Etomidate

[Markus Weis]

An editorial in Anaesthesia in 2005 (1) stated that etomidate had been
withdrawn in the United States, Australia, Canada and the Republic of
Ireland. Apparently this was based on information from a pharmaceutical
company and in correspondence (2) to the article it showed to be incorrect,
at least regarding it being withdrawn in the United States.

The editorial was published two years ago, but sometimes rumours don't stop
circulating...

BFM: What do you use instead of etomidate?

Markus


(1) Morris C, McAllister C. Etomidate for emergency anaesthesia: mad, bad
and dangerous to know? Anaesthesia 2005; 60: 737–40.
(2) Jackson MT, Ramos AS. Etomidate - misused or misunderstood? Anaesthesia
2006; 61: 191.

On Thu, 02 Aug 2007 09:15 +0100 (BST), Blueflightmedic <
trauma at emergencyunit.com> wrote:
>
> Firstly congratulations to all those who responded so magnificently in
> Minneapolis. Condolences to the bereaved. The news broke here in the UK
> at 1 AM just as I was returning home from dealing with a very nasty
> head-on RTC; three serious, 1 died in my hands on scene from massive
> haemorrhage - probably ruptured liver.
>
> Etomidate is rapidly becoming a drug to avoid because of its prolonged
> suppressant effect on the adrenal response. We though initially that it
> was only infusions that caused the problem but there is now good evidence
> that a single induction dose of etomidate causes problems for some days,
> and patients with multiple trauma or severe sepsis do not need adrenal
> suppression. We scarcely ever use it now.
>
>
> > *From:* "Hardcastle, Tim, Dr < tch at sun.ac.za>" <tch at sun.ac.za>
> > *To:* "Trauma-List (E-mail)" <trauma-list at trauma.org >
> > *Date:* Thu, 2 Aug 2007 07:11:01 +0200
> >
> > Hi all
> >
> > A query regarding Etomidate: there is a rumour spreading around
> > South Africa that Etomidate has been "black-boxed" by the FDA and
> > this includes a warning to not use it for RSI. I have been unable
> > to confirm this on their website, but maybe I don't have adequate
> > access. Any list member out tere form the USA who can confirm /
> > deny / give the correct details, so we can give clear guidelines -
> > we still use Etomidate for our RSI in NON-SEPTIC patients (i.e.
> > acute trauma).
> >
> > My reading of the literature does not support avoiding of Etomidate
> > in trauma, with only one study in head trauma suggesting a possible
> > link.
> >
>
> BFM
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