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A review of etomidate for rapid sequence intubation in the emergency department

Published online by Cambridge University Press:  21 May 2015

Janice K. Yeung  and
Peter J. Zed
Janice K. Yeung
Affiliation:
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
Peter J. Zed*
Affiliation:
Emergency Medicine, CSU Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Centre, and Clinical Assistant Professor, Faculty of Pharmaceutical Sciences, University of British Columbia
*
CSU Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Centre, 855 West 12th Ave. Vancouver BC V5Z 1M9; 604 875–4077, fax 604 875–5267, [email protected]

Abstract

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Etomidate is a sedative–hypnotic chemically unrelated to other induction agents. The pharmacological and safety profile of etomidate offers many advantages for induction during rapid sequence intubation (RSI) in the emergency department (ED). Its onset of action is within 5 to 15 seconds, and its duration of action is 5 to 15 minutes. Unlike thiopental, propofol, midazolam and, to a lesser extent, ketamine, etomidate has minimal respiratory or cardiovascular effects and can be safely used in patients with hemodynamic instability or cardiac ischemia. Etomidate is cerebroprotective, with the ability to decrease intracranial pressure and maintain cerebral perfusion, making it an ideal agent for patients with head injuries. Of the currently available induction agents, etomidate offers the most favourable safety profile and is the least likely to produce adverse effects in patients with unknown or untreated medical conditions. Etomidate may cause pain on injection, myoclonic movements on induction, hiccups, nausea and vomiting. Transient adrenal suppression has been reported, but not to a clinically significant degree, after single induction doses for ED RSI. Etomidate has been well studied in the ED and should be adopted for RSI in specific ED patient groups.

Keywords

etomidatesedative–hypnoticagents, inductionrapid sequence intubationinjuries, head
Type
Pharmacotherapy • Pharmacothérapie
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 3 , May 2002 , pp. 194 - 198
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Smith, CE.Rapid-sequence intubation in adults: indications and concerns. Clin Pulm Med 2001;8:147–65.CrossRefGoogle Scholar
2.Walls, RM.Rapid sequence intubation. In: Walls, RM, editor. Manual of emergency airway management. Philadelphia: Lip-pincott Williams & Wilkins; 2000. p. 8–15.Google Scholar
3.Schneider, RE.Sedatives and induction agents. In: Walls, RM, editor. Manual of emergency airway management. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 129–34.Google Scholar
4.Bergen, JM, Smith, DC.A review of etomidate for rapid sequence intubation in the emergency department. J Emerg Med 1997;15:221–30.Google Scholar
5.Sakles, JC, Laurin, EG, Rantapaa, AA, Panacek, EA.Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med 1998;31:325–32.Google Scholar
6.Goodman Gilman, A, Rall, TW, Nies, AS, Taylor, P, editors. Goodman and Gilman’s The pharmacological basis of therapeautics, 8th ed. New York: Pergamon Press; 1990. p. 305.Google Scholar
7.Shields, RE.A comprehensive review of sedative and analgesic agents. Crit Care Nurs Clin North Am 1997;9:281–8.Google Scholar
8.Giese, JL, Stanley, TH.Etomidate: a new intravenous anesthetic induction agent. Pharmacotherapy 1983;3:251–8.CrossRefGoogle ScholarPubMed
9.Wadbrook, PS.Advances in airway pharmacology — emerging trends and evolving controversy. Emerg Med Clin North Am 2000;18:767–88.Google Scholar
10.Schenarts, CL, Burton, JH, Riker, RR.Adrenocortical dysfunction following etomidate induction in emergency department patients. Acad Emerg Med 2001;8:1–7.Google Scholar
11.Doenicke, AW, Roizen, MF, Kugler, J, Kroll, H, Foss, J, Ostwald, P.Reducing myoclonus after etomidate. Anesthesiol 1999;90:113–9.Google Scholar
12.Johnson, DM, King, RW, Bohnett, M.The safety and efficacy of etomidate as an adjunct to endotracheal intubation in the emergency department [abstract]. Acad Emerg Med 1994;1:318–9.Google Scholar
13.Plewa, MC, King, R, Johnson, D, Adams, D, Engoren, M.Etomidate use during emergency intubation of trauma patients. Am J Emerg Med 1997;15:98–100.CrossRefGoogle ScholarPubMed
14.Kociszewski, C, Thomas, SH, Harrison, T, Wedel, SK.Etomidate versus succinylcholine for intubation in an air medical setting. Am J Emerg Med 2000;18:757–63.CrossRefGoogle Scholar
15.Ledowski, T, Wulf, H.The influence of fentanyl vs. s-ketamine on intubating conditions during induction of anaesthesia with etomidate and rocuronium. Eur J Anaesthesiol 2001;18:519–23.CrossRefGoogle ScholarPubMed
16.Fuchs-Buder, T, Sparr, HJ, Ziegenfuss, T.Thiopental or etomidate for rapid sequence intubation with rocuronium. Br J Anaesth 1998;80:504–6.CrossRefGoogle ScholarPubMed
17.Skinner, HJ, Biswas, A, Mahajan, RP.Evaluation of intubating conditions with rocuronium and either propofol or etomidate for rapid sequence induction. Anaesthesia 1998;53:702–10.CrossRefGoogle ScholarPubMed
18.Migden, DR, Reardon, RF.Etomidate sedation for intubation. Am J Emerg Med 1998;16:101–2.CrossRefGoogle ScholarPubMed
19.Woodard, LL, Wolfson, AB, Iorg, EC, Peitzman, AB.Hemodynamic effects of etomidate for rapid sequence intubation in emergency department trauma patients [abstract]. Acad Emerg Med 1995;2:406–7.Google Scholar
20.Smith, DC, Bergen, JM, Smithline, H, Kirschner, R.A trial of etomidate for rapid sequence intubation in the emergency department. J Emerg Med 2000;18:13–6.CrossRefGoogle ScholarPubMed
21.Swanson, ER, Fosnocht, DE, Neff, RJ.The use of etomidate for rapid sequence intubation in the air medical setting. Prehosp Emerg Care 2001;5:142–6.Google Scholar
22.Sokolove, PE, Price, DD, Okada, P.The safety of etomidate for emergency rapid sequence intubation of pediatric patients. Pediatr Emerg Care 2000;16:18–21.Google Scholar
23.Amidate® (etomidate) package insert. Chicago (IL): Abbott Laboratories; 1992.Google Scholar
24.Chirgwin, JE.Etomidate in the ED [letter]. CJEM 2000;2(2):81.Google Scholar