Saturday, March 22, 2014

I Heart Etomidate. And That's Alright.

I love etomidate. As our patient population gets older and sicker, I find myself using that drug more and more frequently. Unlike propofol, etomidate helps to maintain cardiac output and normal blood pressure upon induction. But we've been warned since residency that etomidate causes adrenal insufficiency and could potentially lead to an Addisonian crisis. Because of that, I've always been leery of administering the drug, with that caveat constantly in the back of my mind.

Now there is a new study that says it's okay to give etomidate for induction. In this month's issue of Anesthesiology, researchers from Vanderbilt University retrospectively examined over 3,000 patients undergoing cardiac surgery from 2007 to 2009. During that period, 62% were given etomidate as the induction drug. The study showed that etomidate was not associated with more hypotension, longer mechanical ventilation, longer hospital stay, or increased mortality.

Even though this study was based only on cardiac surgery patients, I find that the information will be useful for my every day practice. Many cardiac patients, with ejection fractions of 30% or lower, sometimes much lower, now undergo noncardiac procedures, like GI endoscopy, angiograms, pacemaker and defibrillator implants, and just plain old general surgery. As the life expectancy of heart patients increases with the use of devices like ICD's, ventricular assist devices, and even artificial heart implants, expect to see more of these tricky cases on the OR schedule for routine procedures like hernia repairs or lap chole's. Etomidate could become your new best pharmaceutical friend.

1 comment:

  1. Etomidate is controversial and the evidence for its safety is debatable. Another recent study showed it increases mortality in non cardiac surgery patients. Caution is advised in the use of Etomidate as a routine induction agent.

    http://www.ncbi.nlm.nih.gov/pubmed/24257383

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