Etomidate for emergency anaesthesia; mad, bad and dangerous to know?

Morris, C.; McAllister, C.

doi:10.1111/j.1365-2044.2005.04325.x

Cited by 69 publications

(38 citation statements)

References 38 publications

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“…Etomidate has fizzled as an intubation drug for patients with septic shock. Even one dose has been associated with increased mortality in children and adults, leading two respected adult journals to recommend against its use for emergency intubations (22,23). The recommended choices of these journals are thiopental for head trauma and ketamine for septic shock.…”

Section: Drugs That Have Recently Fizzledmentioning

confidence: 99%

What’s new in pediatric intensive care

Carcillo

2006

Critical Care Medicine

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Section: Drugs That Have Recently Fizzledmentioning

confidence: 99%

What’s new in pediatric intensive care

Carcillo

2006

Critical Care Medicine

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“…[11][12][13] Authors have therefore suggested that etomidate be avoided for critically ill patients, especially those in septic shock. [14][15][16][17] In trauma patients, a randomized, controlled trial (RCT) comparing etomidate to fentanyl showed that etomidate increased the risk of AI measured 6 hours after administration. Etomidate was also related to more ventilator days and longer intensive care unit (ICU) lengths of stay.…”

Section: Abstract: Adrenal Insufficiency Etomidate Traumatic Brain mentioning

confidence: 99%

Adrenal inhibition following a single dose of etomidate in intubated traumatic brain injury victims

Archambault

Dionne

Lortie

et al. 2012

CJEM

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Background: Etomidate is frequently used to intubate traumatic brain injury (TBI) victims, even though it has been linked to adrenal insufficiency (AI) in some populations. Few studies have explored the risk of prolonged etomidateinduced AI among TBI victims. Objective: To determine the risk and the length of AI induced by etomidate in patients intubated for moderate and severe TBI. Methods: Participants in this observational study were moderate to severe intubated TBI victims aged $ 16 years. The anesthetic used (etomidate versus others) was determined solely by the treating emergency physician. Adrenocorticotropic hormone (ACTH) stimulation tests (250 mg) were performed 24, 48, and 168 hours after intubation. AI was defined as an increase in serum cortisol 1 hour post-ACTH test (delta cortisol) of less than 248.4 nmol/L. Results: Forty subjects (participation 42.6%) underwent ACTH testing. Fifteen received etomidate, and 25 received another anesthetic. There were no statistically significant differences between groups as to the cumulative incidence of AI at any measurement time. However, at 24 hours, exploratory post hoc analyses showed a significant decrease in delta cortisol (adjusted means: etomidate group: 305.1 nmol/L, 95% CI 214.7-384.8 versus other anesthetics: 500.5 nmol/L, 95% CI 441.8-565.7). This decrease was not present at 48 and 168 hours. Conclusion: In TBI victims, although a single dose of etomidate does not increase the cumulative incidence of AI as defined, it seems to decrease the adrenal response to an

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“…in the patients for whom etomidate would normally be used. 7,8 Etomidate has been withdrawn from the market in the USA, Australia, Canada and the Republic of Ireland. Also involuntary movements are common, as is pain on injection and increased nausea and vomiting post-operatively.…”

Section: Induction Agentsmentioning

confidence: 99%