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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, zed@interchange.ubc.ca

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

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