Etomidate is associated with mortality and adrenal insufficiency in sepsis

Abstract

Administration of etomidate for rapid sequence intubation is associated with higher rates of adrenal insufficiency and mortality in patients with sepsis.

Propofol Compared to Etomidate Inductions and Attenuating Propofol Induced Hypotension

“…Two systematic reviews of etomidate's mortality influence (Level I evidence) were found [2,3]. Mortality served as one primary end point with the presence of adrenal insufficiency as a secondary end point in both reviews.…”

“…With a total of 865 patients, five studies were used that assessed mortality of patients receiving etomidate in the meta-analysis by Chan et al [2]. Chan et al [2] saw an increased 28-day mortality rate, with 43% compared to 31%, was found in patients who received etomidate compared with patients who received propofol. Etomidate induced adrenal insufficiency has long been the suspected culprit for the negative impact on survival.…”

“…Both systematic reviews concluded that a single dose of etomidate for induction of anesthesia was associated with increased 28-day mortality [2,3]. With a total of 865 patients, five studies were used that assessed mortality of patients receiving etomidate in the meta-analysis by Chan et al [2].…”

“…Etomidate has long been the drug of choice for intubating the hemodynamically unstable patient due to rapid onset, cardioprotective nature, and hemodynamic 12 randomized clinical trials with various levels of blinding and controls. Two systematic reviews of etomidate's mortality influence (Level I evidence) were also found [2,3]. Articles were included in this review if they were a systematic review or met the following inclusion criteria: induction of anesthesia studied, being performed in a hospital setting, a control group was clearly identifiable, statistical analysis was sufficiently performed including p values, and all results were clearly stated and discussed.…”

“…Recently, literature has been written highlighting the increased mortality rates associated with the use of etomidate in many types of patient populations [2,3]. Chan et al [2] found that a single dose of etomidate for induction of anesthesia was associated with increased 28-day mortality. With these findings in mind, possible alternatives to etomidate should be explored to induce anesthesia in hemodynamically compromised patients.…”