Expert: Dr Ian Jackson - please note UK based - 1/12/2007

Question
I am curious about the current usage for etomidate.  It was the drug of choice for RSI in emergency room, trauma unit and ambulance, mainly due to cardiovascular stability.  I have read recently that it is falling from favor due to suppression of cortisol production in critical patients.  What is your opinion on the use of this agent?

Answer
Hi Joel
Most of the original work on this stemmed from Glasgow and was based on an increased mortality rate in critically ill ITU patients being sedated longterm with etomidate. They finally worked out its effect on cortisol production. Some centres still use it and just give cortisol replacement in these patients. However how pertinent this is to a single dose for RSI is argued about.
Basically it has one of the best cardiovascular profiles for stability (also has low histamine release) and if the conditions demand its use then we use it. However in my own practice this is extremely seldom but I do use it.
Hope this helps
Dr Ian Jackson