Etomidate - a review of robust evidence for its use in various clinical scenarios

• Published in: Acta anaesthesiologica Scandinavica Vol. 58; no. 4; pp. 380 - 389
• Main Authors: ERDOES, G., BASCIANI, R. M., EBERLE, B.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.04.2014; Wiley Subscription Services, Inc
• Subjects: Anesthesia, General; Anesthesia, Intravenous - methods; Anesthetics, Intravenous - adverse effects; Anesthetics, Intravenous - pharmacokinetics; Anesthetics, Intravenous - pharmacology; Cardiovascular Diseases - complications; Conscious Sedation; Drug therapy; Etomidate - adverse effects; Etomidate - pharmacokinetics; Etomidate - pharmacology; Humans; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - pharmacokinetics; Hypnotics and Sedatives - pharmacology; Hypotension - complications; Hypotension - physiopathology; Risk Assessment; Sepsis - mortality
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.12289

Etomidate is an intravenous hypnotic with a favourable clinical profile in haemodynamic high‐risk scenarios. Currently, there is an active debate about the clinical significance of the drug's side effects and its overall risk–benefit ratio. Etomidate‐induced transient adrenocortical suppression is well documented and has been associated with increased mortality in sepsis. In surgical patients at risk of hypotensive complications, however, a review of current literature provides no robust evidence to contraindicate a single‐bolus etomidate induction. Large randomised controlled trials as well as additional observational data are required to compare safety of etomidate and its alternatives.