Effect of Etomidate on Intracranial Pressure and Cerebral Perfusion Pressure

Moss, E.; Powell, D.; Gibson, Robert; Mcdowall, D.G.

doi:10.1093/bja/51.4.347

Cited by 91 publications

(39 citation statements)

References 22 publications

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“…It is considered the most hemodynamically neutral induction agent of all commonly used induction agents and a drug of choice for patients with elevated ICP [13,14].…”

Section: Etomidatementioning

confidence: 99%

Emergency Neurological Life Support: Airway, Ventilation, and Sedation

Seder

Jagoda

2015

Neurocrit Care

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Airway management and ventilation are central to the resuscitation of the neurologically ill. These patients often have evolving processes that threaten the airway and adequate ventilation. Furthermore, intubation, ventilation, and sedative choices directly affect brain perfusion. Therefore, airway, ventilation, and sedation was chosen as an emergency neurological life support protocol. Topics include airway management, when and how to intubate with special attention to hemodynamics and preservation of cerebral blood flow, mechanical ventilation settings, and the use of sedative agents based on the patient's neurological status.

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“…It is considered the most hemodynamically neutral induction agent of all commonly used induction agents and a drug of choice for patients with elevated ICP [13,14].…”

Section: Etomidatementioning

confidence: 99%

Emergency Neurological Life Support: Airway, Ventilation, and Sedation

Seder

Jagoda

2015

Neurocrit Care

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“…In 1979, Moss and colleagues demonstrated the efficacy of etomidate in causing a significant ICP reduction with a minimal reduction in MAP and CPP [39]. Similarly, in pediatrics, Bramwell and colleagues demonstrated that a single dose of etomidate is effective at reducing ICP while maintaining MAP and CPP [40].…”

Section: Contraindications Hypersensitivitymentioning

confidence: 99%

Management of Pediatric Traumatic Brain Injury

Mtaweh

Bell

2015

Curr Treat Options Neurol

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Pediatric severe traumatic brain injury continues to be a major cause of disability and death. Rapid initial airway and hemodynamic stabilization is critical, followed by the need for immediate recognition of intracranial pathology that requires neurosurgical intervention. Intracranial hypertension and cerebral hypoperfusion have been recognized as major insults after trauma and management should be directed at preventing both. Sedation with opioids, moderate hyperventilation to arterial carbon dioxide level of 35-40 mmHg, hyperosmolar therapy with 3 % saline or mannitol, normothermia, and cerebrospinal fluid drainage continue to be the cornerstones of initial management of intracranial hypertension (intracranial pressure >20 mmHg). Refractory intracranial hypertension is treated with high-dose barbiturate therapy to achieve medical burst suppression on electroencephalography and decompressive craniectomy. In addition, those children require antiepileptic medications for seizure prophylaxis, adequate nutritional management, and early physical therapy and rehabilitation referrals. Most of the evidence for care of children with brain injury comes from center-specific practice and experience rather than objective data. This lack of evidence provides the ground for ongoing research; nevertheless, outcomes after traumatic brain injury continue to show improvement.

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“…Etomidate also exhibits neuroprotective effects by reducing intracranial pressure (ICP). [15] However, etomidate can cause hypotension, especially in the critically-ill and under-resuscitated patient such as most emergent trauma patients. We recommend having vasopressor agents ready if needed to treat peri-intubation hypotension.…”

Section: Airway Managementmentioning

confidence: 99%

Traumatic brain injury: A case-based review

Escobedo¹,

Habboushe²,

Kaafarani³

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND: Traumatic brain injuries are common and costly to hospital systems. Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines. This is a review of the current literature discussing the evolving practice of traumatic brain injury.DATA SOURCES: A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses, systematic reviews, and randomized controlled trials. RESULTS:The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas, maintain systolic blood pressure above 90 mmHg, oxygen saturations above 93%, euthermia, intracranial pressures below 20 mmHg, and cerebral perfusion pressure between 60-80 mmHg. CONCLUSION:Much is still unknown about the management of traumatic brain injury. The current practice guidelines have not yet been sufficiently validated, however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.

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Effect of Etomidate on Intracranial Pressure and Cerebral Perfusion Pressure

Cited by 91 publications

References 22 publications

Emergency Neurological Life Support: Airway, Ventilation, and Sedation

Emergency Neurological Life Support: Airway, Ventilation, and Sedation

Management of Pediatric Traumatic Brain Injury

Traumatic brain injury: A case-based review

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