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

Yeung, Janice; Zed, Peter J.

doi:10.1017/s1481803500006370

Cited by 43 publications

(29 citation statements)

References 19 publications

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“…10 Ketamine may be the induction drug of choice for a hemodynamically compromised patient. 16 However, adrenocortical suppression had been reported, even after a single dose of etomidate, making it an undesirable choice in septic patients. 12 White 13 compared thiopental, ketamine, midazolam, and ketamine-midazolam combination for RSII.…”

Section: Induction Drug Choicementioning

confidence: 99%

Rapid Sequence Induction and Intubation

El-Orbany

Connolly

2010

Anesthesia &Amp; Analgesia

213

152

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The changing opinion regarding some of the traditional components of rapid sequence induction and intubation (RSII) creates wide practice variations that impede attempts to establish a standard RSII protocol. There is controversy regarding the choice of induction drug, the dose, and the method of administration. Whereas some prefer the traditional rapid injection of a predetermined dose, others use the titration to loss of consciousness technique. The timing of neuromuscular blocking drug (NMBD) administration is different in both techniques. Whereas the NMBD should immediately follow the induction drug in the traditional technique, it is only given after establishing loss of consciousness in the titration technique. The optimal dose of succinylcholine is controversial with advocates and opponents for both higher and lower doses than the currently recommended 1.0 to 1.5 mg/kg dose. Defasciculation before succinylcholine was traditionally recommended in RSII but is currently controversial. Although the priming technique was advocated to accelerate onset of nondepolarizing NMBDs, its use has decreased because of potential complications and the introduction of rocuronium. Avoidance of manual ventilation before tracheal intubation was traditionally recommended to avoid gastric insufflation, but its use is currently acceptable and even recommended by some to avoid hypoxemia and to "test" the ability to mask ventilate. Cricoid pressure remains the most heated controversy; some believe in its effectiveness in preventing pulmonary aspiration, whereas others believe it should be abandoned because of the lack of scientific evidence of benefit and possible complications. There is still controversy regarding the best position and whether the head-up, head-down, or supine position is the safest during induction of anesthesia in full-stomach patients. These controversial components need to be discussed, studied, and resolved before establishing a standard RSII protocol.

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Section: Induction Drug Choicementioning

confidence: 99%

Rapid Sequence Induction and Intubation

El-Orbany

Connolly

2010

Anesthesia &Amp; Analgesia

213

152

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“…19 Etomidate is a sedative-hypnotic chemically unrelated to any other agent. 20 Due to its rapid onset (5-15 sec), rapid recovery (5-15 min), and minimal effects on cardiovascular and respiratory parameters, etomidate has been suggested as the optimal sedative-hypnotic for rapid sequence intubation in the ED. 20-23 These properties also make etomidate an attractive agent for use during procedural sedation.…”

mentioning

confidence: 99%

Etomidate for Procedural Sedation in the Emergency Department

Falk

Zed

2004

Ann Pharmacother

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“…[4142] It is quickly redistributed to the inactive tissues and is hydrolyzed by plasma esterases into inactive substrates. It has the most favorable hemodynamic profile, with minute alterations in the mean arterial pressure.…”

Section: Administration Of Anesthesiamentioning

confidence: 99%

Renal endocrine manifestations during polytrauma: A cause of concern for the anesthesiologist

Bajwa

Kulshrestha

2012

Indian J Endocr Metab

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Nowadays, an increasing number of patients get admitted with polytrauma, mainly due to road traffic accidents. These polytrauma victims may exhibit associated renal injuries, in addition to bone injuries and injuries to other visceral organs. Nevertheless, even in cases of polytrauma, renal tissue is hyperfunctional as part of the normal protective responses of the body to external insults. Both polytrauma and renal injuries exhibit widespread renal, endocrine, and metabolic responses. The situation is very challenging for the attending anesthesiologist, as he is expected to contribute immensely, not only in the resuscitation of such patients, but if required, to allow the operative procedures in case of life-threatening injuries. During administration of anesthesia, care has to be taken, not only to maintain hemodynamic stability, but equal attention has to be paid to various renal protection strategies. At the same time, various renoendocrine manifestations have to be taken into account, so that a judicious use of anesthesia drugs can be made, to minimize the renal insults.

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

Cited by 43 publications

References 19 publications

Rapid Sequence Induction and Intubation

Rapid Sequence Induction and Intubation

Etomidate for Procedural Sedation in the Emergency Department

Renal endocrine manifestations during polytrauma: A cause of concern for the anesthesiologist

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