Saturday November 22, 2008


Q: Why Etomidate may not be a good choice in neurological and neuro-surgical patients ?

A: It may decrease the seizure threshold.

Etomidate has fall out of favor in medical ICUs for intubation due to its transient effect of causing adrenal insufficiency, which makes it undesirable in septic patients. But another less known side effect is its ability to decrease the threshold for seizure.Despite its effect on above 2 groups of patients, it is still a very valuable drug to use during intubation (atleast in other patients) due to its quality of having minimal effect on hemodynamic changes, faster effect (15 sec) and quick recovery (3-7 mins). Adrenocortical suppression after single dose is transient which last for 12-36 hours.

See nice review article: Should We Use Etomidate as an Induction Agent for Endotracheal Intubation in Patients WithSeptic Shock? - A Critical Appraisal from Dr. William L. Jackson, Critical Care Medicine Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC. (Chest. 2005;127:1031-1038.)