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Which is functionally impaired, etomidate has been studied only in the cardiomyopathic hamster, where there was a slight negative inotropic effect at supratherapeutic concentrations 25 ; , similar to what we have shown for failing human ventricular muscles. Despite the fact that our results in failing and nonfailing human heart muscles agree with findings in animal models, it is important to note that many of our patients had been receiving long-term pharmacologic therapy, which may have influenced their response to etomidate. Patients undergoing heart transplantation had been treated preoperatively with inotropes, including -adrenergic agonists Table 1 ; . The majority of patients undergoing myocardial revascularization had been receiving -blockers, and some had taken calcium channel blockers prior to surgery Table 1 ; . Although the muscle washout period in our experiments was lengthy, the possibility exists that longterm use of these cardiac medications caused myocardial adaptation and altered inotropic responsiveness of our tissues. Despite this possibility, these patients are representative of patients who receive etomidate during cardiac surgery, i.e., all of the interactions between the disease process; the preoperative medications and etomidate would normally be present in the actual clinical situation, and thus the response is important to examine. We conclude that etomidate produces a dosedependent decrease in myocardial contractility in human heart muscle in vitro, but this effect is not likely to be clinically important, even in patients with heart failure. Our data further suggest that any effects of etomidate on myocardial contractility, even at supratherapeutic concentrations, can be overcome by sympathetic nervous system activation. 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