, Volume 31, Issue 3, pp 325-326
Date: 27 Jan 2005

ICU physicians should abandon the use of etomidate!

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Etomidate is an imidazole derivative and a potent short-acting hypnotic that was introduced as an anesthetic drug about 30 years ago [1]. Because induction of anesthesia with etomidate had very few adverse effects on the cardiopulmonary system in either animals [2] or patients [3], this drug was considered the first-line agent for rapid sequence intubation [4]. Experiments with transgenic mice suggested that the favorable hemodynamic profile of etomidate is mediated by activation of α2b-adrenoreceptors [5]. The stimulation of the vascular α-adrenoreceptors would result in a vasoconstriction that would counteract the hypotensive effects of the concomitant anesthetic agents. This α-agonist effect of etomidate may also explain the cardiovascular tolerance to etomidate in hypovolemic conditions [6]. Thus this drug has became very popular among intensive care physicians. They became alarmed almost 20 years ago, however, that prolonged sedation with etomidate caused excessively high death ra ...