Etomidate for rapid-sequence intubation in young children: hemodynamic effects and adverse events.

Abstract

OBJECTIVES:

Physicians commonly use etomidate for adult rapid-sequence intubation (RSI), but the manufacturer does not recommend its use for children under 10 years of age due to a lack of data. The authors present their experience with etomidate for pediatric RSI in order to further develop its risk-benefit profile in this age group.

METHODS:

Trained abstractors reviewed the medical records for all children under 10 years old who received etomidate for RSI between July 1996 and April 2001.

RESULTS:

105 children, with an average age of 3 (+/-2.9) years, received a median dose of 0.32 (+/-0.12) mg/kg of etomidate. The systolic blood pressure increased an average of 4 mm Hg (95% CI = -3.3 to 9.2); the diastolic blood pressure increased 7 mm Hg (95% CI = -3.1 to 11) within 10 minutes of receiving etomidate. The heart rate increased an average of 10 beats/min (95% CI = 4.0 to 17.4). Complications included three patients who vomited within 10 minutes of etomidate administration. There were no cases of documented myoclonus, status epilepticus, or new-onset seizures. Thirty-eight patients received corticosteroids during the hospital course, none for suspected adrenal insufficiency. Three patients died, all from severe brain injury.

CONCLUSIONS:

In children less than 10 years old, etomidate seems to produce minimal hemodynamic changes, and appears to have a low risk of clinically important adrenal insufficiency, myoclonus, and status epilepticus. The association between etomidate and emesis (observed in less than 3% of enrolled patients) remains unclear. For clinical situations in which minimal blood pressure changes during RSI are critical, etomidate appears to have a favorable risk-benefit profile for children under 10 years old.

• Authors: Gregory Guldner, Jason Schultz, Perry Sexton, Corwyn Fortner, Mark Richmond
• Journal: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (Acad Emerg Med) Vol. 10 Issue 2 Pg. 134-9 (Feb 2003) ISSN: 1069-6563 [Print] United States
• PMID: 12574010 (Publication Type: Journal Article)

Chemical References

• Hypnotics and Sedatives
• Etomidate

Topics

• Child, Preschool
• Etomidate (adverse effects, therapeutic use)
• Hemodynamics (drug effects)
• Humans
• Hypnotics and Sedatives (adverse effects, therapeutic use)
• Intubation (methods)
• Vomiting (etiology)