Etomidate for Procedural Sedation in the Emergency Department

Keim, Samuel M.; Erstad, Brian L.; Sakles, John C.; Davis, Virgil

doi:10.1592/phco.22.8.586.33204

Cited by 36 publications

(23 citation statements)

References 45 publications

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“…Although there are little data to describe the minimum dose of these agents required to induce adequate sedation, the doses used in this study are close to what has been described in previous studies of ED procedural sedation. [4][5][6][9][10][11] We observed some differences in the two agents used, including changes in blood pressure, time of the procedure, and procedural success. It appears that using either etomidate or propofol for the sedation of critically ill patients has rates of complications similar to previous reports for both agents in more stable patients.…”

Section: Discussionmentioning

confidence: 94%

Procedural Sedation of Critically Ill Patients in the Emergency Department

Miner

Martel

Meyer

et al. 2005

Academic Emergency Medicine

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Objectives: Procedural sedation is routinely performed in the emergency department (ED). However, some authors believe it is unsafe in nonintubated, critically ill patients. The objective of this study was to determine the safety of ED procedural sedation in the American Society of Anesthesiologists (ASA) physical status classification P3 and P4 patients. Methods: This was a prospective observational study of patients undergoing procedural sedation in the ED between August 2002 and December 2003 who were classified as ASA physical status score P3 or P4. Patients received either propofol or etomidate at the discretion of the treating physician before their painful procedure. Doses, vital signs, endtidal CO 2 (ETCO 2 ) by nasal cannulae, and pulse oximetry were recorded. Respiratory depression (RD) was defined as a change from baseline ETCO 2 .10 mm Hg, an oxygen saturation of ,90%, or an absent ETCO 2 waveform at any time. Results: Sixty-two critically ill, nonintubated patients were enrolled. Thirty-one patients received propofol, and 31 patients received etomidate. No cardiac rhythm abnormalities were detected. RD was seen in 37 of 62 patients (59.7%): 19 of the 31 (61.3%) who received propofol and 18 of the 31 (58.1%) who received etomidate. The mean decrease from baseline systolic blood pressure was 11.3% (95% confidence interval [CI] = 7.3% to 15.5%): 5.0% (95% CI = 3.0% to 8.1%) for those receiving etomidate and 17.1% (95% CI = 9.9% to 24.3%) for those receiving propofol. No adverse events were reported. Conclusions: The rate of subclinical RD detected by these criteria was similar to previous reports for noncritically ill patients. Procedural sedation of nonintubated ASA physical status score P3 and P4 patients in the ED with either propofol or etomidate appears to be safe.

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Section: Discussionmentioning

confidence: 94%

Procedural Sedation of Critically Ill Patients in the Emergency Department

Miner

Martel

Meyer

et al. 2005

Academic Emergency Medicine

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“…4,13,45,49 It has been clearly demonstrated that many of the drugs used in procedural sedation and analgesia predispose the patient to the development of hypoxemia, and that drug combinations, especially benzodiazepines and opioids, have a potentiating effect in suppressing respirations. 49,53 Despite the evidence that desaturation may occur during procedural sedation and analgesia, there is little information regarding the clinical significance of transient desaturation.…”

Section: Critical Questionsmentioning

confidence: 99%

“…A substantial body of evidence supports the routine safe use of procedural sedation and analgesia by emergency physicians. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] …”

mentioning

confidence: 99%

Clinical policy: Procedural sedation and analgesia in the emergency department

Godwin¹,

An²,

Wolf³

et al. 2005

Annals of Emergency Medicine

309

237

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“…The main disadvantage is gastric irritation, which can lead to vomiting. Also, it has no intrinsic analgesic effect [31]. Chloral hydrate produces effective sedation in 80-90% of patients [32].…”

Section: Hypnoticsmentioning

confidence: 99%

Sedation/anaesthesia in paediatric radiology

Arlachov¹,

Ganatra²

2012

The British Journal of Radiology

136

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Objectives In this article we will give a comprehensive literature review on sedation/general anaesthesia (S/GA) and discuss the international variations in practice and options available for S/GA for imaging children. Methods The key articles were obtained primarily from PubMed, MEDLINE, ERIC, NHS Evidence and The Cochrane Library. Results Recently, paediatric radiology has seen a surge of diagnostic and therapeutic procedures, some of which require children to be still and compliant for up to 1 h. It is difficult and sometimes even impossible to obtain quick and high-quality images without employing sedating techniques in certain children. As with any medical procedure, S/GA in radiological practice is not without risks and can have potentially disastrous consequences if mismanaged. In order to reduce any complications and practice safety in radiological units, it is imperative to carry out pre-sedation assessments of children, obtain parental/guardian consent, monitor them closely before, during and after the procedure and have adequate equipment, a safe environment and a well-trained personnel. Conclusion Although the S/GA techniques, sedative drugs and personnel involved vary from country to country, the ultimate goal of S/GA in radiology remains the same; namely, to provide safety and comfort for the patients. Advances in knowledge Imaging children under general anaesthesia is becoming routine and preferred by operators because it ensures patient conformity and provides a more controlled environment.

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Etomidate for Procedural Sedation in the Emergency Department

Abstract: Although controversial, etomidate holds promise as a potent sedative agent for patients undergoing painful procedures in the emergency department. A large prospective evaluation is needed to document the performance and complications of this agent.

Cited by 36 publications

References 45 publications

Procedural Sedation of Critically Ill Patients in the Emergency Department

Procedural Sedation of Critically Ill Patients in the Emergency Department

Clinical policy: Procedural sedation and analgesia in the emergency department

Sedation/anaesthesia in paediatric radiology

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