12553\u20138."},{"key":"2065_CR14","doi-asserted-by":"publisher","unstructured":"Das D, Sen C. Anupam Goswami. Effect of Vitamin C on adrenal suppression by etomidate induction in patients undergoing cardiac surgery: A randomized controlled trial. Ann Card Anaesth. 2016;19(3):410\u2013417. https:\/\/doi.org\/10.4103\/0971-9784.185522","DOI":"10.4103\/0971-9784.185522"},{"key":"2065_CR15","unstructured":"Nooraee N, Fathi M, Edalat L, Behnaz F, Mohajerani SA, Dabbagh A. Effect of Vitamin C on Serum Cortisol after Etomidate Induction of Anesthesia. J Cell Mol Anesth. 2015;1(1):28\u20133."},{"key":"2065_CR16","unstructured":"N, Nathan JC, Vandroux. Role of vitamin C on adrenocortical effects of etomidate. Ann Fr Anesth Reanim. 1991;10(4):329\u201332"}],"updated-by":[{"DOI":"10.1186\/s12871-023-02090-4","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T00:00:00Z","timestamp":1683763200000}}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-023-02065-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12871-023-02065-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-023-02065-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T08:07:29Z","timestamp":1683792449000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcanesthesiol.biomedcentral.com\/articles\/10.1186\/s12871-023-02065-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,1]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["2065"],"URL":"https:\/\/doi.org\/10.1186\/s12871-023-02065-5","relation":{"correction":[{"id-type":"doi","id":"10.1186\/s12871-023-02090-4","asserted-by":"object"}]},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,1]]},"assertion":[{"value":"30 November 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 March 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2023","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1186\/s12871-023-02090-4","URL":"https:\/\/doi.org\/10.1186\/s12871-023-02090-4","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The data presented in the manuscript and its supplemental files do not contain any details relevant to any individual patient and thus, no consent for publication was required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"This study was approved by the regional ethics committee with No. IR.TBZMED.REC.1397.925 ((2019-02-04) and registered in IRCT with IRCT registration number: IRCT20090923002496N11. Written informed consent was obtained from each patient\u2019 relatives. I confirm that all methods were carried out in accordance with relevant guidelines and regulations. All procedures in the study involving human participants were performed in accordance with the ethics standards of the institutional and national research committee and with the Helsinki Declaration and its later amendments or comparable ethics standards.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"104"}}