Which patient population should exercise caution when administering etomidate?

Etomidate is a medication commonly used for induction in anesthesia due to its rapid onset and minimal cardiovascular effects. However, it is known to inhibit the enzyme involved in steroidogenesis, which can lead to adrenal suppression. This is particularly critical in specific patient populations, such as those who may have pre-existing adrenal insufficiency or conditions that already compromise their adrenal function.

In patients with adrenal suppression, the administration of etomidate can exacerbate their condition, as it further decreases the production of adrenal hormones crucial for stress response and homeostasis. This can lead to potentially life-threatening adrenal crises, especially in individuals who may require increased cortisol levels during times of physiological stress, such as surgery or critical illness.

Given these factors, caution is especially warranted when etomidate is being considered for patients with known adrenal suppression issues, making this patient population the one that necessitates the most careful consideration when using this anesthetic agent.