Controversies Surrounding the Use of Etomidate for Rapid Sequence Intubation in Patients with Suspected Sepsis

Edwin, Stephanie B.; Walker, Peter

doi:10.1345/aph.1m664

Cited by 28 publications

(14 citation statements)

References 22 publications

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“…42 It remains difficult to form firm conclusions on the use of etomidate. In this setting of controversy, a logical and reasonable conclusion was reached by Edwin and Walker, 46 who suggested using etomidate only in "hemodynamically unstable patients who cannot tolerate an alternative induction agent despite the administration of fluids or vasoactive agents. "…”

Section: Sedatives and Anestheticsmentioning

confidence: 99%

Emergency Tracheal Intubation: Techniques and OutcomesDiscussion

Mechlin

Hurford

2014

Respir Care

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Performing emergency endotracheal intubation necessarily means doing so under less than ideal conditions. Rates of first-time success will be lower than endotracheal intubation performed under controlled conditions in the operating room. Some factors associated with improved success are predictable and can be modified to improve outcome. Factors to be discussed include the initial decision to perform endotracheal intubation in out-of-hospital settings, qualifications and training of providers performing intubation, the technique selected for advanced airway management, and the use of sedatives and neuromuscular blocking agents.

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Section: Sedatives and Anestheticsmentioning

confidence: 99%

Emergency Tracheal Intubation: Techniques and OutcomesDiscussion

Mechlin

Hurford

2014

Respir Care

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“…While etomidate has limited hemodynamic effects making it a desirable choice for quick sedative effects, it does possess unwanted side effects that can be dangerous for certain patient populations [6]. Its inhibition of 11-β-hydroxylase to convert cholesterol to cortisol can lead to adrenal insufficiency and caution should be taken in cases of septic shock with adrenal insufficiency due to controversial data regarding higher mortality rates associated with etomidate administration [7]- [14].…”

Section: Introductionmentioning

confidence: 99%

Retrospective Review of Propofol versus Etomidate during Rapid Sequence Intubation in the Emergency Department at a Tertiary Academic Center

Rocchio¹,

Sylvester²,

Beik³

et al. 2017

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Background: Etomidate is the standard induction agent used during rapid sequence intubation (RSI) in the emergency department (ED). Etomidate shortages require providers to utilize alternative agents. The purpose of this study is to compare the safety and procedural outcomes of propofol and etomidate for RSI in the ED. Methods: This was a retrospective chart review of adult patients in the ED who received propofol or etomidate for induction during RSI. The main endpoint was hypotension, defined as a systolic blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg, within the first hour of intubation. Time to intubation, intensive care unit length of stay, hospital length of stay, and in-hospital mortality were also evaluated. Results: Two hundred and seventy five patient charts were reviewed. Of the 98 patients included, 43 patients received propofol and 55 patients received etomidate. Propofol was associated with an increased incidence of hypotension within the first hour of intubation (65.1% vs. 25.5%, p < 0.001). No difference was found in the time to intubation: ≤5 minutes (51.2% vs. 34.6%, p = 0.83). The mortality rate was 11.6% in the propofol group and 27.3% in the etomidate group (p = 0.004). There was no difference in hospital or intensive care unit length of stay between the propofol and etomidate groups (7.7 vs. 9.2 days, p = 0.23; 4.2 vs. 6.3 days, p = 0.31). Conclusion: Propofol was a safe and procedurally effective induction agent for RSI. Compared to etomidate, it was associated with an increased rate of hypotension within the first hour of intubation, with no difference in the percent of patients that required an intervention.

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“…If etomidate does have deleterious physiologic consequences, it also remains to be determined it these can be reversed by the administration of exogenous corticosteroids. [ 61 62 ] Carbo-etomidate, an analog of etomidate with similar hypnotic properties and cardiovascular stability, does not seem to suppress steroid synthesis in animal studies and thus may be a promising alternative. [ 63 ]…”

Section: Future Perspectivesmentioning

confidence: 99%

Etomidate in pediatric anesthesiology: Where are we now?

Tobias

2015

Saudi J Anaesth

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Etomidate is an intravenous anesthetic agent released for clinical use in the United States in 1972. Its popularity in clinical practice is the result of its beneficial effects on intracerebral dynamics with limited effects on hemodynamic function. These properties have made it a safe and effective anesthetic induction agent in both adult and pediatric patients with altered myocardial performance, congenial heart disease, or hypovolemia. However, recent concern has been expressed regarding its effects on the endogenous production of corticosteroids and the impact of that effect on patient outcomes. The following manuscript reviews clinical reports regarding etomidate use in the pediatric population and discusses recent concerns regarding its effects on corticosteroid metabolism and the implications of such effects for clinical use.

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Controversies Surrounding the Use of Etomidate for Rapid Sequence Intubation in Patients with Suspected Sepsis

Abstract: Until further studies are available, etomidate should be reserved for hemodynamically unstable patients who cannot tolerate an alternative induction agent despite the administration of fluids or vasoactive agents.

Cited by 28 publications

References 22 publications

Emergency Tracheal Intubation: Techniques and OutcomesDiscussion

Emergency Tracheal Intubation: Techniques and OutcomesDiscussion

Retrospective Review of Propofol versus Etomidate during Rapid Sequence Intubation in the Emergency Department at a Tertiary Academic Center

Etomidate in pediatric anesthesiology: Where are we now?

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