Monday March 26, 2007
Etomidate for intubation - yes or no?

Dr. Annane says: ICU physicians should abandon the use of etomidate! 1 Even a single dose of Etomidate for intubation can induce longer than expected (24 -36 hours) adrenal insufficiency particularly in septic patients. But dilemma for ICU physicians never ends. Either they use other agents such as midazolam, fentanyl, propofol etc and manage post-intubation hypotension shrewdly to avoid essential organs damage or add irrespectively low dose steroid along with etomidate ?
In references below, we are putting major articles in this regard from recent literature and here is a great review on said topic,

The uncertain risk of single dose Etomidate in the critically ill (reference: Hospial Pharmacy, Volume 40, number 8, 2005, page 658-661)

References: click to get abstract/article if available

1. ICU physicians should abandon the use of etomidate! -Intensive Care Med 2005, 31:325-326
2. Adrenocortical function in critically ill patients 24 h after a single dose of etomidate. - Anaesthesia 1999, 54:861-867
3. Should We Use Etomidate as an Induction Agent for Endotracheal Intubation in Patients With Septic Shock? - A Critical Appraisal -William L. Jackson, Jr, MD, FCCP - Chest. 2005;127:1031-1038
4. Etomidate for endotracheal intubation in sepsis: acknowledging the good while accepting the bad. - Chest 2005, 127:707-709