Advantages and Disadvantages of Etomidate Use for Intubation of Patients with Sepsis

  title={Advantages and Disadvantages of Etomidate Use for Intubation of Patients with Sepsis},
  author={Antoine J. Cherfan and Yaseen M. Arabi and Hasan M. Al-Dorzi and Lisa P. Kenny},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
Etomidate is a potent imidazole hypnotic used widely in single doses in the rapid sequence intubation of critically ill patients with sepsis due to its presumed hemodynamic safety, fast onset, and short duration of action. However, the literature is conflicting regarding the hemodynamic advantages of etomidate over other induction agents, and its safety in this population is a matter of strong debate in the critical care community as the drug is associated with suppression of adrenal… 

Pro: etomidate is the ideal induction agent for a cardiac anesthetic.

  • A. BuddeB. Mets
  • Medicine
    Journal of cardiothoracic and vascular anesthesia
  • 2013
The use of etomidate for the induction of general anesthesia may obviate the treatment of postinduction hypotension, as it has minimal effects on cardiovascular parameters and would appear to be an ideal induction agent when compared with propofol, thiopental, ketamine, or midazolam.

Etomidate and its Analogs: A Review of Pharmacokinetics and Pharmacodynamics

Several analogs of etomidate have been developed, with the aim of retaining its stable cardiorespiratory profile, whilst eliminating its suppressive effect on the adrenocortical axis, and one of these molecules, ABP-700, was studied in extensive phase I clinical trials.

Exogenous Vasopressin-Induced Hyponatremia in Patients With Vasodilatory Shock

2 patients who developed hyponatremia within hours of initiation of vasopressin infusion are presented and the use of hypertonic saline is required for more rapid normalization of serum sodium due to concerns for potential seizure activity.

Clinical study of etomidate emulsion combined with remifentanil in general anesthesia

Continuous infusion of etomidate emulsion at 10 μg · kg−1 · minute−1 combined with remifentanil during anesthesia has the advantages of hemodynamic stability, quick wake-up, and few adverse reactions.

Continuous-Infusion Etomidate in a Patient Receiving Extracorporeal Membrane Oxygenation.

This is the first report of the use of continuous-infusion etomidate during ECMO, and could be considered in difficult-to-manage patients after other alternatives have failed, to question the role of the ECMO circuit.

Two Forgotten Induction Agents ; Etomidate versus Thiopental Sodium with Rocuronium for Rapid Sequence Induction

Etomidate-rocuronium is better than thiopental-rocursorium in terms of intubating conditions and haemodynamic stability during rapid sequence induction in non-septic surgical patients in emergency department.

Anesthetic Induction With Etomidate in Cardiac Surgical Patients: A PRISMA-Compliant Systematic Review and Meta-Analysis.

It is suggested that single-dose ETM during anesthetic induction could be associated with more stable hemodynamics, transient and reversible lower cortisol levels, and a higher adrenal insufficiency incidence, but not worse outcomes in cardiac surgical patients.

Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial

In patients with CHD undergoing noncardiac major surgery, etomidate- based anesthesia is associated with fewer cardiovascular events and smaller hemodynamic changes than propofol-based anesthesia.

Tertiary peritonitis: considerations for complex team-based care

This narrative review describes key—but not all—elements in a framework for the coordinate multiprofessional team-based management of a patient with tertiary peritonitis to mitigate this risk of death and promote recovery.

Etomidate Use Is Associated With Less Hypotension Than Ketamine for Emergency Department Sepsis Intubations: A NEAR Cohort Study

The objectives of this study were 1) to describe the current use of etomidate and other induction agents in patients with sepsis and 2) to compare adverse events between etomidate and ketamine in



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

Etomidate is cerebroprotective, with the ability to decrease intracranial pressure and maintain cerebral perfusion, making it an ideal agent for patients with head injuries and should be adopted for RSI in specific ED patient groups.

The effects of etomidate on adrenal responsiveness and mortality in patients with septic shock

The use of bolus dose etomidate in the 72 h before study inclusion is associated with an increased incidence of inadequate response to corticotropin, but is also likely to be associated with a increase in mortality.

Duration of adrenal inhibition following a single dose of etomidate in critically ill patients

A single bolus infusion of etomidate resulted in wide adrenal inhibition in critically ill patients, however, this alteration was reversible by 48 h following the drug administration, and the empirical use of steroid supplementation for 48’h following a single dose of Etomidate in ICU patients without septic shock should thus be considered.

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

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.

The effect of etomidate on adrenal function in critical illness: a systematic review

There is an increased rate of AI and mortality in critically ill patients who received etomidate and non-etomidate anesthesia, and this results in an increased risk ratio (RR) for AI.

The incidence of relative adrenal insufficiency in patients with septic shock after the administration of etomidate

The incidence of relative adrenal insufficiency in patients with septic shock is increased when the stimulation test is performed after the administration of etomidate.

Adrenal suppression following a single dose of etomidate for rapid sequence induction: a prospective randomized study.

The use of etomidate for RSI in trauma patients led to chemical evidence of adrenocortical insufficiency and may have contributed to increased hospital and ICU lengths of stay and increased ventilator days.

Effect of induction agent on vasopressor and steroid use, and outcome in patients with septic shock

Etomidate use for critically ill patients should consider all of these issues and not simply the possibility of adrenal suppression, which may not be important when steroid supplements are used.